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Endocrine Flashcards

1
Q

What is the endocrine system mediated by?

A

Hormones

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2
Q

What are 3 basic problems that occur with the endocrine system?

A

Excess hormone
Reduced hormone
Physical gland enlargement

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3
Q

What effects can physical gland enlargement have? (2)

A

Mass

Pressure

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4
Q

Thyroxine excess

A

Hyperthyroidism

Thyrotoxicosis

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5
Q

Thyroxine lack

A

Hypothyroidism

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6
Q

Thyroid mass

A

Goitre

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7
Q

What can cause hyperthyroidism? (3)

A

Graves disease
Goitre / toxic adenoma
Pituitary driven

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8
Q

Symptoms of hyperthyroidism

A

Sweating, heat intolerance
Irritability, poor sleep, anxiety, palpitations
Excess appetite, weight loss, diarrhoea
Breathlessness

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9
Q

Signs of hyperthyroidism

A 
Warm moist skin
Tachycardia, irregular heart rate
Increased blood pressure, heart failure 
Fine tremor
Goitre
Pre-tibial myxoedema
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10
Q

Signs of Graves Disease

A 
Eye disease
Exophthalmos
Ophthalmoplegia
Lid lag/ retraction 
Loss of visual clarity
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11
Q

Diagnosis of hyperthyroidism

A

Clinical
Blood tests - Thyroid function tests - Low TSH, High T3, T4; Auto antibodies
Radiology sometimes

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12
Q

What drugs are used to manage hyperthyroidism?

A

Anti thyroid drugs - carbimazole, prophylthiouracil
Beta blockers control symptoms
Radioactive iodine I(131) - caution in young patients and contraindicated if pregnant/ breastfeeding

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13
Q

What causes hypothyroidism?

A

Auto-immune
Iatrogenic - surgery, radioiodine
Iodine deficiency
Rarely pituitary disease

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14
Q

Symptoms of hypothyroidism

A 
Reduced metabolism
Cold intolerance
Weight gain
Constipation
Hoarse voice
Puffed face and extremities
Mental slowness, poor memory 
Hair loss
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15
Q

Signs of hypothyroidism

A 
Slow pulse
Large tongue
Deep voice 
Thin/ dry hair, loss of eyebrows
Goitre
Coarsening of fetures
Acute (rare) - coma, hypothermia
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16
Q

Diagnosis of hypothyroidism

A

Clinical
Blood tests - thyroid function tests - high TSH, low T4, T3; Auto-antibodies
Radiology sometimes

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17
Q

How is hypothyroidism managed?

A

Replacement - thyroxine (T4), levothyroxine

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18
Q

What kind of Goitres are there? (3)

A
  1. No associated intrinsic thyroid disease
    - simple cysts/ adenomas
    - iondine deficiency
  2. Associated with intrinsic thyroid disease
    - auto-immune
    - toxic multi-nodular goitre/ adenoma
  3. Malignant
    - rare
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19
Q

Side effects of Goitres?

A

Dysphagia

Breathing difficulties

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20
Q

How can Goitres be investigated?

A
  1. Radiology
    - ultrasound scan
    - radioisotope scan
  2. Fine needle aspiration
  3. Blood tests
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21
Q

How are Goitres treated?

A

Underlying cause treated

May need surgery

22
Q

What are 2 side effects of carbimazole

A

Taste disturbance

Neutropenia

23
Q

Two types of adrenal disease

A

Cushing’s Syndrome
- Excess corticosteroid production
Addison’s disease
- Deficient corticosteroid production

24
Q

What is Cushing’s syndrome cause by?

A
  1. Excess ACTH (Adrenocorticotropic hormone)
    - Pituitary adenoma
    - Ectoptic production by cancers (Lung)
  2. Excess corticosteroids
    - Adrenal adenomas, carcinomas
    - Iatrogenic
25
Symptoms of Cushing's syndrome
``` HBP Weight gain - abdominal obesity Prone to diabetes Prone to infections Thinning skin that bruises easily Redish - purplish streth marks on thighs, stomach, buttocks, arms, legs or breasts Fat deposits on face - round face Muscle or bone weakness Acne ```
26
How is Cushing's syndrome managed?
Address underlying cause - if iatrogenic, reduce/ stop medication Non - iatrogenic, surgery ideally
27
What are the causes of Addison's disease?
1. Iatrogenic - withdrawal of steroids after long term use 2. Hypopituitarism - cancer, infection, vascular, trauma 3. Adrenal destruction - auto-immune disease
28
What are the symptoms of Addison's disease?
``` Chronic disease - General malaise Acute (usually in response to stress) (Infection, trauma, surgery) - Life threatening: shock, hypoglycaemia, vomiting, abdominal pain ```
29
What are the signs of Addison's disease?
``` Hyperpigmentation on: Buccal mucosa Scars Pressure points Skin creases ```
30
What is used to treat Addison's disease?
Hydrocortisone (glucorticoid) 20mg am, 10mg pm | Fludrocortisone (mineralocorticoid)
31
When should dosage be increased?
Times of stress: Infection Trauma Surgery
32
How should an Addisonian crisis be treated?
``` Fluid replacement Glucose Hydrocortisone injections Treat infection if present Hospitalisation ```
33
What is Acromegaly
Excess growth hormone
34
What is it usually due to?
Pituitary adenoma
35
What characteristic features of Acromegaly?
``` Large tongue Excess hair Large "spade like" hands/ feet Myophathy / arthritis Prominent supraorbital ridge Broad nose Prognathism Interdental separation Thick, greasy skin Diabetes HBP Heart failure ```
36
Medical treatment of Acromegaly
Somatostatin analogues (protein which slows down the function of many hormones)
37
Other treatments of Acromegaly
Surgery is compressing nearby structures | May also need radiotherapy
38
How is diabetes diagnosed?
Elevated blood sugar Random plasma glucose >/= 11.1mmol/L Or fasting plasma glucose >/= 7.0mmol/L
39
What complication arise due to diabetes?
``` Infections - especially skin, mouth - boils, abscesses, cellulitis - candidosis - tuberculosis Eye disease (Diabetic retinopathy) - leading cause of blindness in developed world Kidney disease (Diabetic nephropathy) - leading cause for dialysis in UK ```
40
What is diabetic neuropathy?
Loss of nerve function Loss of sensation Loss of bowel and bladder function and sexual function Muscle weakness and pain
41
Athersclerosis
Complication of diabetes Disease of arteries Deposition of fatty material on walls Main reason for premature deaths in diabetes
42
How is type 2 diabetes managed?
``` Initially dietary Medication: - Sulphonylureas - Biguanides - Glitazones ``` Blood sugar monitoring
43
Diabetes risk factors
``` Weight control Physical activity Cholesterol Smoking HBP ```
44
What else should be monitored in patients with diabetes?
``` Regular clinics Eyes photgraphed Feet Monitor blood sugar control - HbA1c Monitor cholesterol Blood pressure ```
45
What medical emergency is most likely to occur with Type 1 diabetes?
Hypoglycaemia, low blood sugar
46
What are the two different types of high blood sugar in diabetics?
Type 1 - Diabetic ketoacidosis (DKA) | Type 2 - Hypersmolar Non-Ketotic Coma (HONK)
47
What causes DKA?
Insulin not taken due to no food intake | Inadequate insulin in acute physiological stress e.g. infection, surgery
48
Diabetic ketoacidosis signs and symptoms
Impaired consciousness Dehydration Ketones on breath
49
Management of DKA
Hospitalisation Insulin replacement Fluids Treat underlying cause
50
Signs and symptoms of hypoglycaemia
``` Irritability Personality change Sweating Tremor Hunger Progresses to impaired consciousness, fits, coma ```
51
How would you treat hypoglycaemia?
``` Don't wait for confirmation of low blood sugar Oral glucose Unconscious: - Hypostop (Buccal gel) - IM glucagon - IV glucose - Oral as soon as able ```

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