Endocrine Complaints 2 Flashcards
Describe the thyroid gland axis
Hypothalamus - TRH
Pituitary - TSH
Thyroid gland - T4 and T3
What is the major thyroid hormone that is secreted by the thyroid gland?
T4
What is the active thyroid hormone?
T3
T3/T4 deficiency
Hypothyroidism
What is the most common cause of hypothyroidism in the world?
Iodine deficiency
What is the most common cause of hypothyroidism in the US?
Hashimoto’s thyroiditis (autoimmune disease)
What is a goiter?
Enlarged thyroid gland
Key signs and symptoms of hypothyroidism
SLOWER metabolism Weight gain Fatigue Dry skin Feeling cold Constipation
Why will TSH be elevated in patients with hypothyroidism?
Due to low levels of T3 and T4 there is no negative feedback so the anterior pituitary continues to release TSH
General treatment for hypothyroidism?
Replace hormone - Hormone deficiency
What is the most common cause of hyperthyroidism in the US?
Grave’s Disease (autoimmune disease)
Key signs and symptoms of Grave’s disease (hyperthyroidism)
FASTER metabolism
Weight loss
Protruding eye balls
Palpitations, sweating, warm skin
Why will TSH be suppressed in patients with hyperthyroidism?
Due to high levels of T3 and T4 there will be negative feedback on the anterior pituitary to make less TSH
General treatment for hyperthyroidism?
Remove hormone - Hormone excess
What is the most common malignancy of the endocrine system?
Thyroid cancer
Disordered growth of thyroid cells
Nodular disease
Parathyroid hormone (PTH) regulates?
Calcium levels
Parathyroid hormone does what to calcium levels?
Increases them
How is the parathyroid hormone regulated?
Via calcium levels in the blood:
- low calcium increases PTH
- high calcium decreases PTH
What is the most common cause of primary hyperparathyroidism?
Adenomas
Most common symptoms of primary hyperparathyroidism?
MOSTLY ASYMPTOMATIC
What is the classic presentation of high calcium levels?
Stones, bones and groans
- kidney stones
- abnormal bones (weakness)
- constipation
What cause of primary hyperparathyroidism is usually symptomatic at discovery?
Hypercalcemia of malignancy
What is the main cause of hypoparathyroidism?
Inadvertent damage or removal of parathyroid glands during surgery
What are the key signs and symptoms of hypoparathyroidism?
Chvostek’s sign
Trousseau sign
Irregular heartbeat
Chvostek’s sign
Tapping the facial nerve just anterior to the ear elicits twitching/spasm of all facial muscles
Trousseau’s sign
Induction of a carpal spasm by inflation of BP cuff
Low PTH levels and Low calcium levels means?
Hypoparathyroidism
The adrenal glands primary products?
Mineralcorticoids and Glucocorticoids
Main glucocorticoid?
Cortisol
What is the glucocorticoid axis?
Hypothalamus - CRH
Anterior pituitary - ACTH
Adrenal gland - Cortisol
Mineralcorticoids are controlled by?
Blood pressure/volume
Main mineralcorticoid?
Aldosterone
Autoimmune cause of adrenal insufficiency?
Addison’s Disease (autoimmune destruction of adrenal glands)
Most common cause of adrenal insufficiency?
Suppression of the axis due to exogenous (administered) glucocorticoids
Key signs of adrenal insufficiency
Glucocorticoid AND Mineralcorticoid deficiency:
- fatigue, weight loss
- low BP, salt craving
- hyperpigmentation*
Addison’s Disease physical exam sign
Hyperpigmentation in areas of increased friction
Hypercortisolism?
Cushing’s syndrome (excess glucocorticoids)
Cushing’s disease cause (ACTH dependent)?
Pituitary adenoma which produces ACTH
Most common cause of cushing’s syndrome (ACTH independent)?
Medical use of glucocorticoids
Main signs of cushing’s syndrome
Moon face
Buffalo hump
Central obesity
Easy bruising and striae
Main cause of aldosteronism (mineralcorticoid excess)?
Adrenal adenoma (Conn’s syndrome)
Main signs of aldosteronism
HTN with low potassium levels
Pheochromocytoma
Catecholamine producing tumor in the adrenal glands
Main signs of a pheochromocytoma
EPISODIC HTN, palpitations, headache, sweating
Common signs of a pituitary tumor
VISUAL LOSS (on optic nerve) Individual features based on hormone secretion
