endocrine

Question 1

why are appetite and weight changes important in endocrine hx?

Answer 1

increased appetite and wt loss: thyrotoxicosis or uncontrolled DM
increased appetite and wt gain: cushings
loss appetite and wt loss: adrenal insufficiency, GI disease
wt gain: hypothyroidism

Question 2

why are changes in bowel habits important in endocrine hx?

Answer 2

diarrhoea=hyperthyroididm

constipation=hypothyroididm and constipation

Question 3

what can cause amenorrhoea?

Answer 3

primary: gonadal dysgenesis, anatomical abnormalities, testicular ferminisation
secondary: excessive exercise or wt loss, medications, thyroid dysfunction, pituitary tumours, ovarian failure, PCOS, pregnancy

Question 4

what can cause impotence?

Answer 4

neuropathies, htn, vascular disease, alcohol, recreastional drugs,
SE anti-hypertensives, anti-depressants, steroids

Question 5

what can cause increased sweating?

Answer 5

hyperthyroidism, phaeochromocytoma, hypoglycaemia, acromegaly

Question 6

what skin changes may occur in endocrine conditions?

Answer 6

hypothyroidism: coarse, pale, dry
acanthosis nigricans=acromegaly, diabetes, cushings, PCOS
excess glucocorticoids: atrophy of skin, easy bruising, striae
primary hypoadrenalism: pigmentation in palmar creases, elbows, gums and buccal mucosa
Cushings: increased pigmentation

Question 7

what can cause polyuria?

Answer 7

DM, diabetes insipidus, hypercalcaemia

Question 8

how do pituitary adenomas cause a bitemporal hemianopia?

Answer 8

compress optic chiasm

Question 9

what psychological disturbances are seen in endocrine conditions?

Answer 9

depression: cushings, hypothyroidism, DM, adrenocortical insufficiency
delirium: thyrotoxicosis, hypothyroidism, hypoparathyroididm, phaechromocytoma, hypoglaycaemia
dementia: hypothyroidism
anxiety and panic disorder: hyperthyroidism, phaechromocytoma, hypoparathyroidism

Question 10

why is medication important in endocrine hx?

Answer 10

excess steroids=cushings
abrupt cessation high dose corticosteroid therapy=acute adrenocortical insufficiency
lithium and amiodarone=hypothyroidism
amiodarone=thyrotoxicosis

Question 11

give some sx of acromegaly.

Answer 11

arthralgia/arthritis, increased bp, carpal tunnel syndrome, diabetes, enlarged organs, field defects

Question 12

give some symptoms of siadh.

Answer 12

spasms, no pitting oedema, anorexia, disorientation, hyponatraemia

Question 13

what causes siadh?

Answer 13

surgery, intracranial (infection, head injury), alveolar (Ca, pus), drugs (opiates, antiepileptics, cytotoxics), hormonal (hypothyroid, low corticosteroid)

Question 14

how is a goitre sized according to WHO criteria?

Answer 14

0=no visible or palpable goitre
1a=detectable on palpation
1b=palpable and visible when neck extended
2=visible with neck in normal position
3=visible from a distance

Question 15

why is the consitency on palpation important?

Answer 15

soft=normal
firm=simple goitre
hard=rubbery in hashimotos thyroiditis, stony hard in carcinoma/cyst/fibrosis

Question 16

when will bruits be heard in a goitre?

Answer 16

graves disease

Question 17

what is necrobiosis lipoidica diabeticorum?

Answer 17

yellow/brown discolouration of shins, due to DM

Question 18

what indicates hyperthyroidism

Answer 18

decrease wt despite increased 
appetite
(although 10% will gain 
weight)
increased appetite
Increased frequency of 
defaecation or diarrhoea
energy can increase or decrease, muscle weaness
Anxious, irritable, emotionally 
labile
decreased concentration
refers a cool environment, 
wears fewer clothes
Increased sweating.
Fine hair and hair loss
Clubbing (thyroid acropachy)
Onycholysis (separation of 
the nail from the nailbed)
Tachycardia, palpitations, 
atrial fibrillation
Infrequent menses.
Fertility problems.

Question 19

what indicates hypothyroidism?

Answer 19

increased wt, decreased appetite
hoarse voice
constipation
decrease energy
Somnolent
Slower movements and 
muscle weakness
ethargy, depression
decreased cocentration
Prefers a warm environment, 
wears extra clothes
Dry flaky skin
Coarse thinning hair
Brittle nails
Bradycardia
Heavy, prolonged or irregular 
menses.
Fertility problems and 
increased risk of miscarriage

Question 20

what drug hx is important in thyroid problems?

Answer 20

Specifically enquire about use of thyroxine, lithium, amiodarone and glucocorticoids

Question 21

what social hx is important in thyroid problems?

Answer 21

Smoking, alcohol, diet (sufficient iodine?) and effect on activities of daily living