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Core Conditions AJL (minus renal and respiratory) > Endocrine > Flashcards

Endocrine Flashcards

1
Q

How common is type 1 diabetes?

A

1 in 20 people in the UK have diabetes

10% of those being type 1

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2
Q

Who does type 1 diabetes affect?

A

Usually diagnosed before 30 years old
Usually lean individuals
Finland & Sardinia have highest incidence

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3
Q

What causes type 1 diabetes?

A

Autoimmune destruction of pancreatic beta-cells

Idiopathic in origin but thought to be found in genetically susceptible individuals and is probably triggered by one or more environmental antigens

Auto-antibodies found against insulin, and islet cell antigens predate the onset of clinical disease by several years

There is an association with other organ specific autoimmune disease

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4
Q

What are the risk factors for type 1 diabetes?

A

Family history
Genetics
Geography (further from equator)

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5
Q

What are the symptoms of type 1 diabetes?

A 
Polydipsia (osmotic diuresis secondary to hyperglycaemia
Nocturia
Excessive fatigue
Weight loss
Loss of muscle bulk

Itchiness in genital area (recurrent thrush)
Blurred vision
Slow healing cuts

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6
Q

What are the signs of type 1 diabetes on examination?

A

Physical examination usually normal

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7
Q

What are the possible differential diagnoses for type 1 diabetes?

A

UTI
Prostatic hypertrophy
Incontinence
Cancer of the urinary tract

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8
Q

What investigations are necessary to diagnose type 1 diabetes?

A

Random plasma glucose concentration of >11mmol/L
Fasting plasma glucose concentration of >7.0mmol/L or higher
Urinalysis: microalbuminuria
FBC, serum U&Es, fasting bloods for cholesterol and triglyceride levels
Liver biochemistry
HbA1c levels (using FBC or finger prick) >48mmol/L

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9
Q

What are the treatments for type 1 diabetes?

A

4 preparations insulins:
Rapid acting - administered shortly before or just after eating. Injected/insulin pump

Short acting - regular/neutral insulin is given before a meal. Injected via syringe/insulin pen

Intermediate acting - isophane insulin

Long acting - no peak of activity allowing constant delivery throughout day (lantus given once a day)

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10
Q

What is type 2 diabetes?

A

Type 2 diabetes develops when the insulin producing cells in the body are unable to produce enough insulin or when insulin produced does not work properly

Known as insulin resistance

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11
Q

How common is type 2 diabetes?

A

1 in 20 people have diabetes

Of these, 90% have type 2 diabetes

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12
Q

Who does type 2 diabetes affect?

A

Usually diagnosed over 30 years
Often overweight
More common in African/Asian decent

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13
Q

What causes type 2 diabetes?

A 
Polygenic disorder
Rare forms caused by mutations in insulin receptors
Environmental factors:
- central obesity
- trigger genetically susceptible
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14
Q

What are the risk factors for type 2 diabetes?

A 
>40 years old
Family history
Overweight/obesity
South Asian/Chinese/Afro-Caribbean/Black African ethnicities
Previous cardiovascular disease
Female with polycystic ovaries
Impaired glucose tolerance
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15
Q

What are the symptoms of type 2 diabetes?

A 
Polydipsia
Nocturia
Excessive fatigue
Weightloss
Itchiness in genital area
Blurred vision
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16
Q

What are the signs of type 2 diabetes on examination?

A 
Physical examination usually normal in early stages
Pts usually overweight
Chronic uncontrolled:
- hypertension
- retinal haemorrhages
- absent pedal pulses
- loss of deep tendon reflexes in ankle
-
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17
Q

What are the possible differential diagnoses of type 2 diabetes?

A 
Metabolic syndrome
UTI
Prostatic hypertrophy
Incontinence
Cancer of urinary tract
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18
Q

What investigations are required to diagnose type 2 diabetes?

A

HbA1c levels measured using FBC or using finger-prick method
- >48mmol/L = type 2 diabetes

Random non fasting plasma glucose concentration >11.1mmol/L

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19
Q

What are the treatment for type 2 diabetes?

A

Lifestyle changes: diet, weight, level of physical activity

Medication:

  • Metformin = first line in type 2 diabetes, reduced CV risk
  • sulphonylureas (gliclazide) = promote insulin secretion, prescribed if pt can’t take Metformin
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20
Q

How common is hypothyroidism?

A

15 in every 1000 women in UK

1 in every 1000 men in UK

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21
Q

Who does hypothyroidism affect?

A

More common in women

Usually 40-50 (menopausal years)

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22
Q

What are the causes of hypothyroidism?

A

Autoimmune disease: most common Hashimotos

  • cytotoxic T-cells and autoantibodies directed against thyroglobulin and thyroid peroxidase
  • first stimulate the thyroid causing enlargement, and then destroy the thyroid follicles causing atrophy of thyroid

Pituitary or hypothalamic failure causing secondary hypothyroidism

Genetic dysfunction: thyroid may be dysfunctional at birth or is predisposed later in life

Chronic iodine deficiency (iodine required to make thyroid hormones)

Treatment for hyperthyroidism

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23
Q

What are the risk factors for hypothyroidism?

A 
Gender (female)
Age >60yrs
Environmental (iodine deficiency)
Autoimmune disease
Family History
Treatment with radioactive iodine
Radiation to neck/upper chest
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24
Q

What are the symptoms of hypothyroidism?

A

Depends on severity

Fatigue
Increased sensitivity to cold
Constipation
Dry/scaly skin
Unexplained weight gain
Muscle weakness
Elevated blood cholesterol level
Pain, stiffness, swelling of joints
Heavier or irregular menstrual periods
Hair thinning
Depression
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25
Q

What are the signs of hypothyroidism on examination?

A 
Slow speech, dull facial expression
Psychosis
Low BP, bradycardia
Dry skin, coarse brittle, straw-like hair, loss of hair
Overweight
Jaundice, pallor
Goitre
Pericardial effusion, oedema (non pitting) 
Hyporeflexia
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26
Q

What are the possible differential diagnoses of hypothyroidism?

A 
Anaemia
Autoimmune thyroid disease and pregnancy 
Thyroid lymphoma
Chronic fatigue syndrome
Depression
Menopause
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27
Q

What investigations are necessary to diagnose hypothyroidism?

A

Thyroid function tests: looking at TSH and thyroxine (T4) levels

  • ⬆️ TSH and ⬇️ T4 = primary hypothyroidism
  • primary hypothyroidism only disease where sustained raised TSH

Assays for anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies helpful in determining aetiology

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28
Q

What are the treatments of hypothyroidism?

A

Thyroxine replacement therapy

Levothyroxine (T4)
- main treatment

Liothyronine (T3)
- is active hormone and acts quicker than T4 but shorter duration so BD

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29
Q

How common is hyperthyroidism?

A

8 in 100 women develop

1 in 100 men develop

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30
Q

Who does hyperthyroidism affect?

A

More common in women
More commonly begins 20-40 years
More common in white people

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31
Q

What are the causes of hyperthyroidism?

A

Graves’ disease:

  • autoimmune disease
  • most common cause of an overactive thyroid (80%)
  • most common in females
  • anti-thyroid stimulating hormone receptor antibodies (IgG) stimulate thyrocytes to secrete thyroid hormones

Toxic multi nodular goitre

Toxic adenoma
- responsible for 5% of hyperthyroidism cases

Thyroiditis

Over medication of thyroxine

Pituitary problems

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32
Q

What are the risk factors for hyperthyroidism?

A 
Gender (female)
Family history
Smoking
High iodine intake
Thyroid trauma
Child birth
Stress
Genetics
33
Q

What are the symptoms of hyperthyroidism?

A 
Weight loss despite increased appetite
Restlessness, irritability
Breathlessness, palpitations 
Heat intolerance, increased thirst, sweating
Itching, thinning hair
Malaise, vomiting, diarrhoea 
Infrequent, light menstruation - oligomenorrhoea
Eye complaints
Stiffness, muscle weakness, tremor
Oncholysis
34
Q

What are the signs of hyperthyroidism on examination?

A 
Tremor
Hyperkinesis
Psychosis
Proximal myopathy, muscle wasting, pretibial myxoedema
Oncholysis, thyroid acropatchy
Palmar erthema
Tachycardia, AF 
Warm, vasodilated peripheries
Systolic hypertension
Exophthalmos, lid lag, stare
Goitre, bruit
35
Q

What are the possible differential diagnoses of hyperthyroidism?

A

Graves’ disease
Goitre
Thyrotoxicosis

36
Q

What investigations are necessary to diagnose hyperthyroidism?

A

Thyroid function test: looking at levels of thyroid stimulating hormone (TSH) and thyroxine (T4)

  • serum TSH suppressed
  • serum free T3 and T4 elevated

Thyroglobulin antibodies

Thyroid ultrasound

37
Q

What are the treatments of hyperthyroidism?

A

Anti thyroid drugs

  • Carbimazole - blocks thyroid hormone synthesis and have immunosuppressive effects which affects Graves’ disease process
  • beta blockers - as most symptoms Re mediated via sympathetic nervous system

Radioactive iodine treatment
- accumulates in thyroid gland and causes local irradiation damage

Surgery
- thyroidectomy

38
Q

How common is goitre?

A

Affects 12% people worldwide

39
Q

Who does goitre affect?

A

More common in women

More common in >40s

40
Q

What are the causes of goitre?

A

Diffuse: entire thyroid gland enlarged and smooth to touch

  • Physiological; puberty, pregnancy
  • Autoimmune; graves, Hashimotos
  • Acute viral thyroiditis
  • Iodine deficiency

Nodular: solid or fluid filled nodules present, lumpy to touch, multiple or single nodules

  • multi nodular
  • solitary nodule
  • fibrotic
  • cysts

Tumours:

  • adenoma
  • carcinoma
  • lymphoma
41
Q

What are the risk factors for goitre?

A 
Gender (female)
Age (⬆️ with age)
Family history
Iodine deficient diet
Pregnancy and menopause
Medication
Exposure to radiation
42
Q

What are the symptoms of goitre?

A 
Usually noticed as cosmetic defect
Discomfort/pain in neck
Difficulty breathing/swallowing (tracheal compression
Hoarseness/change in voice
Symptoms for hypo&hyperthyroidism
43
Q

What are the signs of goitre on examination?

A

Bruit

Lymphadenopathy

44
Q

What are the possible differential diagnoses of goitre?

A

Oesophageal cancer

Tracheal/bronchial cancer

45
Q

What investigations are necessary to diagnose goitre?

A

Blood tests:
- thyroid function and thyroid antibodies

Imaging
- high resolution thyroid ultrasound

FNA
- cytology necessary to assess for malignancy

Thyroid scan

46
Q

What are the treatments for goitre and thyroid nodule?

A

Watch and wait

Anti thyroid medication/radioactive iodine

Levothyroxine

Surgical intervention

47
Q

What is the goitre grading system?

A 
0 = not palpable or visible even when neck extended
1 = palpable
1A = detected on palpation
1B = palpable and visible when neck extended
2 = visible when neck in normal position
3 = large goitre visible from distance
Simple = non toxic
Toxic = hyperthyroid
48
Q

How common is thyroid nodule?

A

1 in 12-15 young women

1 in 40 young men

49
Q

Who does thyroid nodule affect?

A 
More common in women
Increasing incidence with age
50% 50 yr olds
60% 60 yr olds
70% 70 yr olds
50
Q

What are the causes of thyroid nodules?

A 
Iodine deficiency
Hypertrophy of thyroid tissue
Thyroid cyst
Thyroiditis
Multi- nodular goitre thyroid cancer
51
Q

What are e risk factors for thyroid nodules?

A 
Gende (female)
⬆️ age
Radiation to neck/upper chest
Pre-existing thyroid condition
Family history
52
Q

What are the symptoms of thyroid nodules?

A 
Usually Asymptomatic
Usually noticed as cosmetic defect
Discomfort/pain in neck
Difficulty breathing/swallowing
Hoarseness/voice changes
Symptoms of hypo/hyper thyroid
53
Q

What are the signs of thyroid nodules on examination?

A

Moveable (less likely to be malignant)
Fixed nodule - malignancy
Lymphadenopathy

54
Q

What is the differential diagnosis for thyroid nodule?

A

Goitre

55
Q

What investigations are necessary to diagnose thyroid nodules?

A

Blood tests- serum TSH and free T4
Immunoassays: antibodies titres to thyroperoxidase or thyroglobulin

FNA

Thyroid ultrasound

  • detects poorly palpable nodules
  • determine size/number of nodules, solid/cystic
  • assist in FNA

Radionuclide scanning

56
Q

How common is Cushing’s syndrome?

A

Very rare

1 in 50,000

57
Q

Who does Cushing’s syndrome affect?

A

Adults 20-50 years

Women 3x more likely

58
Q

What are the causes of Cushing’s syndrome?

A

Adrenocorticotrophic hormone (ACTH) dependent causes:

  • pituitary dependent (Cushing’s disease): primary hyper- secretion of ACTH
  • ectopic ACTH- producing tumours

Non- ACTH dependent causes

  • adrenal adenomas
  • adrenal carcinomas
  • glucocorticoid administration

Other
- alcohol induced pseudo-Cushing’s syndrome

59
Q

What are the risk factors for Cushing’s syndrome?

A

Obesity
Type 2 diabetes
Poorly controlled blood glucose
Hypertension

60
Q

What are the symptoms of Cushing’s syndrome?

A 
Weight gain
Change of appearance
Depression
Insomnia
Amenorrhoea/oligomenorrhoea
Thin skin/easy bruising
Muscular weakness
Back pain
61
Q

What are e symptoms of Cushing’s syndrome on examination?

A 
Moon face
Plethora
Depression/psychosis
Thin skin/bruising, skin infections
Hypertension
Osteoporosis, kyphosis, pathological fractures, rib fractures
Buffalo hump
Central obesity, striae, 
Proximal myopathy, proximal muscle wasting
62
Q

What are the possible differential diagnoses of Cushing’s syndrome?

A

Cushing’s disease
Hypothyroidism
Hypertension

63
Q

What investigations are necessary to diagnose Cushing’s syndrome?

A

Confirm raised cortisol

Establishing cause of Cushing’s syndrome:

  • adrenal CT/MRI will detect adrenal adenomas and carcinomas
  • pituitary MRI and CT will detect some but not all pituitary adenomas

Corticotrophin- releasing hormone test

64
Q

What is the difference between Cushing’s disease and Cushing’s syndrome?

A

Cushing’s disease is when the ACTH comes from the pituitary gland

Cushing’s syndrome is where there is an adrenal tumour producing too much cortisol, or too much ACTH is made which causes the adrenal glands to make cortisol

65
Q

What are the treatments for Cushing’s syndrome?

A

Surgical removal for most pituitary tumour indicated

Drugs inhibiting cortisol synthesis

External beam irradiation to pituitary

Iatrogenic Cushing’s syndrome

66
Q

What is parathyroid adenoma?

A

Benign tumour of parathyroid gland and last common cause of hyperparathyroidism

Leads to hypercalcaemia

67
Q

What other aetiology of parathyroid adenoma?

A

Genetic
Idiopathic
Secondary to excess PTSH

68
Q

What are the risk factors for parathyroid adenoma?

A

Age (>60yrs)

Irradiation

69
Q

What are the symptoms of parathyroid adenoma?

A 
Often Asymptomatic
Confusion
Constipation
Lethargy
Muscle pain
Nausea
70
Q

What is the aetiology of primary hyperparathyroidism?

A

Single parathyroid adenoma

  • most common cause
  • benign
  • increased parathyroid hormone

Hyperplasia of multiple parathyroid glands

  • benign enlargement
  • increased parathyroid hormone

Parathyroid carcinoma
- very rare cause

71
Q

What is the aetiology of secondary hyperparathyroidism?

A

Kidney disease
- hypocalcaemia leading to over stimulation

Vitamin D deficiency
- hypocalcaemia

Intestinal malabsorption
- hypocalcaemia

72
Q

What are the symptoms of hyperparathyroidism?

A 
Tiredness
Muscle weakness
Nausea/vomiting
Constipation
Abdo pain
Polydipsia
Polyuria
Depression
73
Q

What are the complications of hyperparathyroidism?

A 
Kidney stones
Corneal calcification
Pancreatitis
Peptic ulceration
Renal damage
74
Q

What is Addison’s disease?

A

Primary adrenal insufficiency (hypoadrenalism)

Rare condition in which there is destruction of entire adrenal cortex therefore not enough cortisol or aldosterone is produced

75
Q

What is the aetiology of Addison’s disease?

A

90+% of cases are auto antibody destruction

Others: surgical removal, TB, haemorrhage

76
Q

What are the symptoms of Addison’s disease?

A 
Lethargy 
Depression
Anorexia
Weight loss
Postural hypotension - salt and water loss
Hyper pigmentation
77
Q

What is addisonian crisis?

A 
Vomiting
Abdo pains
Profound weakness
Hypoglycaemia
Hypovolaemic shock
78
Q

What investigations are necessary to diagnose Addison’s disease?

A 
Single cortisol measurements
Short ACTH stimulation test
Plasma ACTH level
Long ACTH stimulation test
Adrenal antibodies testing
79
Q

What is Type 1 diabetes?

A

It is an autoimmune disease that causes the insulin producing beta cells in the pancreas to be destroyed, preventing the body from being able to produce enough insulin to adequately regulate blood glucose levels

Core Conditions AJL (minus renal and respiratory) (10 decks)

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