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3 - Clinical Skills > Endocrine and Tiredness > Flashcards

Endocrine and Tiredness Flashcards

1
Q

What are the most likely causes of tiredness?

A

Stress
Depression
Viral/post viral infections (including covid)
Sleep related problems

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2
Q

Name lifestyle factors contributing to tiredness.

A

Stressful life events
Busy work/study/family commitments
Nutritionally inadequate/unhealthy diets/eating patterns
Alcohol and drug use
Physical activity - too little or too much
Sleep disorders: primary insomnia (poor sleep habits), secondary insomnia (due to pain, breathlessness or anxiety) or obstructive sleep apnoea

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3
Q

Name psychosocial factors causing tiredness.

A

Anxiety and depression

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4
Q

List physical factors causing tiredness.

A

Pre-existing medical conditions
New medical conditions presenting as tiredness
Medications

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5
Q

List conditions presenting as tiredness.

A

Iron deficiency anaemia
Post-viral fatigue including glandular fever
Endocrine conditions - type 2 diabetes, thyroid dysfunction, addisons disease
UTI
Renal impairment
Hypercalcaemia
Pregnancy

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6
Q

Who is at risk for iron deficiency anaemia?

A

Menstrauting and pregnant people
Growing rapidly (children, adolescents)
People with inadequate diets
Intermittent blood loss from the GI tract due to cancers or peptic ulcers
Malabsorption problems e.g. Coeliac disease

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7
Q

Who is at risk of thyroid problems?

A

Older people
Pre-existing autoimmune conditions e.g. T1 DM
People with FHx of thyroid problems
Genetic conditions e.g. Down’s Syndrome
People with past history of neck radiation or surgery
Certain medications e.g. amiodarone, lithium

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8
Q

What causes hypercalcaemia?

A

Malignancy

Hyperparathyroidism

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9
Q

What do we ask when exploring tiredness?

A 
What do they mean by tiredness/what does it feel like? 
How long has it been going on for?
How is it affecting their daily life? 
What do they think may be going on? 
What are their concerns?
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10
Q

What other features do we look at when exploring tiredness?

A

Associated symptoms including red flags
Past medical history
Medications
Personal/social history

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11
Q

List some common endocrine disorders.

A

T2DM
Primary hypothyroidism
Polycystic ovary syndrome

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12
Q

List moderately common endocrine conditions.

A

Hyperthyroidism
T1DM
Male hypogonadism

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13
Q

List uncommon endocrine conditions

A

Hypopituitarism
Addison’s Disease
Differentiated thyroid cancer

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14
Q

List rare endocrine conditions.

A

Carcinoid tumour
Pituitary dependent Cushing’s Disease
Acromegaly

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15
Q

Name the key symptoms of the endocrine system.

A 
Lethargy/tiredness 
Change in weight 
Change in mood 
Changes in temperature tolerance 
Changes to facial or body appearance 
Changes to skin, nails, hair 
Changes in bowel habit 
Passing more urine than normal 
Menstrual changes
Erectile dysfunction 
Galactorrhoea 
Gynaecomastia
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16
Q

List conditions causing tiredness.

A 
Diabetes
Hypothyroidism/hyperthyroidism 
Cushing's syndrome 
Hypopituitarism 
Addison's Disease
Cushing's Disease
Acromegaly
17
Q

What is important to consider when exploring weight changes.

A 
Changes - loss or gain 
How much and how long 
Intentional weight loss or not 
Change in appetite 
Change in bowel habit 
Change in nutrition or activity levels 
Patient perspective
18
Q

List examples of endocrine conditions causing weight changes.

A

T1DM: increased appetite, decreasing weight
Hypothyroidism: decreased appetite, increasing weight
Hyperthyroidism: increased appetite, decreasing weight
Cushing’s Syndrome: increased appetite and weight
Addison’s Disease: decreased appetite and weight

19
Q

What do you need to explore in changes of mood?

A

Description of current mood
How long change has been going on for
Affect on them day to day

20
Q

What conditions cause mood changes?

A

Direct effect of condition itself e.g. anxiety from hyperthyroidism due to sympathetic activation
May be a consequence of symptoms e.g. low mood due to impact of fatigue

21
Q

What to discuss with temperature changes?

A

Less tolerant of cold/heat?
Wearing more/less clothes?
E.g. cold intolerance in someone with hypothyroidism
heat intolerance in someone with hyperthyroidism

22
Q

List examples of conditions causing changes to facial or body appearance.

A

Cushing’s Syndrome (excess glucocorticoid): puffy moon face, central adiposity, buffalo hump
Acromegaly (GH excess): sausage shaped fingers, big hands and feet, thickened facial features - frontal bossing, widely spaced teeth, heavy jaw

23
Q

List conditions causing changes to skin, nails or hair.

A

Hypothyroidism: dry skin, hair loss
Addison’s Disease: pigmented palmar creases
Androgen excess: e.g. PCOS leading to hirsutism: excessive hair growth in an androgen dependent distribution - upper lip/chin/back/chest/abdomen/legs in a genotypically female person
Hair loss/thinning that can occur in hypothyroidism or hypopituitarism

24
Q

What to explore with changes in bowel habit.

A

Comparison with normal bowel habit.
How long has this been going on?
Any changes in diet/medication/physical activity
Screen for red flags: blood, malena, tenesmus

25
Q

List examples of conditions causing changes in bowel habit.

A

Constipation - hypothyroidism

Softer, more frequent bowel motions in hyperthyroidism

26
Q

What is polyuria defined as?

A

> 3L/day

27
Q

What is important to consider in polyuria?

A

Bigger/more frequent volumes?
During the day or night?
How much do they drink during the day?
More thirsty than usual (polydispia)

28
Q

List examples of conditions causing increased urine excretion.

A

Diabetes, GH excess which causes hyperglycaemia = osmotic diuresis
Diabetes insipidus = lack of ADH

29
Q

What to explore with changes in menstruations?

A

Current period description
How long does this compare to previous cycles
How long has this been going on for

30
Q

List examples of conditions causing changes to menstruations.

A

Diabetes
PCOS
Thyroid dysfunction
Problems with pituitary or hypothalamus

31
Q

What causes erectile dysfunction?

A

Stress/emotional issues
Vascular disease
Autonomic dysfunction
Hypogonadism

32
Q

What is galactorrhoea?

A

Breast milk production in people who are not pregnant or breastfeeding

33
Q

What is gynaecomastia and conditions causing this.

A

Breast tissue enlargement
Hyperprolactinemia due to tumour in pituitary
Males: kidney failure, liver cirrhosis, hypogonadism, hyperthyroidism, aging, medications (spironolactone, digoxin, tricyclic antidepressants), substances (anabolic steroids, alcohol)

34
Q

PMHx for endocrine conditions.

A

Previous diagnosis of diabetes or gestational diabetes
Previous diagnosis with a thyroid problem
HTN
TB

35
Q

Medications

A

For diabetes or a thyroid condition
Prescribed corticosteroids
Male gynaecomastia e.g. spironolactone, antypsychotics, methadone

36
Q

FHx

A

Thyroid problems or diabetes

37
Q

Personal and Social Hx

A

Substance use (alcohol, drugs, sports supplements, drugs

3 - Clinical Skills (9 decks)

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