endocrine Flashcards
Type 1 DM
- who does it most commonly affect?
- pathogenesis?
- risk factors? 3
- common HLA types seen? 2
children/adolescents
- but can occur at any age (LADA = late autoimmune diabetes of adults)
autoimmune destruction of B cells in the islets of langerhans. Therefore little/no endogenous insulin is produced.
- FH (and genetics)
- PMH of other autoimmune conditions
- Caucasian (?lower vit D levels)
(- ?viral trigger)
90% have HLA DR3 +/- DR4
type 1 DM
- commonest symptoms? 4
- other symptoms? 5
- common initial acute presentation? + additional symptoms? 4
- clinical sign? 1
- polydipsia
- polyuria (esp at night)
- weight loss (esp muscle bulk)
- fatigue
- genital itchiness/recrrent thrush
- blurred vision (due to drying of eyes)
- increased appetite
- mood changes
- slow wound healing
ketoacidosis (DKA) (in addition to above ^severity:)
- nausea/vomiting
- abdominal pain
- confusion/reduced GCS
- SOB
- ‘pear drop/nailpolish’ breath
type 1 DM
- blood test (+ numerical results)?
- blood tests, if in DKA? 4
- other test? 1
blood glucose
- random: >11mmol/L
- fasting: >7mmol/L
if in DKA - FBC - ketones - U&E - ABG (metabolic acidosis) (nb also do ECG & CXR)
nb avoid HbA1c in type 1 DM for diagnosis as will likely not be elevated due to short presentation
- urine dipstick
type 1 DM
- pharmacological treatment?
- monitoring?
- education about? 6
- insulin (subcutaneous, long, short + medium acting)
- blood glucose
- HbA1c levels
- how to monitor glucose levels and inject insulin (incl rotating injection site)
- diet + exercise
- avoid binge drinking (delayed hypo)
- risk of ketoacidosis during periods of illness
- detecting + managing hypoglycaemia
- importance of eye and foot care and check ups
DM type 1, differentials:
- endocrine? 2
- other? 4
- MODY (maturity onset diabetes of the young - autosomal dominant)
- endocrine tumour secreting GH or glucagon
- diabetes insipidus
- psychogenic polydipsia
- transient hyperglycaemia w illness/stress
- drugs (incl steroids)
nb many more DD for acute DKA (anything that causes abdominal pain/vomitting like alcohol, ruptured appendix etc - see acute abdomen*)
Diabetes Mellitus type 2:
- pathogenesis?
- norm age of onset?
- non-modifiable risk factors? 6
- modifiable risk factors? 3
- medications that increase risk? 3
- pathogenesis?
decreased insulin secretion +/- insulin resistance
- 40-50 (but can get MODY)
- family history
- PMH of gestational DM
- PMH of polycystic ovary syndrome
- PMH of HTN
- black or asian ethnicity
- low birth weight
nb metabolic syndrome = high blood sugar, high cholesterol, HTN + central obesity
- obesity
- inactivity
- low fibre/high sugar diet
(nb smoking + alcohol also increase risk) - statins
- corticosteroids
- thiazide diuretic + B blocker
type 2 Diabetes Mellitus:
- symptoms? 12
MOST type 2 DM is ASYMPTOMATIC until complications occur!!
- poyluria
- polydipsia
- increased hunger
- fatigue
- unexplained weight loss (or gain?)
- blurred vision
- headaches
- recurrent infections
- poor wound healing
- recurrent vaginal thrush
- acanthosis nigrocans
- numbness/tingling of feet
type 2 Diabetes Mellitus:
- signs on examination? 2
- blood tests? 2 (incl abnormal numbers)
- diagnostic criteria? 2
- other test? 1
- diabetic retinopathy
- diabetic nephropathy
- blood glucose (see below)
- HbA1c >48mmol/L
- symptoms of hyperglycaemia PLUS fasting glucose of >7mmol/L or random glucose of >11mmol/L (or HbA1c >48mmol/L)
- asymptomatic but with two separate positive glucose blood tests
- urine dipstick
type 2 Diabetes Mellitus:
- non-pharmacological treatment? 3
- 3 classes of drug used (bar insulin)? + examples?
- what’s 1st line etc?
- loose weight
- more high fibre/low sugar diet
- exercise more
- metformin
- sulphonylureas (gliclazide)
- thiazolidinediones (pioglitazone)
metformin is first line (titrate up to minimise GI upset + monitor renal function)
gliclazide as mono therapy or w metformin is 2nd line
thiazolidines are third line if metformin +/- gliclazide contraindicated or not adequate (even then you’d norm start on insulin)
nb many other drugs as well…
type 2 Diabetes Mellitus:
- monitoring blood tests? 2
- what needs monitoring for? 3
- HbA1c
- U&E (see kidney function)
- diabetic retinopathy
- diabetic neuropathy (foot care)
- diabetic nephropathy (see above)
hypothyroidism:
- risk factors? 3
- drugs which can cause? 4
- other causes? 4
- female
- FH
- PMH of autoimmune conditions
- anti-thyroid drugs (e.g. carbimazole for hyperthyroidism)
- lithium
- amiodarone
- iodine
- autoimmune (hashimotos or primary atrophic hypothyroidism)
- iodine deficiency (commonest worldwide)
- radiation or surgery to thyroid
- pregnancy problems
(nb secondary causes (i.e. pituitary dysfunction) are very rare)
hypothyroidism:
- symptoms? 14
- depression
- decrease in memory/cognition
- fatigue
- weight gain
- anorexia (can cause paradoxical weight loss)
- cold intolerance
- myalgia
- cramps
- weakness
- constipation
- menorrHAGIA
- hoarse voice
- goitre
- dry/brittle hair
hypothyroidism:
- signs? 11
(- acronym for signs)
BRADYCARDIC
B - Bradycardia
R - Reflexes relax slowly
A - Ataxia (cerebellar)
D - Dry/thin skin/hair (loose outer third of eyebrows)
Y - Yawning/drowsy/coma
C - Cold hands (also inappropriate clothes for weather)
A - Ascites +/- non-pitting oedema (lids, hands, feet)
R - Round puffy face/double chin/obese
D - Defeated demeanor/depression
I - Immobile +/- ileus
C - CCF
Also:
- neuropathy
- myopathy
- goitre
Hypothyroidism:
- blood tests? 3 (and results for primary hypothyroidism)
- medication?
nb have a low threshold for doing TFTs, thyroid signs are subtle and often missed or misdiagnosed
- TSH
- serum T4
- thyroid antibodies
high TSH and low T4
levothyroxine for life (with yearly TFTs)
hypothyroidism:
- common differentials? 3
- depression
- dementia
- anaemia
nb because of the non-specific signs and symptoms there are maaaannnyy other causes so, if TFT is negative, make sure to do a full systems review
