Endocrine and Tiredness Flashcards
What are the most likely causes of tiredness?
Stress
Depression
Viral/post viral infections (including covid)
Sleep related problems
Name lifestyle factors contributing to tiredness.
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
Name psychosocial factors causing tiredness.
Anxiety and depression
List physical factors causing tiredness.
Pre-existing medical conditions
New medical conditions presenting as tiredness
Medications
List conditions presenting as tiredness.
Iron deficiency anaemia
Post-viral fatigue including glandular fever
Endocrine conditions - type 2 diabetes, thyroid dysfunction, addisons disease
UTI
Renal impairment
Hypercalcaemia
Pregnancy
Who is at risk for iron deficiency anaemia?
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
Who is at risk of thyroid problems?
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
What causes hypercalcaemia?
Malignancy
Hyperparathyroidism
What do we ask when exploring tiredness?
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?
What other features do we look at when exploring tiredness?
Associated symptoms including red flags
Past medical history
Medications
Personal/social history
List some common endocrine disorders.
T2DM
Primary hypothyroidism
Polycystic ovary syndrome
List moderately common endocrine conditions.
Hyperthyroidism
T1DM
Male hypogonadism
List uncommon endocrine conditions
Hypopituitarism
Addison’s Disease
Differentiated thyroid cancer
List rare endocrine conditions.
Carcinoid tumour
Pituitary dependent Cushing’s Disease
Acromegaly
Name the key symptoms of the endocrine system.
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
List conditions causing tiredness.
Diabetes Hypothyroidism/hyperthyroidism Cushing's syndrome Hypopituitarism Addison's Disease Cushing's Disease Acromegaly
What is important to consider when exploring weight changes.
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
List examples of endocrine conditions causing weight changes.
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
What do you need to explore in changes of mood?
Description of current mood
How long change has been going on for
Affect on them day to day
What conditions cause mood changes?
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
What to discuss with temperature changes?
Less tolerant of cold/heat?
Wearing more/less clothes?
E.g. cold intolerance in someone with hypothyroidism
heat intolerance in someone with hyperthyroidism
List examples of conditions causing changes to facial or body appearance.
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
List conditions causing changes to skin, nails or hair.
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
What to explore with changes in bowel habit.
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
List examples of conditions causing changes in bowel habit.
Constipation - hypothyroidism
Softer, more frequent bowel motions in hyperthyroidism
What is polyuria defined as?
> 3L/day
What is important to consider in polyuria?
Bigger/more frequent volumes?
During the day or night?
How much do they drink during the day?
More thirsty than usual (polydispia)
List examples of conditions causing increased urine excretion.
Diabetes, GH excess which causes hyperglycaemia = osmotic diuresis
Diabetes insipidus = lack of ADH
What to explore with changes in menstruations?
Current period description
How long does this compare to previous cycles
How long has this been going on for
List examples of conditions causing changes to menstruations.
Diabetes
PCOS
Thyroid dysfunction
Problems with pituitary or hypothalamus
What causes erectile dysfunction?
Stress/emotional issues
Vascular disease
Autonomic dysfunction
Hypogonadism
What is galactorrhoea?
Breast milk production in people who are not pregnant or breastfeeding
What is gynaecomastia and conditions causing this.
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)
PMHx for endocrine conditions.
Previous diagnosis of diabetes or gestational diabetes
Previous diagnosis with a thyroid problem
HTN
TB
Medications
For diabetes or a thyroid condition
Prescribed corticosteroids
Male gynaecomastia e.g. spironolactone, antypsychotics, methadone
FHx
Thyroid problems or diabetes
Personal and Social Hx
Substance use (alcohol, drugs, sports supplements, drugs
