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Y3 Core Conditions > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Approximately how many adults in the UK have type 1 diabetes?

A

370,000

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2
Q

The incidence of type 1 diabetes peaks between which stages of life?

A

Early childhood (6 months to 5 years) and then in puberty

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3
Q

Name 5 types of diabetes?

A
  1. Type 1
  2. Type 2
  3. Gestational
  4. Monogenic
  5. Drug/chemical induced
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4
Q

What % chance have you got of developing type 1 diabetes, if your sibling has it?

A

10%

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5
Q

What are the classic symptoms of type 1 diabetes in children? (4)

A
  1. weight loss
  2. fatigue
  3. thirst (polydipsia)
  4. polyuria
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6
Q

What are the classic symptoms/presenting features of type 1 diabetes in adults? (5)

A
  1. Rapid weight loss
  2. Ketosis
  3. Age of onset younger than 50 years
  4. BMI < 25kg/m2
  5. Personal/family history of autoimmune diseases
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7
Q

Which blood test is performed to investigate type 1 diabetes, and what result indicates suspected T1DM?

A

Random plasma glucose >11mmol/L

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8
Q

How soon should a child be seen if T1DM is suspected?

A

Same day referral to paediatric diabetes team

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9
Q

If the presentation of T1DM is atypical, what further investigations can be carried out? (2 blood tests?)

A
  1. C-peptide

2. Diabetes-specific autoantibody

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10
Q

Which immunisations are particularly important for children with T1DM to have? (2)

A
  1. Influenza

2. Pneumococcal infections

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11
Q

How many people in the UK have been diagnosed type 2 diabetes (T2DM)?

A

3.5 million

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12
Q

What is type 2 diabetes?

A

A resistance to insulin and a relative insulin deficiency, resulting in persistent hyperglycaemia

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13
Q

What causes type 1 diabetes?

A

Usually it is a destruction of beta-cells in the pancreatic islets of Langerhans. Most commonly due to autoimmunity.

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14
Q

What are the risk factors for T2DM? (9)

A
  1. Obesity and inactivity
  2. Family history
  3. Ethnicity - afro/caribbean
  4. History of gestational diabetes
  5. Poor dietary habits (low fibre, high GI)
  6. Drugs: e.g. statins corticosteroids, thiazide diuretic combined with a beta-blocker
  7. Polycystic ovarian syndrome
  8. Low birth weight for gestational age
  9. Metabolic syndrome: raised BP, abnormal blood lipid levels, fatty liver, central obesity
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15
Q

What are the characteristic features/symptoms of T2DM?

A

Thirst, polyuria, blurred vision recurrent infections, tiredness …however these are not usually severe and may be absent.

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16
Q

What are the complications of poorly managed/undiagnosed T2DM? (the list is endless, but think in terms of microvascular/microvascular/metabolic etc).

A
  1. Macrovascular complications - CVD, cerebrovascular disease, peripheral arterial disease
  2. Microvascular complications - nephropathy, retinopathy and neuropathy
  3. Metabolic complications - dyslipidaemia and DKA
  4. Anxiety and depression
  5. Infections - particularly UTIs and skin infections
  6. Dementia
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17
Q

Which blood tests are measured to investigate suspected T2DM? and which corresponding levels would indicate it? (3)

A
  1. HbA1c >48mmol/mol
  2. Plasma glucose >11mmol/L
  3. Fasting plasma glucose >7mmol/L
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18
Q

When should HbA1c not be used to diagnose diabetes? (3)

A
  1. In children and young people
  2. Pregnant women or women <2 months postpartum
  3. People with end-stage CKD, HIV, pancreatic damage, on corticosteroids
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19
Q

In which gender is hypothyroidism more common?

A

Females

20
Q

In the UK what is the most common cause of primary hypothyroidism?

A

Autoimmune thyroiditis (Hashimoto’s or atrophic)

21
Q

Worldwide, what is the most common cause of primary hypothyroidism?

A

Iodine deficiency

22
Q

What are the causes of primary hypothyroidism? (7)

A
  1. Iodine deficiency
  2. Autoimmune thyroiditis
  3. Thyroid trauma (e.g. surgery/radiotherapy)
  4. Drugs: Amiodarone, lithium, interferons, thalidomide, rifampicin, and 15% of people treated with carbimazole/propylthiouracil for hyperthyroidism, will go on to develop hypothyroidism.
  5. Transient thyroiditis
  6. Thyroid infiltrative disorders
  7. Congenital hypothyroidism
23
Q

What are the causes of secondary hypothyroidism? (2)

A
  1. Pituitary dysfunction - tumours (pituitary adenoma), surgery, radiotherapy, trauma, infection, Sheehan’s syndrome, TB, syphilis, sarcoidosis
  2. Hypothalamic dysfunction - tumours (gliomas), drugs (retinoids/bexarotene), and all above as for pituitary.
24
Q

What are the risk factors for hypothyroidism? (4)

A
  1. Poor intake of dietary iodine (found in fish and dairy products)
  2. Family history (including other autoimmune diseases too)
  3. Down’s syndrome
  4. Amiodarone/Lithium use
    There are many other diseases/conditions that can cause hypothyroidism too.
25
Q

What are the symptoms of hypothyroidism? (8)

A
  1. Fatigue
  2. Cold intolerance
  3. Weight gain
  4. Constipation
  5. Non-specific weakness, myalgia
  6. Depression, impaired concentration and memory
  7. Dry skin
  8. Menstrual irregularities
26
Q

What is Cushing’s syndrome?

A

It is a clinical manifestation of pathological hypercortisolism from any cause.

27
Q

How does Cushing’s syndrome typically present?

A

Patients often display weight gain with central obesity, facial rounding and plethora, proximal muscle weakness, and thinning of the skin.

28
Q

What complications can people with Cushing’s syndrome develop? (4)

A

Metabolic complications including;

  1. Diabetes
  2. Dyslipidaemia
  3. Metabolic bone disease
  4. Hypertension
29
Q

What causes Cushing’s syndrome? (3)

A
  1. ACTH-secreting pituitary tumours (AKA Cushing’s disease)
  2. Autonomous adrenal cortisol overproduction
  3. Ectopic ACTH-secreting tumours
30
Q

What are the risk factors for developing Cushing’s syndrome? (4)

A
  1. Exogenous corticosteroid use
  2. Pituitary adenoma
  3. Adrenal adenoma
  4. Adrenal carcinoma
31
Q

What symptoms are key diagnostic factors? (at least 4)

A
  1. Present of risk factors
  2. Facial plethora
  3. Supraclavicular fullness
  4. Violaceous striae
32
Q

What are the diagnostic investigations to consider for Cushing’s syndrome? (4)

A
  1. Urine pregnancy test
  2. Serum glucose
  3. Late-night salivary cortisol
  4. 1mg overnight dexamethasone suppression test
33
Q

What is Addison’s disease?

A

Addison’s disease (primary adrenal insufficiency) is a result of destruction of the adrenal cortex –> this causes reduced production of glucocorticoids (e.g. cortisol), mineralocorticoids (e.g. aldosterone) and adrenal androgens (e.g. dehydroepiandrosterone)

34
Q

What is the most common cause of Addison’s disease in the developed world?

A

Autoimmune disease (70-90% of cases)

35
Q

In lesser developed countries, what is the most common cause of Addison’s disease?

A

TB

36
Q

Aside from autoimmune disease and TB, what are the other, rarer causes of Addison’s disease? (5)

A
  1. Adrenal metastases
  2. Adrenal haemorrhage
  3. Infections e.g. cytomegalovirus and HIV
  4. Amyloidosis
  5. Congenital adrenal hyperplasia
37
Q

Addison’s disease is associated with other autoimmune conditions, what are they? (3)

A
  1. Hypothyroidism
  2. Type 1 diabetes
  3. Autoimmune polyendocrine syndrome (60% of people with Addison’s)
38
Q

What are the two types of autoimmune polyendocrine syndrome?

A
  1. Polyglandular autoimmune syndrome type 1

2. Polyglandular autoimmune syndrome type 2 (more common) - linked to HLA DR3 and DR4

39
Q

What is the most common complication of Addison’s disease?

A

Adrenal crisis

40
Q

What is an adrenal crisis?

A

This occurs when a person with Addison’s disease suffers severe physical stress. The adrenal gland cannot supply the extra corticosteroids needed to cope with the stress, and life-threatening symptoms develop. Adrenal crisis may precipitate severe dehydration, hypotension, hypovolaemic shock, altered consciousness, seizures, stroke or cardiac arrest.

41
Q

Addison’s disease is hard to diagnose, as the symptoms are non-specific and overlap with other conditions, however, when should Addison’s disease be suspected in someone? (6)

A

In a person with persistent, non-specific symptoms including:

  1. Fatigue
  2. Hyperpigmentation (affects 92% of people with Addison’s)
  3. GI symptoms - weight loss, loss of appetite, cravings for salt, soy sauce or liquorice
  4. MSK symptoms - muscle weakness, cramps and joint pains
  5. CV symptoms - postural dizziness due to hypotension
  6. Headache, low-grade fever, increased thirst/urination
42
Q

Addison’s disease should be considered in people with what other conditions? (6)

A
  1. Hypothyroidism - particularly if symptoms worsen when starting levothyroxine
  2. Type 1 diabetes
  3. Pernicious anaemia
  4. Alopecia
  5. Coeliac disease
  6. Hyponatraemia and hyperkalaemia
43
Q

What are the differential diagnoses for Addison’s disease? (6)

A
  1. Gastroenteritis - nausea and vomiting are key features of adrenal crisis
  2. Depression - chronic fatigue, malaise, anorexia may mimic depression
  3. Eating disorders
  4. Type 1 diabetes
  5. Chronic fatigue syndrome
  6. Hyperemesis and chloasma of pregnancy
44
Q

If Addison’s disease or adrenal insufficiency is suspected, what investigation can be requested?

A

A serum cortisol level and U&Es

- ideally the serum cortisol level should be obtained between 8-9am

45
Q

What is hyperparathyroidism?

A

An enlargement of one of the glands resulting in over production of calcium

46
Q

What is primary hyperparathyroidism associated with?

A

Primary hyperparathyroidism may be associated with uncommon familial disorders including multiple endocrine neoplasia type 1 and type 2A syndromes, familial hyperparathyroidism-jaw tumour syndrome, and familial isolated hyperparathyroidism

47
Q

How does parathyroid hormone result in hypercalcaemia?

A

Excess PTH causes hypercalcaemia by increasing renal calcium reabsorption and mobilizing calcium from bone. It also indirectly increases intestinal calcium absorption, by increasing synthesis of serum 1,25-dihydroxyvitamin D3 (calcitriol, the active form of vitamin D3)

Y3 Core Conditions (19 decks)

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