Endocrine and general Flashcards
Facial Features of Acromegaly
Prominent supraorbital ridges Large nose Protrusion of lower jaw (Prognathism) Deep voice Thick lips, Macroglossia Bitemporal hemianopia
Body features of acromegaly
Neck goitre (visceromegaly leading to hyperthyroidism)
Large hands with broad palms
Large feet
Organomegaly
Systemic features of acromegaly
Hypertension
DM - glycosuria
Most common cause of acromegaly
Growth hormone secreting pituitary adenoma
Investigations for acromegaly
Basal IGF1 elevation
Oral glucose tolerance test
MRI pituitary
Other anterior pituitary hormones: any hypothyroidism or secretion of prolactin by adenoma
Complications of acromegaly
Disfigurement Obstructive sleep apnea (macroglossia) Hypopitutarism Carpal tunnel syndrome HT with LVH, DM
Management of acromegaly
Transphenoidal surgery to remove pituitary tumor
Dopamine agonist (carbergoline) or HG hormone receptor antagonist (Octreotide)
Difference between Acromegaly and Paget’s disease
Acromegaly has soft tissue involvement but Paget only affects bones
Features of Atopic eczema
- Dry skin, symmetrical, lichenification and excoriations
- Neck: post-inflammatory hyperpigmentation at sides
- Trunk: patches/ papules with lichenification, excoriation, crusting
- Hand and feet: lichenified papules with pigmentation over finger knuckles, ankles, dorsa of feet and hands
- Painful fissuring and cracking of fingers and palm
Causes of Atopic eczema
- Genetic predisposition to hypersensitivity response/ Atopy
Ddx of atopic eczema
Contact dermatitis: only at site of irritant contact
Drug eruption: trunk and proximal limbs
Seborrhoeic dermatitis: hairline, eye brows, nasolabial folds, axilla, groin
Psoriasis: well-defined, silver scaling erythematous papules, always at extensor surfaces
Dermatophytosis: annular scaly rash with central clearing
Investigations for atopic eczema
Skin patch/ prick test
Skin swab for bacterial culture
Serum IgE
Features of Cushing’s syndrome
Cause
Ddx
Moon face, acne, hirsutism Pigmentation Truncal obesity, Buffalo hump, purple striae Limb muscle wasting Bruising
Cause: excessive glucocorticoids
Ddx
- Iatrogenic
- ACTH dependent: pituitary adenoma, ectopic ACTH production (e.g. cancer)
- ACTH independent: Adrenal tumors
Investigations for Cushing’s syndrome
24 hour urinary free cortisol
Dexamethasone suppression test: Low dose for confirmation of Cushing’s syndrome, high dose for ACTH-dependent Cushing’s syndrome (suppress cortisol and ACTH)
ACTH levels
Corticotrophin releasing factor stimulation test: Pituitary-dependent Cushing’s disease
MRI pituitary and adrenals
Complications of Cushing’s syndrome
Hypertension, Diabetes mellitus, Osteoporosis, Immune suppression, Proximal muscle wasting, frequent bruising, Avascular necrosis of hip joint (iatrogenic cause)
Management of Cushing’s syndrome
Transphenoidal surgery for pituitary lesion
Control hypercortisolism with Metyrapone and Ketoconazole
Suppress pituitary ACTH secretion with cabergoline and pasireotide
Ddx of diabetic retinopathy
Hypertensive retinopathy
Central retinal vein thrombosis:
- Venous dilatation and tortuosity
- Flame-shaped hemorrhage
- Cotton wool spots
- Papilloedema
- Neovascularization
Investigations for diabetic retinopathy
Blood glucose, HbA1c
Dipstick for proteinuria
Screen for other diabetic complications
Management of diabetic retinopathy
Glucose and BP control
Laser photocoagulation
Vitrectomy
Anti-VEGF against proliferative neovascularization
Features of Erythema nodosum
Bilateral, multiple, tender, erythematous subcutaneous nodules
ANTERIOR aspects of legs and knees
Bruise-like, brown patches
+/- Arthalgia at ankle joint
Causes of erythema nodosum
TB
Streptococcal infection
Drugs: sulphonamide, oral contraceptives
Sarcoidosis, IBD
Ddx of erythema nodosum
Other panniculitis e.g. erythema induratum
Vasculitis e.g. polyarteritis nodosa
Pre-tibial myxedema of Grave’s disease
Superficial thrombophlebitis
Features of Grave’s disease
Eyes: Proptosis, lid lag and retraction, periorbital edema, opthalmoplegia
Hands: sweaty, action tremor, palmar erythema
Neck: thyroidectomy scar, goiter moves with swallowing
Limb: Pre-tibial myxedema, proximal myopathy
Heart failure
Causes of neck swelling and thyrotoxicosis symptoms
Grave’s disease
Toxic multinodular goiter
Toxic thyroid adenoma
Subacute thyroiditis
Investigations for Grave’s disease
Thyroid function test
TSH receptor autoantibodies
Anti-thyroglobulin antibodies
Anti-thyroperoxidase antibodies
Radionucleotide scans
Ultrasound
4 stages of hypertensive retinopathy
1: Silver wiring
2: + Arteriovenous nipping
3: + cotton wool spots, flame shaped hemorrhages
4: + papilloedema
Causes of secondary hypertension
Renal: chronic renal failure, renal artery stenosis, IgA nephropathy
Vascular: Coarctation of aorta
Metabolic: Cushing’s syndrome, pheochromocytoma
Drugs: mineralocorticoids and glucocorticoids
Causes of neck goiter with euthyroid presentation
Controlled Grave’s
Hashimoto’s thyroiditis
Euthyroid goiter
