Endocrine Conditions Flashcards
What is the pathology of type 1 diabetes?
Autoimmune destruction of the B cells in the islets of langerhans leading to insulin deficiency
At what age does type 1 DM usually present?
12
What are the symptoms of type 1 DM?
Polyuria
Polydipsia
Weight loss
How is type 1 DM diagnosed?
Symptoms plus one of:
Random venous plasma glucose concentration >11.1 mol/l
Fasting plasma glucose concentration >7
2hr plasma glucose concentration >11.1mmol/l 2hrs after a 75 anhydrous glucose in OGTT
How is type 1 DM treated?
Patient education is crucial
Insulin - different regimes
Eg - rapid acting mixed with intermediate acting before breakfast and evening meal
What are the complications of diabetes mellitus?
Microvascular - retinopathy, nephropathy, neuropathy
Macrovascular - coronary vascular disease, cerebrovascular disease, peripheral vascular disease
Hypoglycaemia
BG <4 mol/l
Tremor, sweating, irritability, dizziness, pallor
What is the pathology of diabetic ketoacidosis?
Hyperglycaemia Dehydration Ketosis Metabolic acidosis Potassium imbalance
What are the symptoms of diabetic ketoacidosis?
Polyuria Polydipsia Nausea/vomiting Abdominal pain Acetone smell to breath Altered consciousness
What investigations would be done if diabetic ketoacidosis was suspected?
Blood glucose
Venous blood gas
Blood - ketones, bicarbonate
Urinalysis for ketones too
How is diabetic ketoacidosis treated?
Weight-based fixed IV insulin infusion
Aggressive fluid replacement
Monitor K and replace if needed
Treat underlying cause
What are the complications of diabetic ketoacidosis?
Cerebral oedema
Hypoglycaemia
Hypo/hyperkalaemia
Pulmonary oedema
What is the pathology of type 2 diabetes?
Combination of insulin resistance and inadequate production (B cell destruction) / impaired secretion of insulin (B cell dysfunction)
What are the causes of type 2 diabetes?
Obesity
Cushing’s
Chronic pancreatitis
What is the average age of onset for type 2 diabetes?
50
How does type 2 diabetes present?
Can present with complications of diabetes (eg vascular problems)
Fatigue
Polyuria
Polydipsia
How is type 2 diabetes investigated?
FBC
Glucose
OGTT
HbA1c
How is type 2 diabetes treated?
Patient education
Dietary modification
Metformin - biguanide, increases insulin sensitivity, SE lactic acidosis
Then add:
Sulphonylurea - eg glimepiride, stimulates insulin release from pancreas, SE hypoglycaemia
Thiazolidinedione - eg pioglitazone, increases insulin sensitivity
DPP-4 inhibitor, SGLT inhibitor
What is the pathology of Cushing’s syndrome?
Excess cortisol
What are the causes of Cushing’s syndrome?
Exogenous - iatrogenic, steroids, alcohol
ACTH dependent - pituitary overproduction of ACTH, Cushing’s disease (pituitary adenoma)
ACTH independent - adrenal adenoma
What are the signs of Cushing’s syndrome?
Moon face Central obesity Proximal muscle wasting Easy bruising Hirsutism
What investigations would be done if Cushing’s syndrome was suspected?
24hr urinary free cortisol
Random blood cortisol
Low-dose dexamethasone suppression test - to see if ACTH can be suppressed
High dose dexamethasone suppression test - to differentiate between pituitary or ectopic secretion
How is Cushing’s syndrome treated?
Remove tumour if that’s the cause
What is the pathology of Addison’s disease?
Destruction of adrenal cortices - steroid (glucocorticoid) and aldosterone (mineralocorticoid) deficiency
Autoimmune
What are the signs of Addison’s disease?
Bronze hyperpigmentation of skin Postural hypotension Fatigue Nausea Cramps
What investigations would be done if Addison’s disease was suspected?
Short synacthen test
Hyponatraemia
How is Addison’s disease treated?
Hydrocortisone to replace steroid
Fludrocortisone to replace mineralocorticoid
What are the causes of hyperthyroidism?
Grave’s disease
Toxic multi nodular goitre
What are the features of hyperthyroidism?
Anxiety Irritability Sweating Heat intolerance Tachycardia Weight loss Fatigue Frequent loose stools
What investigation findings would hyperthyroidism give?
TSH - decreased
T3T4 - increased
Grave’s disease
Cause of hyperthyroidism
TSH receptor antibodies
Exopthalmos, pre-orbital myxoedema
How is hyperthyroidism treated?
Carbimazole
What are the causes of hypothyroidism?
Hashimoto's thyroiditis Iodine deficiency Congenital Radio-iodine Lithium
What are the signs of hypothyroidism?
Weight gain Fatigue Dry skin Fluid retention Amenorrhoea Constipation
What investigation findings would primary hypothyroidism give?
TSH - increased
T3T4 - decreased
What investigation findings would secondary hypothyroidism give?
TSH - decreased
T3T4 - decreased
Hashimoto’s thyroiditis
Cause of hypothyroidism
Anti-thyroid peroxidase antibodies (anti-TPO)
Anti-thyroglobulin antibodies
How is hypothyroidism treated?
Levothyroxine
Acromegaly
Increased growth hormone
Most common cause - pituitary adenoma
Presentation - bilateral hemianopia, coarse features
Treatment - trans-sphenoidal removal of pituitary adenoma, somatostatin
Hypercalcaemia
Bones, stones, moans and groans
Cause - bone metastases (breast, lung, prostate)
Treatment - fluid rehydration, loop diuretics
What is the cause of hyperparathyroidism?
Solitary parathyroid adenoma
Associated with MEN I and II
What is the presentation of hyperparathyroidism?
50% asymptomatic
50% - bones, stones, moans and groans
What would primary hyperparathyroidism show investigation wise?
(Cause - tumour)
PTH - high
Ca - high
What would secondary hyperparathyroidism show investigation wise?
(Cause - low vit D, CKD)
PTH - high
Ca - low/normal
How is hyperparathyroidism treated?
High fluid
Resect if significant symptoms
Phaochromocytoma
Tumour of adrenal medulla
Secretes noradrenaline and adrenaline
Signs - flushing, palpitations, sweating, headache
Investigation - 24hr urine catecholamines x 3
Treatment - alpha blocker (phenoxybenzamine)
What are the different types of thyroid cancer?
Papillary - 70%
Follicular - 20%
Medullary - 5%
Anaplastic - <5%
Diabetes insipidus
Kidney’s can’t conserve water - frequent urination, pronounced thirst
Investigation - water deprivation test
Treatment - desmopressin
Syndrome of inappropriate ADH secretion (SIADH)
ADH (vasopressin) causes water retention by increasing the permeability of the nephron
Causes - meningitis, encephalitis, tumour, SAH, TB, asthma, COPD, malignancy, drugs (antidepressants, carbamazepine, diuretics)
Treatment - fluid restriction, correct Na
Congenital adrenal hyperplasia
21-hydroxylase
