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VIVAs > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is acromeagly?

A

excessive GH secretion in adults, typically due to an anterior pituitary adenoma

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2
Q

What are clinical features on history for acromeagly?

A
  • Symptoms of current symptoms - headache, visual disturbances
  • Resp: OSA, Difficult intubation
  • Cardiac: HTN, CAD, cardiomyopathy, arrhythmias
  • Endocrine: Diabetes
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3
Q

What are clinical features on exam for acromeagly?

A

General inspection
- Body habitus/BMI
- Large tongue
- Mandibular enlargement

Cardiac:
- Arryhthmias
- CCF signs

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4
Q

What Ix for acromeagly?

A

Bloods:
- BSL
- GH levels, IGF-1

ECG:
- LVH

TTE:
- Systolic/diastolic dysfunction

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5
Q

What is diabetes?

A

hyperglycemia due to an absolute or a relative deficiency of insulin

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6
Q

What are clinical features on history for diabetes?

A
  • Duration of diagnosis
  • Insulin requirement
  • Complications of diabetes
  • Ketoacidosis and hospital admissions
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7
Q

What are clinical features on examination for diabetes?

A

General inspection:
- Obesity, dehydration
- muscle wasting (peripheral neuropathy)
- Ulcers

Cardiac:
- BP lying and standing (autonomic neuropathy)
- Cardiac failure (secondary to IHD)

Eyes:
Visual acuity, fundoscopy

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8
Q

What Ix for diabetes?

A

Bloods:
- HbA1c, renal function
- BSL

ECG
- Ischaemia

TTE/stress testing if meet criteria

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9
Q

What is the clinical features of hypercalcaemia?

A

Renal stones
Abdominal pain
Osteopenia
Confusion

Stones, Bones, Abdominal Groans & Psychological Moans

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10
Q

What is the management of severe hypercalcaemia?

A
  • Phosphate
  • Rehydration
  • Pamidronate (1st line)
  • Forced diuresis (2nd line)
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11
Q

What are the clinical features of acute hypocalcaemia?

A

o Perioral paresthesias, restlessness, seizures
o Refractory heart failure
o Neuromuscular irritability:
-Inspiratory stridor/laryngospasm
- Tetany, hypereflexia
-Chvostek sign – tapping gently on facial nerve under ear causes brisk twitches on same side of face
-Trousseau sign – tourniquet on arm causes contraction of hand

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12
Q

What are the most common causes of hyperthyroidism?

A
  • Grave’s disease
  • Multinodular goitre
  • Toxic adenoma
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13
Q

What are the clinical features on history of hyperthyroidism?

A

weight loss, heat intolerance, sweating, palpitations,
diarrhea, tremor, irritability, anxiety, fatigue

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14
Q

What are the clinical features on exam of hyperthyroidism?

A

o Fine tremor, palmar erythema, moist + warm peripheries,
tachycardia, AF
o Proximal myopathy, brisk reflexes
o Enlarged neck, check for pemberton’s sign, check tracheal position
o Eyes – exophthalmos (protrusion of eyeball from orbit),
lid lag, chemosis
o CVS – high output CCF, systolic flow murmurs,
cardiomegaly
o Legs – pretibial myxedema

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15
Q

What Ix are useful in hyperthyroidism?

A
  • TFTs - High T3, T4, low TSH
  • CT neck to assess for compression of structures eg trachea
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16
Q

What is the management for hyperthyroidism?

A
  • Carbimazole or PTU
  • propranolol
  • Radioactive iodine
  • Surgery
17
Q

What is a thyroid storm?

A

life-threatening exacerbation of hyperthyroid state with evidence of decompensation in one or more organ systems

18
Q

What are causes of hypothyroidism?

A

o Chronic autoimmune (Hashimoto’s) thyroiditis
o Iatrogenic – thyroidectomy, external neck irradiation, radioiodine therapy, lithium, amiodarone

19
Q

What are the clinical features on history of hypothyroidism?

A

fatigue, lethargy, weight gain, slow speech, cold intolerance, decreased sweating, constipation

20
Q

What are the clinical features on exam of hypothyroidism?

A

o Mental sluggishness, hypothyroid speech (slow, nasal + deep pitch), deafness
o Hands – cyanosis, swelling, dry + cold skin, bradycardia, small volume pulse from decreased CO, carpal tunnel
o Face – yellow skin, alopecia, loss of eyebrows, swelling, periorbital oedema
o Chest – pericardial effusion, pleural effusion
o Peripheries – proximal myopathy, non-pitting oedema, peripheral neuropathy, slow reflexes
o Peripheral neuropathy, slow reflexes

21
Q

Describe the TFTs for Primary hypothyroidism

A

Low T3, T4
High TSH

Primary issue with thyroid - TSH trying to get it to make more

Causes include thyroidectomy, autoimmune thyroiditis

22
Q

Describe the TFTs for subclinical hypothyroidism

A

Normal T3, T4
Raised TSH

Normal T3/4 = subclinical
Raised TSH suggests feedback trying to increase thryoid output

23
Q

Describe the TFTs for secondary hypothyroidism

A

Low T3, T4
Low/normal TSH

Low thyroid function but due to non thyroid cause - not being stimulated
eg Pituitary adenoma, surgery/radiotherapy that decreases TSH/TRH production

24
Q

Describe the TFTs for Primary hyperthyroidism

A

Raised T3/4
Low TSH (negative feedback)

  • Causes:
    ○ Grave’s disease (75%)
    ○ Toxic multinodular goitre
  • The thyroid itself is producing too much, appropriate TSH suppression
25
Q

Describe the TFTs for subclinical hyperthyroidism

A
  • Normal T3,T4
  • Low TSH

Normal T3/4 = subclinical
Low TSH suggests feedback trying to decrease thryoid output

26
Q

Describe the TFTs for secondary hyperthyroidism

A
  • Raised T3/4
  • Raised TSH (excess production)
  • Causes:
    ○ TSH secreting tumour
  • Too much TSH stimulating the thyroid
27
Q

Describe the TFTs for sick euthyroid syndrome

A
  • Low T3, normal T4
  • Normal/ish TSH
  • Normal hormonal feedback is dysregulated in critical illness
28
Q

What is cushing’s syndrome

A

excessive levels of glucocorticoids

Due to high ACTH (eg cushings disease -microadenoma) or excess cortisol production due to adrenocortical tumours

29
Q

What are clinical features on history of cushing’s syndrome?

A

o Most common symptom = relatively sudden onset weight gain (central) with associated moon face
o Hypertension, OSA, GORD
o Diabetes – impaired glucose tolerance
o Skeletal muscle wasting + weakness (difficulty
climbing stairs)
o Osteoporosis + fractures
o Immunusuppression – predisposition to infection

30
Q

What are clinical features on exam of cushing’s syndrome?

A

o Moon-like facies with plethora + telangiectasia
o Central obesity, buffalo hump (due to fat deposition
over interscapular area)
o Thin skin, bruising, excessive pigmentation
o Proximal muscle wasting
o Purple abdominal striae
o Hypertension

31
Q

What are investigations for cushing’s syndrome?

A

Bloods - Hypernatraemia, hyperglycaemia
ECG - LVH due to hypertension
Urine - high 24 hr free cortisol

Short dexamethasone suppression test - midnight oral dex should supress mane cortisol

32
Q

What are anaesthetic issues related to cushing’s syndrome?

A

Resp:
* Obesity & OSA – rapid desaturation due to ↓FRC
* Potentially difficult airway
* GORD with aspiration risk – need for preoperative acid suppression therapy & RSI

Cardiac:
* Poorly controlled hypertension & ECG abnormalities

Endo:
* Electrolyte abnormalities & impaired glucose tolerance
* Supplemental steroids may be required preoperatively if iatrogenic Cushing’s syndrome

Other:
* Muscle relaxants – decrease initial dose due to skeletal muscle weakness, hypokalemia may increase sensitivity to non-depolarising agents
* Careful positioning – susceptibility to pressure sores & fractures because of fragile skin & osteoporosis

33
Q

What is the approach to patients taking steroids for steroid replacement?

A
  • Daily glucocorticoid dose equivalent to prednisolone >5mg/day for longer than 1 month represents a adrenal suppressive dose
  • Dexamethasone is sufficient to cover stress dosing although lacks mineralocorticoid activity so if a patient has primary adrenal insufficiency won’t cover the loss of aldosterone

If they have a primary deficiency - Hydrocortisone 100 mg intravenously on induction, followed by immediate initiation of a continuous infusion of hydrocortisone 200 mg.24 h−1

VIVAs (7 decks)

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