Endocrine Conditions Flashcards by Leanda Akuoko

Who is typically affected by Cushing’s syndrome?

WOMEN

aged 20-40

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

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

MODIFIABLE- obesity

PMH- DM2, hypertension, osteoporosis

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What is the presentation of Cushing’s syndrome?

"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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What are the clinical signs of Cushing’s Syndrome?

Raised white cell count
Hypokalaemia
Metabolic alkalosis

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What are the differentials associated with Cushing’s syndrome?

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

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What investigations are performed in suspected Cushing’s Syndrome?

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

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

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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What are the treatments available for Cushing’s syndrome?

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

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Who is typically affected by type 1 diabetes?

CAUCASIANS

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Who is typically affected by type 2 diabetes?

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

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What are the causes of Type 1 diabetes?

TYPE 1A- immune mediated

TYPE 1B- idiopathic

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What are the causes of Type 2 diabetes?

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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What are the risk factors for developing diabetes?

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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What are the presenting symptoms of diabetes?

Polyuria
Lethargy
boils
pruritis vulvae
ketonuria
dehydration

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Clinical signs of diabetes?

High plasma glucose >11mmol/l

HbA1c above 48mmol/mol

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What investigations can be done to determine diabetes?

BLOODS: plasma glucose, fasting glucose, HbA1c

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What is the line of treatment for diabetes?

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

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What are the main causes of goitre?

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

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What are some of the risk factors associated with goitre?

NON-MODIFIABLE- family history

MODIFIABLE- smoking, radiation exposure, excessive iodine consumption

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Some of the clinical signs of goitre?

Thyroid movement on swallowing
Asymmetry in the neck
Regional lymphadenopathy

What differential diagnoses can be made from goitre presentation?

Hashimoto’s
Graves
Thyroid cyst

What investigations can be done in suspected goitre?

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

What is the best treatment for a goitre?

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

Who is typically affected by hyperthyroidism?

I in 2000 people annually

What is the cause of hyperthyroidism?

PMH- Graves' disease, TSH secreting pituitary adenomas | IATROGENIC- amiodarone, lithium, exogenous iodine

What are the risk factors for developing hyperthyroidism?

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

What are the symptoms and main complaints of hyperthyroidism?

``` weight loss irritability weakness and fatigue diarrhoea sweating mental illness heat intolerance loss of libido ```

What are the clinical signs associated with hyperthyroidism?

``` Palmar erythema sweaty and warm palms fine tremor tachycardia hair thinning pruritis gynaecomastia ```

What are some differential diagnoses in connection with hyperthyroidism?

Phaeochromocytoma

What investigations should be done in suspected hyperthyroidism?

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

What treatment should be given in hyperthyroidism?

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

Who is most likely to be affected by hypothyroidism?

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

What are the main causes of hypothyroidism?

Iodine deficiency | Autoimmune and iatrogenic causes

What are the causes of primary hypothyroidism?

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

What are some of the causes of secondary hypothyroidism?

Isolated TSH deficiency Hypopituitarism Hypothalamic disorders

What are the risk factors for hypothyroidism?

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

What are some of the symptoms of hypothyroidism?

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

What are the clinical signs associated with hypothyroidism?

Myxoedema Bradycardia Delayed carpel tunnel syndrome Serous cavity efffusions

What are some differential diagnoses of hypothyroidism?

Addison disease Hypopituitarism Goitre causes Thyroid lymphoma

What investigations would be carried out in suspected hypothyroidism?

BLOODS: TFTs - RAISED TSH, LOW T4, LOW T3= primary - LOW TSH, LOW T4, LOW T3= secondary (secondary school was all lows)

What is the treatment available for hypothyroidism?

Levothyroxine

Who is more likely to be affected by thyroid nodules?

WOMEN

What are the main causes of thyroid nodules?

Hashimotos Hypothyroidism Malignant tumour Thyroiditis

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

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

What are some red flags associated with thyroid nodules?

Single dominant/solitary nodule is indicative of CANCER

What are the clinical signs associated with thyroid nodules?

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

What are the differential diagnoses of thyroid nodules?

Graves Hashimotos Non/toxic goitre

What investigations should be done in suspected thyroid nodules?

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

What is the best treatment for thyroid nodules?

remove if malignant | leave if benign, asymptomatic and non-compressive!