Endocrine Flashcards
Follow up investigations for Cushings
BP Dipstick urine for glucose Visual fields 24 free urinary cortisol Overnight/low dexamthesone supression test
Causes of Cushings Syndrome
Cushings disease (pituitary adenoma producing ATCH) Steroid use Ectopic ATCH (small cell lung cancer) Adrenal adenoma
Questions to ask Cushingoid patient
Have you noticed any change in your appearance? Mood? Periods?
What is a differential for Cushing spotter?
Hypothyroidism
Questions for acromegaly patient
Have you noticed a change in your appearance? Do you sweat excessively? Do you suffer from high blood pressure? Have you changed shoe size?
Symptoms of acromegaly
Headaches Visual problems Pins and needles Back ache Muscle weakness Bigger hands and feet
How is acromegaly diagnosed?
GH response to OGGT test, if not suppressed then acromegaly
What follow does acromegaly need?
Colonoscopy from age 40
Treatment of acromegaly
Transphenoidal surgery Radiotherapy (not great) Bromocriptine (pre-op)
Symptoms of DKA
breath ketones low HR high RR (Kussmaul) low BP Vomiting/abdo pain
Symptoms of hypoglycaemia
(Adrenergic/sympathetic overdrive) Sweaty Cold and Clammy high HR, BP Myoclonic jerks/seizure
Diagnostic triad of ketoacidosis
Hyperglycaemia + Ketonuria + Acidosis
Tx of DKA
PANICS Potassium Acidosis - ABG, ketones Normal Saline Insulin by Insulin Catheter and Cultures Stomach Aspiration
Why do you get deformity in diabetic neuropathy?
Because light touch and sensation are lost first, so loss of protective sensation
Graves disease triad
Goitre + eyes signs + thyrotoxicosis
Graves eye disease
Periorbital edema Proptosis/exopthalmos Lid retraction opthalmoplegia (upgaze palsy) Keratopathy
Tx for Graves Disease
Carbimazole Block and replace (better relapse rate) Surgery Radioiodine
Features of hypothyroid
Gruff voice Coarse facial features Dry cold scaly skin Slow pulse May have goitre (Hashimoto’s) Myoxedema
Hashimotos Thyroiditis
Autoimmune goitre hypothyroid
Women
high TSH
anti TPO or anti Tg
Usually needs lifelong thyroxine
Causes of thyrotoxicosis
Graves
Toxinoduar goitre
De Quervains thyroiditis
Acute phase Hashimotos
Indications for thyroid surgery
Failure/intolerance of medical tx
Large goitre
Patient choice
Complications of Thyroid Surgery
Bleeding
Thyroid Crisis
Hypoparathyroidsism
Damage to recurrent laryngeal
Late hypothyroidism
Recurrent hyperthyroidism
Causes of a goitre
Multinodular goitre (euthyroid or if toxic then hyper)
Simple goitre
Graves
Hashimotos (hypo)
Follow Up marker thyroid cancer
Calcitonin
