Endocrine Conditions Flashcards
What is the difference between primary and secondary thyroid disorders?
Primary - due to damage/disease of the thyroid
Secondary - due to damage/disease of the hypothalamus or pituitary
What is hypothyroidism?
Thyroid gland doe not produce enough thyroxine
What are the causes of hypothyroidism?
- Autoimmune (atrophic or Hashimoto’s thyroiditis=lymphocyte infiltration)
- Iodine deficiency
- post-thyroidectomy
- thyroiditis
What are the symptoms of hypothyroidism?
- tiredness/lethargy
- weight gain
- depressed mood
- constipations
- weakness
- cold intolerance
What are the signs of hypothyroidism?
- Bradycardia
- slow relaxing reflexes
- ataxia (lack of voluntary control of muscle movements)
- dry skin
- yawning
- cold hands
- ascites
- round puffy face
- poor movement
- goitre
What is the treatment for hypothyroidism?
Levoxythyroxine.
-check and monitor levels
What is hyperthyroidism?
Overactive thyroid gland produces too much T4
What are the causes of hyperthyroidism?
- Grave’s disease (IgG antibodies bind to TSH receptors on thyroid gland)
- toxic multi/solitary nodular goitre
- ectopic thyroid tissue
What are the symptoms of hyperthyroidism?
- weight loss
- sweating
- diarrhoea
- increase appetite
- heat intolerance
- malaise
- tremor
- overactive
- irritability
- stiffness
What are the signs of hyperthyroidism?
- tachycardia
- tremor
- hyperkinesia
- warm vasodilated peripheries
- goitre
- fast/irregular pulse
What must you do before treatment?
Must get biochemical confirmation before treatment
- raised T4/3
- suppressed TSH (usually)
- IgG antibodies to TSH if Grave’s disease
How is hyperthyroidism treated?
- anti-thyroid drugs (carbimazole)
- radioactive iodine
- thyroidectomy
What are the complication of hyperthyroidism?
- angina
- heart failure
What is goitre?
Swelling in the neck due to enlarged thyroid gland
What are the causes of goitre?
- simple
- autoimmune
- thyroiditis
- nodular
What is acromegaly?
Excessive growth hormone secretion from the pituitary gland
What are the causes of acromegaly?
- tumour
- ectopic GH-releasing hormone
What are the symptoms of acromegaly?
- increased ring and hat size
- large tongue
- increased sweating
- loss of libido
- weight gain
- tiredness
- headaches
What are the signs of acromegaly?
- prognathism (jaw protudes forward)
- interdental seperation
- thick greasy skin
How is acromegaly diagnosed?
- glucose tolerance test (GH not decrease despite high glucose)
- IGF-1 levels (raised)
How is acromegaly treated?
- transphenoidal surgery to remove the pituitary tumour
- somatostatin analogues (somatostatin inhibits GH secretion)
- GH receptor antagonist
- radiotherapy
- dopamine agonists
What are the complications of acromegaly?
- impaired glucose tolerance (DM in 15%)
- increased blood pressure
- LV hypertrophy
- cardiomyopathy
- arrhythmias
- neoplasia
What is Addison’s disease?
Primary hypoadrenalism. The adrenal cortex does not produce enough mineralcortcoid, glucocorticoid or sexsteroid
What are the causes of Addison’s disease?
- autoimmune (80%)
- TB
- adrenal metastases
- lymphoma
- adrenal haemorrhage
What are the symptoms of Addison’s disease?
- tiredness
- weight loss
- fever
- malaise
- weakness
- anoerexia
- abdominal pain
- nausea/vomitting
What are the signs of Addison’s disease?
- skin pigmentation
- postural hypotension
- dehydration
- loss of body hair
How is Addison’s disease diagnosed?
- low Na and high K (due to lack of aldosterone)
- low glucose (due to lack of cortisol)
- ACTH stimulation test (cortisol not increase after giving ACTH)
What does SIADH stand for and what is this condition?
Syndrome of inappropriate Antidiuretic hormone secretion. Inappropriate secretion of ADH causes water retention and hyponatraemia.
What are the causes of SIADH?
- tumours
- meningitis
- head trauma
- alcohol withdrawal
- drugs
- subarachnoid haemorrhage
What are the signs of SIADH?
- evolaemic state (normal blood volume)
- concentrated urine
- hyponatraemia
- normal renal, kidney, thyroid function
What are the symptoms of SIADH?
- confusion
- nausea
- irritability
- fits
- coma
How is SIADH managed?
- restrict fluid intake to 500-1000ml
- measure osmolarity of blood
- demeclocycline (block binding of ADH to receptors of kidney tubules)
What is hypercalcaemia of malignancy?
Tumour secretes substances which cause hypercalcaemia
What substance are secreted from tumours which cause hypercalcaemia?
- PTH-related peptide (most common)
- PTH
- 1,25-dihydroxyvitamin D
What are the symptoms of hypercalcaemia of malignancy?
- tiredness
- malaise
- dehydration
- abdominal pain (due to renal stones)
- hypertension (Ca causes vasoconstriction)
- pain pain/fractures (due to bone resorption)
How is hypercalcaemia of malignancy managed?
- treat malignancy
- rehydration
- glucocorticosteroids (inhibit osteoclast resorption)
What is hypokalaemia?
Low serum potassium
What are the causes of hypokalaemia?
- diuretics
- hyperaldosteronism
- chronic kidney disease
- reduce K intake
- vomitting and diarrhoea
What are the symptoms of hypokalaemia?
- asymptomatic
- muscle weakness
- atrial/ventricular ectopic beats
How is hypokalaemia managed?
- treat underlying cause
- withdraw diuretics
- potassium supplements
What is a neuroendocrine pancreatic tumour?
Tumour arising from the cells of the islets of Langerhans.
Maybe be hormone secreting or non-functional
What are the symtoms of neuroendocrine pancreatic tumours?
- abdominal pain
- jaundice (if obstructive)
- depends on hormone secreted
What are the 4 type of secretory neuroendocrine tumours and their effects?
- insulinoma -> low glucose
- glucagonoma -> high glucose
- gastrinoma -> inc gastric activity
- somatostatinoma -> dec gastric activity
How are neuroendocrine tumours managed?
- CT or MRI
- biochemical tests for hormones
- surgical excision
- chemotherapy
- antagonists for hormones
What is hyperkalaemia?
High serum potassium
What are the causes of hyperkalaemia?
- decreased excretion (CKD, drugs, acidosis, hypoaldosteronism)
- increased release from cells (acidosis, vigorous exercise)
- increased intake (salt, blood transfusion)
What are the symptoms of hyperkalaemia?
- cardiac arrest
- muscle weakness
- hypotension
- bradycardia
How is hyperkalaemia managed?
- treat the cause
- supraphysiologcical insulin (drive K into cells)
- ion exchange resins
- monitor levels
What is hypocalcaemia?
low calcium plasma levels
What are the causes of hypocalcaemia?
- increased phosphate levels
- hypoparathyroidism
- vitamin D deficiency
- drugs
What are the symptoms of hypocalcaemia?
- spasm or twitch
- paraesthesia (pins and needles)
- numbness
- cramps
- tetany (intermittent muscle spasms
- convulsions
What are the signs of hypocalcaemia?
- prolonged QT interval
- Chvostek’s sign (gentle tapping over facial nerve causes facial spasm in the same side)
- Trousseau’s sign (inflation of blood pressure cuff causes spasms of hand and wrist)
- papiloedema (swelling of optic disc due to increase intercranial pressure)
How is hypocalcaemia diagnosed?
- low serum calcium
- clinical history
How is hypocalcaemia managed?
- if vitamin D deficient: give colecalciferol or hydroxylated vitamin D
- oral calcium supplements
- if PTH deficient: PTH replacement
What is hyperparathyroidism?
Excessive amount of PTH is secreted from the parathyroid gland.
What are the causes of primary hyperparathyroidism?
Due to disease of the parathyroid gland
- adenoma
- carcinoma
- hyperplasia
What is the cause of secondary hyperparathyroidism?
Decrease in plasma Ca causes an APPROPRIATE increase in PTH
- Vit D deficient
- CKD
What is the cause of tertiary hyperparathyroidism?
Increase in plasma Ca causes an INAPPROPRIATE increase in PTH
-prolonged secondary hyperparathyroidism
What are the symptoms of hyperparthyroidism?
- asymptomatic
- weak
- tired
- depressed
- abdominal pain (due to renal stones)
- bone pain/fractures (due to osteopoenia)
What are the signs of hyperparathyroidism?
- increased plasma Ca
- increased bone resorptions
- hypertension
How is hyperparathyroidism managed?
- PTH, Ca blood tests
- bone scan
- increase fluid intake
- avoid a high Ca and vitamin D diet
- surgical excision of adenoma
- surgical excision of hyperplastic glands
What is diabetes insipidus?
Vasopressinn deficiency or insensitivity which leads to excess excretion of dilute urine with a compensatory thirst
What are the symptoms of diabetes insipidus?
- polyuria
- polydypsia
- dehydration
- hypernatraemia symptoms (lethargy, thirst, weakness, irritability, confusion)
What are the signs of diabetes insipidus?
- high plasma osmolarity
- low urine osmolarity
What are the causes of diabetes insipidus?
Cranial -idiopathic -congenital defects -pituitary tumour -pituitary trauma -auto-immune -pituitary infection Nephrogenic -inherited -drugs (renal damage) -chronic kidney disease
How is diabetes insipidus diagnosed?
8hr water deprivation test
- dilute urine despite dehydration <600 mOsmol/kg
- if urine osmolarity increases when desmopressin is given - cause is cranial
How is diabetes insipidus treated?
Cranial -MRI -desmopressin -test pituitray function Nephrogenic -treat cause of CKD -thiazide diuretics (dec rate of blood filtration by kidneys)
What is primary hyperaldosteronism also called?
Conn’s syndrome
What is primary hyperaldosteronism?
increased mineralcorticoid secretion from the zone glomerulosa of the adrenal gland
What does hyperaldosteronism result in?
- hypertension
- potassium loss (aldosterone inc K secretion)
- sodium retention (aldosterone inc Na reabsorption)
What are the causes of primary hyperaldosteronism?
- adrenal adenoma
- bilateral adrenocortical hyperplasia
- adrenal acrcinoma
What are the symptoms of primary hyperaldosteronism?
- asymptomatic
- muscle weakness
- polyuria
- polydypsia
- cramps
- paraesthesia
- hypertension
How is primary hyperaldosteronism managed?
- laparascopic adrenalectomy
- spironolactone and amiloride (K sparing diuretic - aldosterone antagonist)
- ca channel blockes
What are the complications of primary hyperaldosteronism?
-retinal damage
-cardiac damage
due to hypertension
What is secondary hyperaldosteronism?
High aldosterone secretion due to high renin secretion from kidneys
What is cushing’s syndrome?
increased glucocorticosteroid in the blood and loss of feedback mechanisms
What is cushing’s disease?
increased glucocorticosteroid production due to increased ACTH from a pituitary adenoma
What are the causes of cushings sydrome?
- pituitary adenoma producing ACTH (cushing’s disease)
- ectopic ACTH production
- corticosteroid medication
- adrenal adenoma/cancer
- adrenal nodular hyperplasia
What are the symptoms of Cushing’s syndrome?
- moon face (redder rounder face)
- purple striae
- weight gain
- hair growth
- acne
What are the signs of Cushing’s syndrome?
- bufalo hump
- hypertension
- proximal myopathy
- moon face
- easy bruising
- central obesity
How is Cushing’s syndrome diagnosed?
- 48hr low dose dexamethasone test (not dec cortisol levels in CS due to loss of negative feedback)
- urine cortisol
- blood cortisol
- high dose dexamethasone test (indicate CD)
How is cushing’s syndrome treated?
- stop corticosteroid medication
- adrenalectomy
- surgical removal of tumour
- metyrapone (inhibits cortisol production)
- radiation treatment of tumour
What is diabetes mellitus?
lack of or reduced sensitivity to endogenous insulin resulting in hyperglycaemia
What is Type 1 Diabetes Melitus?
severe insulin deficiency, usually auto-immune mediated
What causes T1 DM?
- auto-immune destruction of beta cells
- environmental influence
- linked to HLA-DR3 and HLA-DR4
What is the clinical presentation of T1 DM?
- polydipsia (excessive drinking)
- polyuria (excessive urination)
- weight loss
- ketoacidosis
What is T2 DM?
increased insulin resistance and decrease secretion due to lifestyle
What are the risk factors of T2 DM?
- obesity
- lack of exercise
- calorie excess
- alcohol excess
- low birthweight
Does T2 DM have genetic susceptibility?
Yes, polygenic links.
80% concordance with identical twins
No major HLA association
What is impaired glucose tolernace (IGT)?
raised blood glucose levels but not high enough to be classed as DM (7.8mmol/L - 11.1mmol/L)
What is impaired fasting glucose (IFT)?
raised blood glucose when fasting (6.1mmol/L-7mmol/L)
How is DM diagnosed?
- symptoms of hyperglycaemia (polyuria, polydypsia, weight loss, visual blurring)
- raised venous glucose (fasting >7mmol/L normal>11.1mmol/L)
- HbAlc
What is the clinical presentation of DM?
- polyuria
- polydypsia
- weight loss
- lack of energy
- visual blurring
- pruritus vulva (due to infection)
What are the complications of DM?
- retinopathy
- cataracts
- polyneuropathy
- erectile dysfunction
- staphylococcus skin infection
- atherosclerosis (inc risk of MI and stroke)
- diabetic foot (dec sensation, ischaemia, infection)
What is diabetic foot?
- decreased sensation
- ischaemia causing ulceration/gangrene
- infection
How is diabetic foot managed?
- regular chiropody
- rest
- appropriate footwear
- amputation
What lifestyle changes are involved in the management of DM?
- low sugar and saturated fats
- high fibre and starchy carbs
- increased exercise
What medications are used to managed DM?
- metformin (first line use to dec blood glucose)
- suphonylureas and meglitinides (inc insulin secretion)
- thiazolidinediones (dec insulin resistance)
- insulin
What does insulin based therapy involve in DM management?
- educate patients of lifestyle changes
- plan to fit lifestyle
- insulin pumps - continuous subcutaneous insulin
- long acting recombinant insulin analogues
- long acting isophane (NICE recommended)
- ultra fast acting
