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Core Conditions > Endocrine Conditions > Flashcards

Endocrine Conditions Flashcards

1
Q

Who is typically affected by Cushing’s syndrome?

A

WOMEN

aged 20-40

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2
Q

What are the different types of Cushing’s and their causes?

A

ADRENOCORTICOTROPHIC HORMONE DEPENDENT (80%)

  • excess ACTH secreted from pituitary adenomas
  • ACTH secreted from an ecopic source e.g. small cell carcinoma, bronchial, carcinoid tumour

ADRENOCORTICOTROPHIC HORMONE INDEPENDENT (20%)

  • excess cortisol secreted from a benign adrenal adenoma
  • excess cortisol secreted from an adrenal carcinoma
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3
Q

What are the risk factors associated with Cushing’s syndrome?

A

MODIFIABLE- obesity

PMH- DM2, hypertension, osteoporosis

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4
Q

What is the presentation of Cushing’s syndrome?

A 
"LEMON ON A STICK"
Truncal obesity
Proximal muscle wasting
Buffalo hump- dorsal fat pad
facial fullness/ moon face
Menstrual abnormalities
Easy bruising
Acne, hirsutism
Reddish/purple striae on the abdomen, breast and thigh
Reduced libido
Depression
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5
Q

What are the clinical signs of Cushing’s Syndrome?

A

Raised white cell count
Hypokalaemia
Metabolic alkalosis

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6
Q

What are the differentials associated with Cushing’s syndrome?

A 
Chronic severe anxiety/depression
Excessive alcohol consumption
Obesity
Poorly controlled diabetes
HIV infection
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7
Q

What investigations are performed in suspected Cushing’s Syndrome?

A

BLOODS: FBC, U+Es
24 urinary free cortisol
Midnight cortisol levels
Dexamethasone suppressed corticotropin-releasing hormone (CRH)

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8
Q

What investigations are done to determine the cause of Cushing’s syndrome?

A

PLASMA ACTH

  • undetectable plasma ACTH with elevated serum cortisol is ACTH INDEPENDENT CUSHING’S
  • elevated plasma ACTH is ACTH DEPENDENT CUSHING’S

MRI PITUITARY
CHEST/ABDO CT scans

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9
Q

What are the treatments available for Cushing’s syndrome?

A

MEDICINE- metyrapone, ketoconazole, mitotane
SURGERY- trans-sphenoidal microsurgery for removing pituitary tumours, surgical removal of adrenocortical tumours
RADIOTHERAPY- pituitary radiotherapy

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10
Q

Who is typically affected by type 1 diabetes?

A

CAUCASIANS

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11
Q

Who is typically affected by type 2 diabetes?

A

South Asian, African, Poly, Middle eastern, native american.

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12
Q

What are the causes of Type 1 diabetes?

A

TYPE 1A- immune mediated

TYPE 1B- idiopathic

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13
Q

What are the causes of Type 2 diabetes?

A

GENETIC DEFECTS

  • beta cell function
  • insulin action

PANCRATIC DISEASES
- chronic pancreatitis, cystic fibrosis, hereditary haemochromatosis, pancreatic cancer, fibrocalculous pancreatopathy

ENDOCRINOPATHIES
- Cushing’s syndromes, acromegaly, phaeochromocytoma, glucagonoma, somatostatinoma

DRUG INDUCED
- Glucocorticoids, protease inhibitors, beta blockers,

INFECTIONS
-congenital rubella, cosackie virus, cyomegalovirus

GESTATIONAL DIABETES

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14
Q

What are the risk factors for developing diabetes?

A

NON-MODIFIABLE- ethnicity, family history
MODIFIABLE- obesity, lack of physical activity
PMH- PCOS, drug therapy (thiazide diuretic and beta blocker), impaired glucose tolerance/ fasting glucose

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15
Q

What are the presenting symptoms of diabetes?

A 
Polyuria
Lethargy
boils
pruritis vulvae
ketonuria
dehydration
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16
Q

Clinical signs of diabetes?

A

High plasma glucose >11mmol/l

HbA1c above 48mmol/mol

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17
Q

What investigations can be done to determine diabetes?

A

BLOODS: plasma glucose, fasting glucose, HbA1c

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18
Q

What is the line of treatment for diabetes?

A

Insulin injections
Metformin
DPP4 inhibitor, sulfonlurea, pioglitazone
Lifestyle advice- increase exercise and monitor diet.

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19
Q

What are the main causes of goitre?

A

PMH- Iodine deficiency, Hashimoto’s thyroiditis, Graves disease, pregnancy, menopause
IATROGENIC- lithium, amiodarone

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20
Q

What are some of the risk factors associated with goitre?

A

NON-MODIFIABLE- family history

MODIFIABLE- smoking, radiation exposure, excessive iodine consumption

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21
Q

Some of the clinical signs of goitre?

A

Thyroid movement on swallowing
Asymmetry in the neck
Regional lymphadenopathy

22
Q

What differential diagnoses can be made from goitre presentation?

A

Hashimoto’s
Graves
Thyroid cyst

23
Q

What investigations can be done in suspected goitre?

A

BLOODS: TFTs, basal plasma calcitonin, carcinoembryonic antigen
IMAGING: CT, MRI, USS
SAMPLING: Fine needle aspiration

24
Q

What is the best treatment for a goitre?

A

If caused by Hashimoto’s, levothyroxine should be administered.

25
Q

Who is typically affected by hyperthyroidism?

A

I in 2000 people annually

26
Q

What is the cause of hyperthyroidism?

A

PMH- Graves’ disease, TSH secreting pituitary adenomas

IATROGENIC- amiodarone, lithium, exogenous iodine

27
Q

What are the risk factors for developing hyperthyroidism?

A

NON-MODIFIABLE- family history
MODIFIABLE- smoking, excessive iodine consumption
PMH- trauma to the thyroid gland, toxic mulitinodular goitre, highly active antiretroviral therapy (HAART)

28
Q

What are the symptoms and main complaints of hyperthyroidism?

A 
weight loss
irritability
weakness and fatigue
diarrhoea
sweating
mental illness
heat intolerance
loss of libido
29
Q

What are the clinical signs associated with hyperthyroidism?

A 
Palmar erythema
sweaty and warm palms
fine tremor
tachycardia
hair thinning
pruritis
gynaecomastia
30
Q

What are some differential diagnoses in connection with hyperthyroidism?

A

Phaeochromocytoma

31
Q

What investigations should be done in suspected hyperthyroidism?

A

BLOODS: TFTs, autoantibodies, CRP, ESR
IMAGING: USS

32
Q

What treatment should be given in hyperthyroidism?

A

Thionamides (carbimazole, propylthiouracil)
Radioiodine
Subtotal/near total thyroidectomy

33
Q

Who is most likely to be affected by hypothyroidism?

A

Increasing age
Most common in those aged 60
Most common in WOMEN

34
Q

What are the main causes of hypothyroidism?

A

Iodine deficiency

Autoimmune and iatrogenic causes

35
Q

What are the causes of primary hypothyroidism?

A 
Hashimoto's
Radioiodine treatment, surgery and radiotherapy
Amiodarone and lithium
Congenital defects
Infiltration of the thyroid
36
Q

What are some of the causes of secondary hypothyroidism?

A

Isolated TSH deficiency
Hypopituitarism
Hypothalamic disorders

37
Q

What are the risk factors for hypothyroidism?

A

Autoimmune disease (Diabetes type 1, rheumatoid arthritis)
Family histoy
Gender- female.

38
Q

What are some of the symptoms of hypothyroidism?

A 
Fatigue and lethargy
cold intolerance
dry skin, hair loss
slowing of intellectual activity
constipation
deep hoarse voice
reduced libido
39
Q

What are the clinical signs associated with hypothyroidism?

A

Myxoedema
Bradycardia
Delayed carpel tunnel syndrome
Serous cavity efffusions

40
Q

What are some differential diagnoses of hypothyroidism?

A

Addison disease
Hypopituitarism
Goitre causes
Thyroid lymphoma

41
Q

What investigations would be carried out in suspected hypothyroidism?

A

BLOODS: TFTs

  • RAISED TSH, LOW T4, LOW T3= primary
  • LOW TSH, LOW T4, LOW T3= secondary

(secondary school was all lows)

42
Q

What is the treatment available for hypothyroidism?

A

Levothyroxine

43
Q

Who is more likely to be affected by thyroid nodules?

A

WOMEN

44
Q

What are the main causes of thyroid nodules?

A

Hashimotos
Hypothyroidism
Malignant tumour
Thyroiditis

45
Q

What are some of the risk factors associated with thyroid nodules?

A

NON-MODIFIABLE- family history
MODIFIABLE- radiation exposure
PMH- trauma to thyroid gland, pre-existing thyroid condition

46
Q

What are some red flags associated with thyroid nodules?

A

Single dominant/solitary nodule is indicative of CANCER

47
Q

What are the clinical signs associated with thyroid nodules?

A

Thyroid movement on swallowing
Enlargement/asymmetry of the neck
Regional lymphadenopathy

48
Q

What are the differential diagnoses of thyroid nodules?

A

Graves
Hashimotos
Non/toxic goitre

49
Q

What investigations should be done in suspected thyroid nodules?

A

BLOODS: TFTs
IMAGING: USS, CT, MRI, radionuclide isotope scanning
SAMPLING: fine needle aspiration

50
Q

What is the best treatment for thyroid nodules?

A

remove if malignant

leave if benign, asymptomatic and non-compressive!

Core Conditions (11 decks)

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