Endocrine Flashcards
what is the difference between primary and secondary disease
primary - problem with the actual gland, graves disease
secondary - a problem in another gland is having an effect on the secretions of another gland
what stimulates release of hormones from pituitary gland
hormones or nerve activation from hypothalamis
what hormones are released from pituitary gland
anterior - acth, growth hormone, fsh, lh, tsh
posterior - adh, prolactin
what are the types of tumour in the pituitary gland
functional - can still release hormones but levels may be skewered,
non-functional - no release of hormones
what is the change of hormones released in functional tumours at different ages
younger than 40 - increase in ACTH, stimulates release of cortisol, result in cushings disease
older than 40 - growth hormone, results in acromegaly
what is acromegaly
increase in GH but bones have fused so growing bones cannot grow any longer. instead, get increase of bulk in bones in mandible, skull, nose, fingers, feet, and increase in thickness of soft tissue
how can acromegaly be tested for
GH test isnt stable, instead measure insulin like growth factor - might have increased spacing or loose fitting denture
what can cause hyperthroidism
graves disease - antibody fitting into TSH receptor, stimulating production of thyroid hormone
tumour - more likely to be primary than secondary
what are the symptoms of hyperthyroidism
symptoms - sweating, fast heart rate, anxious, ophthalamopy
signs - tachycardia, warm skin, atrial fibrillation, higher BP, goitre
how can hyperthyroidism be treated
carbimazole, blocks action of T4, beta blockers to reduce effect, surgery to reduce size
what can cause hypothyroidism
hashimoto’s disease - antigens stimulating production of antibodies against thyroid gland
secondary - non-functioning adenoma in pituitary
what are the symptoms of hypothyroidism
symptoms - weight gain, constipation, tiredness
signs - bradycardia, hyperlipidaemia, dry coarse skin
how can hypothyroidism be treated
by giving thyroxin
how would blood test help to define the cause of hyperthyroidism
all causes will have high T3
low TSH - primary cause - graves disease
high TSH - secondary cause - pituitary
how would blood test help to define cause of hypothyroidism
all causes will have low T3
low TSH - secondary cause - pituitary tumour
high TSH - primary cause - hashimotos disease
what is the difference between diabetes mellitus and insipidus
mellitus - to do with glucose levels in the blood, hyperglycaemia
insipidus - lack of ADH so unable to concentrate urine
how can diabetes mellitus be diagnosed
random glucose test - not always accurate, glucose levels may be high if just ate carbohydrates
fasting test - levels of glucose normally
glucose tolerance test - measure levels before eating then 2 hours after, if above 11.1 - diabetes
what causes type 1 diabetes
autoimmune disease against insulin, unable to get glucose into cells, antibodies may be - islet cell autoantibody, insulin auto antibodies, glutamic acid decarboxylase
what symptoms are present in type 1
diabetes symptoms - polyuria, polydipsia and tiredness
also hyperglycaemia and ketoacidosis
what is ketoacidosis
diabetics are unable to get glucose into cells so instead use ketones for energy production. acid is produced as a by product, this increases acid in body - can be dangerous or fatal
how is type 2 diabetes diagnosed
normally from non-type 1
why are type 2 diabetics less likely to go into ketoacidosis
they have a low level of insulin to prevent it, normally present before it gets to this stage, however, if left long enough they will
what causes type 2 diabetes
poor diet and lack of exercise, constantly releasing insulin, cells become desensitised, also eventually run out of insulin
what complications are normally associated with type 2 diabetes
hyperlipidaemia, cardiovascular problems, more unusual infections
what are symptoms of type 2 diabetes
obesity, hypertension, infections, hyperglycaemia
compare type 1 and type 2
type 1 - hyperglycaemia with ketoacidosis, presents with diabetic symptoms (polyuria, polydipsia, tiredness), young and thin
type 2 - old and fat, more complications (infections and cardiovascular problems), less likely to go into ketoacidosis
how is type 1 diabetes managed
insulin injections. can be done by themselves or nurse. doing it themselves - more control over it, can eat when they like, if a nurse - only get it twice a day so need to plan around insulin injections
how is type 2 diabetes managed
changing lifestyle, diet and exercise, may be on drugs to improve insulin release and increase sensitivity to insulin (sulphonylureas and biguanides)
what is hypoglycaemia
low blood sugar levels, when take insulin and dont eat, levels get too low, can cause dizzyness, increase in hR and confusion before unconsciousness
what are some complications of diabetes
hypo, large vessel disease - increased risk of atherosclerosis, angina and hypertension
small vessel disease - poor wound healing, increased infection risk, neuropathy
what might cause adrenal hyperfunction
primary tumour - adrenal adenoma
secondary - pituitary tumour, functioning
what would be the consequence and symptoms of adrenal hyperfunction
excess cortisol and aldosterone. cushing’s syndrome symptoms - diabetes type 2 symptoms, weight gain, infections, back pain
signs - hypertension, obesity, thin skin
how would the cause of adrenal hyperfunction be investigated
check blood levels of ACTH and cortisol
cortisol will always be high
if ACTH high - pituitary tumour, negative feedback not working. if ACTH low - primary tumour
what might cause adrenal hypofunction
may be autoimmune attacking adrenal gland
or secondary - non-functioning pituitary tumour
what are some symptoms of adrenal hypofunction
weight loss and lethargy
signs - hypotension, due to lack of aldosterone for fluid reabsorption
addisons disease
how can addisons disease be investigated
blood test for cortisol and acth
cortisol is always low
if acth low - secondary, pituitary adenoma
if acth high - primary, autoimmune
can also use synthacth - if positive result - primary cause
what is addisons crisis
hypovolemia, vomiting and fluid loss - need fluid in and iv steroid - lack of aldosterone and cortisol
how is addisons disease treated
by giving fludrocortisone - replacement for aldosterone and hydrocortisone for cortisol, also fluid replacement
what is the difference between patients with addisons disease and those on synthetic steroids
addisons disease only need replacement of physiological control, unable to reabsorb fluid so hypovolemia and hypotension, whereas steroids give supra-physiological control, more than they require, normally have hypertension
what is the problem with patients on synthetic steroids for a long period of time
high levels of cortisol so switch of production of cortisol, can get adrenal atrophy. when they then come off medication, get an increase in ACTH but nothing to stimulate and unable to produce their own cortisol
why can the dose of steroid given not fixed
because levels of cortisol released is dependant on environment and stimulus, if get an infection, get an increase in cortisol released, in response to stress
what patients might require steroid prophylaxis
those with addisons disease, only getting enough for physiological normal. those on synthetic steroids already have more than they need so they should be fine for an infection
what advice should be given to patients on prednisolone after dental treatment
if over 15mg - dont have to do anything, should have enough
if 1-15mg - should double their dose on the day of treatment and for 2 days after, increases just incase of stress they have enough cortisol to prevent adisonian crisis
those who have stopped taking steroids in the past 3 months - should be given just incase
what dental treatment requires steroid prophylaxis
minor oral surgery or spreading dental infection
routine or restoration - not required
what is also common in patients on steroids - dental aspects
candida infections, increased risk of diabetes - type 2, other complications also involved - e.g. cardiovascular disease, oral pigmentation
