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Core Conditions > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the pathogenesis of type 1 diabetes ?

A

AutoimmuneDestruction of pancreatic beta cells (which normally secrete insulin) - absolute insulin deficiency

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2
Q

What are the causes of diabetes type 1?

A
  • genetic susceptibility
  • HLA gene system - DR3 and DR4 genes in chromosome 6 modulate autoimmune disease
  • environmental triggers e.g. Viruses, diet, toxins, emotional/physical stress
  • idiopathic
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3
Q

What symptoms do all types of diabetes present with ?

A
  • polyuria
  • polydipsia
  • lethargy
  • boils
  • pruritis vulvae
  • freq, recurrent or prolonged infections
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4
Q

Which symptoms are more specific to the presentation of type 1 diabetes ?

A
  • weight loss
  • dehydration
  • ketonuria
  • hyperventilation
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5
Q

How is the diagnosis of diabetes made (investigations etc)?

A
  • one abnormal plasma glucose with diabetic symptoms
    OR
  • Two abnormal fasting venous plasma glucose readings
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6
Q

What readings suggests diabetes ?

A

Fasting plasma glucose > 7 mmol/L
Random plasma glucose > 11.1
Glucose tolerance test > 11.1
HbA1c > 48

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7
Q

When would you reconsider whether apparent diabetes type 1 in a younger person was actually type 2?

A
  • obese

- family history (esp. If non-white)

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8
Q

What can be tested to distinguish between type 1 and type 2 diabetes ?

A

Specific autoantibodies and C-peptide (present in type 1)

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9
Q

Management plan for type 1 diabetes ?

A
  • insulin
  • education
  • smoking cessation
  • monitoring feet, eyes, kidneys
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10
Q

In what situation would you reconsider a diagnosis of type 2 diabetes to be type 1?

A
  • ketonuria
  • marked weight loss
  • do not have features of metabolic syndrome
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11
Q

What are the 4 main determinants for type 2 diabetes ?

A
  • increasing age
  • obesity
  • ethnicity
  • family history
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12
Q

What is the pathogenesis of type 2 diabetes ?

A

Body is no longer able to secrete enough insulin to meet its requirements due to less insulin secretion and increased insulin resistance -> relative insulin deficiency

  • insulin less able to bind to receptor due to resistance, higher circulating levels of insulin but increased glucose production from liver and decreased uptake of glucose by cells
  • hyperglycaemia and lipid excess toxic to beta cells - may advance disease
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13
Q

Which drugs may cause type 2 diabetes ?

A
  • thiazide diuretic

- b blockers

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14
Q

Which medical syndromes are linked to a higher risk of type 2 diabetes ?

A
  • polycystic ovary syndrome

- metabolic syndrome

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15
Q

What is the main difference Presentation between type 1 and type 2 diabetes ?

A

Type 2 tend to be subacute and longer duration of symptoms

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16
Q

What surgical procedure can reverse diabetes ?

A

Bariatric surgery - gastric bypass

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17
Q

What complication may diabetic patient present with ? (5)

A
  • staphylococcal skin infections
  • retinopathy
  • neuropathy
  • macro vascular disease e.g. Stroke, MI, PVD
  • erectile dysfunction
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18
Q

What is the first line treatment for type 2 diabetes ?

A

Diet and exercise changes

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19
Q

When would you start drug treatment for type 2 diabetes ?

A

If diet and exercise has achieved unsatisfactory metabolic control within 4-6 weeks

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20
Q

First line drug treatment for type 2 diabetes ?

How does it work ?

A

Metformin

  • reduces rate of gluconeogenesis (and so hepatic glucose output) and increases insulin sensitivity
  • doesn’t affect insulin output or predispose to hypoglycaemia or weight gain
  • reduces CV risk
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21
Q

What must be monitored while on Metformin ?

A

Serum creatinine/ e GFR - eliminated via kidneys

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22
Q

What is the second line treatment for type 2 diabetes ?

How does it work?

A

Sulfonylureas e.g. Gliclazide

  • promotes insulin release
  • ineffective in those with decreased beta cells
  • may cause Weight gain it hypoglycaemia
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23
Q

What is the third line treatment for type 2 diabetes ?

How does it work ?

A

Thiazolidinediones aka glitazones
- reduce insulin resistance
- fat redistribution, reducing truncal obesity
-

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24
Q

When is insulin therapy required for type 2 diabetes ?

A

When all other therapies have been tried and can’t keep hba1c

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25
Q

What is Cushing’s syndrome ?

A

Chronic excess of free glucocorticoids due to prolonged exposure of elevated levels of endogenous or exogenous glucocorticoids

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26
Q

What is the most common cause of Cushing’s syndrome ?

A

Therapeutic administration of synthetic steroids or ACTH

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27
Q

What are the ACTH dependant causes of Cushing’s syndrome ?

A
  • pituitary producing excess ACTH (Cushing’s disease)
  • ectopic ACTH producing tumours e.g. From small cell lung carcinoma
  • ACTH administration
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28
Q

What are the ACTH independent causes of Cushing’s syndrome ?

A

Primary endogenous cortisol:

  • adrenal Adenoma
  • adrenal carcinoma
  • glucocorticoid administration
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29
Q

What may present on the skin in Cushing’s syndrome ?

A
  • striae
  • bruising
  • pigmentation
  • hirsutism
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30
Q

Classical signs in Cushing’s syndrome ?

A
  • moon face
  • buffalo hump
  • truncal obesity
  • proximal muscle wasting and weakness
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31
Q

What does the dexamethosone suppression test measure ?

A

Measures whether ACTH secretion by the pituitary can be suppressed (taking dexamethosone should reduce ACTH production and therefore cortisol)
- diagnostic for Cushing’s

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32
Q

Which specialist tests can be done for Cushing’s ?

A
  • insulin stress test
  • Desmopressin stimulation test
  • corticotrophin releasing hormone test
33
Q

What is the treatment for Cushing’s syndrome ?

A

Surgical removal of tumours

Pharm: metyrapone and ketoconaole

34
Q

What are the complication of Cushing’s syndrome if left untreated ?

A
  • hypertension
  • stroke
  • heart attack
  • infections
35
Q

Who is hypothyroidism most likely to present in ?

A
  • women

- peak age of onset 60 years

36
Q

What is the most common cause of hypothyroidism world wide ?

A

Iodine deficiency

37
Q

In areas where iodine deficiency is not a problem, what are the most common causes of hypothyroidism ?

A
  • autoimmune

- iatrogenic

38
Q

What is Hashimoto’s thyroiditis and what is the pathogenesis ?

A
  • autoimmune disease producing atrophic changes with regeneration leading to goitre formation
39
Q

What are the primary causes of hypothyroidism ? (Caiiid)

A
  • autoimmune - Hashimoto’s thyroiditis
  • iatrogenic e.g. Radio-iodine therapy
  • iodine deficiency
  • drugs e.g. Amiodarone
  • congenital - dysmorphogenesis, absence of thyroid gland
  • infiltration e.g. Amyloidosis, sarcoidosis
40
Q

What are the secondary causes of hypothyroidism ?

A
  • isolated TSH deficiency
  • hypopituitarism - neoplasm, infiltration, infection, radiotherapy
  • hypothalamic disorders - neoplasms and trauma
41
Q

What types of hypothyroidism are transient ?

A
  • postpartum

- withdrawal of thyroid suppressive therapy

42
Q

Symptoms of hypothyroidism

A
  • tiredness, lethargy, intolerance to cold
  • dry skin, hair loss
  • slowing of intellectual activity - memory, concentration
  • decreased appetite, weight gain, constipation
  • menorrhagia and later oligomenorrhoea/amenorrhoea
  • Reduced libido
43
Q

Signs of hypothyroidism

A
  • dry, coarse skin, hair
  • cold peripheries
  • puffy face, hands, feet (myxoedema)
  • bradycardia
  • delayed tendon reflex
  • ## carpel tunnel syndrome
44
Q

In autoimmune hypothyroiditis, patients may have features of which other conditions ?

A
  • vitiligo
  • pernicious anaemia
  • Addison’s disease
  • diabetes mellitus
45
Q

What are the more atypical presentations of hypothyroidism ?

A
  • acute renal failure
  • female sexual dysfunction
  • Hyoercholesterolaemia
46
Q

What are the signs and symptoms of myxoedema ?

A
  • expressionless, dull face with periorbital puffiness, tongue swelling, sparse hair
  • pale cool skin with rough, doughy texture
  • enlarged heart
  • psychosis
  • cerebellar ataxia, encephalopathy

patients can develop in to myxoedema coma

47
Q

Which investigations should be carried out for hypothyroidism ?

A
  • Serum TSH (if high confirms primary hypothyroidism)

- T4 - low free serum level = hypothyroidism

48
Q

How would the thyroid gland feel on palpation in Hashimoto’s thyroiditis ?

A

Painless goitre, varying in size, rubber consistency and irregular surface e

49
Q

What is the thyroid stimulates and controlled by ?

A

TSH from anterior pituitary gland , which is released by TRH from the hypothalamus

50
Q

Where is T4 converted to T3?

A

Peripherally e.g. In liver and kidneys

51
Q

Who is hyperthyroidism most likely to present in ?

A

Women aged 20-50

52
Q

What are the risk factors for hyperthyroidism ?

A
  • family history
  • high iodine intake
  • smoking (esp. For associated eye problems)
  • trauma to thyroid
53
Q

What is the pathogenesis in Graves’ disease ?

A

Autoimmune process where IgG antibodies bind to TSH receptors, acting like TSH and stimulate thyroid hormones

54
Q

What is de Quervains thyroiditis ?

A

Transient form of hyperthyroidism from acute inflammatory process, usually viral in origin,.

  • also present with fever, neck pain, malaise, tachycardia, local thyroid tenderness
  • TFTs show initial hyperthyroidism, then transient hypothyroidism follows
55
Q

What signs may be seen in the hands in hyperthyroidism ?

A
  • palmar erythema
  • sweaty warm palms
  • fine tremor
  • thyroid acropathy - clubbing, painful swellings of digits
56
Q

What happens to the reflexes in hyperthyroidism ?

A

Brisk reflexes

57
Q

What signs may be seen in the eyes in hyperthyroidism ?

A
  • exophthalmos
  • opthalmoplegia
  • lid lag
  • lid retraction
58
Q

What dermopathy is seen in hyperthyroidism ?

A

Pre tibial myxoedema - non pitting plaques with pink/purple colour just above lateral malleolus

59
Q

What symptoms may be described in thyroid in hyperthyroidism ?

A
  • weight loss despite increased appetite
  • fine tremor, usually in hands
  • heat intolerance
  • irritability
  • mental health - anxiety -> psychosis
  • sweating
  • diarrhoea
60
Q

What may precipitate a thyrotoxic crisis/storm ?

A
  • infections
  • poor compliance with meds
  • radio iodine therapy
61
Q

How would thyrotoxic crisis present ?

A
  • fever > 38.5
  • tachycardia
  • delirium or coma
  • seizures
  • vomiting
  • diarrhoea and jaundice
62
Q

What is first line antithyroid drug and how does it work ?

A

Carbimazole: inhibits formation of thyroid hormone

* careful of bone marrow suppression, patient must report signs of infection especially sore throat*

63
Q

Conditions presenting similarly to hyperthyroidism ?

A
  • mild hyperthyroidism may be confused for anxiety
  • phaeochromocytoma
  • any cause of weight loss
64
Q

What is the pathogenesis of goitre formation ?

A

Low T3/T4 means the negative feedback loop is inactive, causing increased TSH secretion which In turn causes follicular hyper trophy and hyperplasia -> goitre

65
Q

What is meant by a nontoxic thyroid nodule ?

A

Thyroid nodule with no hyperthyroidism

66
Q

What is a multinodular goitre?

A

Irregular enlargement of thyroid gland due to repeated episodes of hyperplasia and involution (degeneration) of simple goitre

67
Q

In what age groups are thyroid nodules most likely to be malignant ?

A

Under 20 or over 70

68
Q

What are the red flag signs for goitre ? (5)

A
  • stridor
  • child with thyroid nodule
  • unexplained hoarseness of voice associated with goitre
  • painless mass enlarging rapidly
  • palpable cervical lymphadenopathy
69
Q

What investigations should be carried out in patients with thyroid nodules or goitre ?

A
  • TFTs
  • ultrasound
  • FNA
70
Q

What sized thyroid nodule is likely to be cancerous ?

A

> 4cm

71
Q

Who is type 1 diabetes most likely to present in ?

A

Juveniles of Northern European ancestry

Peak age of onset around puberty

72
Q

What blood results would suggest hypothyroidism ?

A

Raised TSH, low T4

73
Q

Raised TSH and raised T4 would suggest which diagnosis ?

A
  • TSH secreting tumour

- thyroid hormone resistance

74
Q

Low TSH and raised T3/T4 suggests which diagnosis?

A

Hyperthyroidism

75
Q

Which patients should be screened for thyroid dysfunction ?

A
  • AF
  • hyperlipidaemia
  • diabetes annual review
  • women with type 1 DM, in 1st trimester and post delivery
  • those on amiodarone and lithium
  • those with downs or turners syndrome and Addison’s disease
76
Q

When is parathyroid hormone (PTH) usually secreted

..

A

In response to low levels of ionised Ca

77
Q

What are the actions of parathyroid hormone ?

A
  • increased osteoblast activity - releasing Ca and PO4(3-) from bones
  • increased calcium and decreased phosphate reabsorption at kidneys
  • vit D production increased
78
Q

Symptoms and signs of primary hyperparathyroidism ?

A
  • weak, tired, depressed
  • dehydrated but polyuric
  • renal stones
  • abdo pain
  • pancreatitis and peptic ulcers
  • osteopenia/osteoporosis
  • hypertension
79
Q

What is Conns syndrome

A

Primary aldosteronism - increased sodium and water retention

  • hypertension
  • hypokalaemia
  • alkalosis (retain sodium is in exchange for potassium or proton so overall alkalosis)

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