Endocrine Flashcards
Picture of raynaulds
This appearance is highly suggestive of primary raynaulds characterised by bilateral, young individuals with no signs of secondary rheumatic pathology like rheumatoid arthritis, scleroderma and normal nailfold papillary and a negative autoantibody profile.
On examination, this appearance is consistent hyperthyroidism. Being more common in women, and the most common cause being Graves disease. The patient has obvious exopthalmos, with upper lid retraction due to increased sympathetic tone of the levator palpabrae muscle. There is pre ganglionic ipsilateral horner’s syndrome with ptosis and pupil dilation. There may also be raised JVP which would make me suspicious of SVCO- assess using pembertons sign. Also ?corneal ulcer and chemosis.
Referral to endocrine for carbimazole treatment, but FBC first and propanolol first. USS and Radioactive iodine uptake.
WHO Goitre grading system
This appearance is consistent with GRAVES.
These are features which are specific to GRAVES disease only and include:
- graves opthalmopathy
- graves acropathy
- graves dermatopathy (pretibial myxoedema)
graves acropathy always occurs in association with opthalmoscopy and dermatopathy
- it is a triad of digital clubbing, swelling and periosteal bone formation in the extremities
- no treatment
graves dermatopathy is
- bilateral, asymmetric, firm, nonpitting, and painless nodules and plaques present on the extensor aspects of the lower legs and feet. often described as resembling orange peel.
- responds well to steroids.
graves opthalmopathy
- lagophthalmos - inability to close eyes completely = corneal ulcer risk
- periorbal oedema and chemosis (primarily congestive)
- proptosis (protrusion of the eye anteriorly)
- exopthalmos (severe version of proptosis where the whites of sclera are visible)
- opthalmoplegia (upward gase affected first)
if there is concurrent htyroxotocosis there is upper lip retraction, lid lag and visual loss due to optic nerve compression.
Mechanism: Circulating IgG stimulating glycosoaminoglycan production in fibroblasts and in keratinocytes
