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1st/2nd Year Revision > Endocrine Conditions > Flashcards

Endocrine Conditions Flashcards

1
Q

What is the pathology of type 1 diabetes?

A

Autoimmune destruction of the B cells in the islets of langerhans leading to insulin deficiency

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2
Q

At what age does type 1 DM usually present?

A

12

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3
Q

What are the symptoms of type 1 DM?

A

Polyuria
Polydipsia
Weight loss

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4
Q

How is type 1 DM diagnosed?

A

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

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5
Q

How is type 1 DM treated?

A

Patient education is crucial
Insulin - different regimes
Eg - rapid acting mixed with intermediate acting before breakfast and evening meal

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6
Q

What are the complications of diabetes mellitus?

A

Microvascular - retinopathy, nephropathy, neuropathy

Macrovascular - coronary vascular disease, cerebrovascular disease, peripheral vascular disease

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7
Q

Hypoglycaemia

A

BG <4 mol/l

Tremor, sweating, irritability, dizziness, pallor

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8
Q

What is the pathology of diabetic ketoacidosis?

A 
Hyperglycaemia
Dehydration
Ketosis
Metabolic acidosis
Potassium imbalance
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9
Q

What are the symptoms of diabetic ketoacidosis?

A 
Polyuria
Polydipsia
Nausea/vomiting
Abdominal pain
Acetone smell to breath
Altered consciousness
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10
Q

What investigations would be done if diabetic ketoacidosis was suspected?

A

Blood glucose
Venous blood gas
Blood - ketones, bicarbonate
Urinalysis for ketones too

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11
Q

How is diabetic ketoacidosis treated?

A

Weight-based fixed IV insulin infusion
Aggressive fluid replacement
Monitor K and replace if needed
Treat underlying cause

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12
Q

What are the complications of diabetic ketoacidosis?

A

Cerebral oedema
Hypoglycaemia
Hypo/hyperkalaemia
Pulmonary oedema

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13
Q

What is the pathology of type 2 diabetes?

A

Combination of insulin resistance and inadequate production (B cell destruction) / impaired secretion of insulin (B cell dysfunction)

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14
Q

What are the causes of type 2 diabetes?

A

Obesity
Cushing’s
Chronic pancreatitis

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15
Q

What is the average age of onset for type 2 diabetes?

A

50

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16
Q

How does type 2 diabetes present?

A

Can present with complications of diabetes (eg vascular problems)
Fatigue
Polyuria
Polydipsia

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17
Q

How is type 2 diabetes investigated?

A

FBC
Glucose
OGTT
HbA1c

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18
Q

How is type 2 diabetes treated?

A

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

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19
Q

What is the pathology of Cushing’s syndrome?

A

Excess cortisol

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20
Q

What are the causes of Cushing’s syndrome?

A

Exogenous - iatrogenic, steroids, alcohol
ACTH dependent - pituitary overproduction of ACTH, Cushing’s disease (pituitary adenoma)
ACTH independent - adrenal adenoma

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21
Q

What are the signs of Cushing’s syndrome?

A 
Moon face
Central obesity
Proximal muscle wasting
Easy bruising
Hirsutism
22
Q

What investigations would be done if Cushing’s syndrome was suspected?

A

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

23
Q

How is Cushing’s syndrome treated?

A

Remove tumour if that’s the cause

24
Q

What is the pathology of Addison’s disease?

A

Destruction of adrenal cortices - steroid (glucocorticoid) and aldosterone (mineralocorticoid) deficiency
Autoimmune

25
Q

What are the signs of Addison’s disease?

A 
Bronze hyperpigmentation of skin
Postural hypotension
Fatigue
Nausea
Cramps
26
Q

What investigations would be done if Addison’s disease was suspected?

A

Short synacthen test

Hyponatraemia

27
Q

How is Addison’s disease treated?

A

Hydrocortisone to replace steroid

Fludrocortisone to replace mineralocorticoid

28
Q

What are the causes of hyperthyroidism?

A

Grave’s disease

Toxic multi nodular goitre

29
Q

What are the features of hyperthyroidism?

A 
Anxiety
Irritability
Sweating
Heat intolerance
Tachycardia
Weight loss
Fatigue
Frequent loose stools
30
Q

What investigation findings would hyperthyroidism give?

A

TSH - decreased

T3T4 - increased

31
Q

Grave’s disease

A

Cause of hyperthyroidism
TSH receptor antibodies
Exopthalmos, pre-orbital myxoedema

32
Q

How is hyperthyroidism treated?

A

Carbimazole

33
Q

What are the causes of hypothyroidism?

A 
Hashimoto's thyroiditis
Iodine deficiency
Congenital
Radio-iodine
Lithium
34
Q

What are the signs of hypothyroidism?

A 
Weight gain
Fatigue
Dry skin
Fluid retention
Amenorrhoea
Constipation
35
Q

What investigation findings would primary hypothyroidism give?

A

TSH - increased

T3T4 - decreased

36
Q

What investigation findings would secondary hypothyroidism give?

A

TSH - decreased

T3T4 - decreased

37
Q

Hashimoto’s thyroiditis

A

Cause of hypothyroidism
Anti-thyroid peroxidase antibodies (anti-TPO)
Anti-thyroglobulin antibodies

38
Q

How is hypothyroidism treated?

A

Levothyroxine

39
Q

Acromegaly

A

Increased growth hormone
Most common cause - pituitary adenoma
Presentation - bilateral hemianopia, coarse features
Treatment - trans-sphenoidal removal of pituitary adenoma, somatostatin

40
Q

Hypercalcaemia

A

Bones, stones, moans and groans
Cause - bone metastases (breast, lung, prostate)
Treatment - fluid rehydration, loop diuretics

41
Q

What is the cause of hyperparathyroidism?

A

Solitary parathyroid adenoma

Associated with MEN I and II

42
Q

What is the presentation of hyperparathyroidism?

A

50% asymptomatic

50% - bones, stones, moans and groans

43
Q

What would primary hyperparathyroidism show investigation wise?

A

(Cause - tumour)
PTH - high
Ca - high

44
Q

What would secondary hyperparathyroidism show investigation wise?

A

(Cause - low vit D, CKD)
PTH - high
Ca - low/normal

45
Q

How is hyperparathyroidism treated?

A

High fluid

Resect if significant symptoms

46
Q

Phaochromocytoma

A

Tumour of adrenal medulla
Secretes noradrenaline and adrenaline
Signs - flushing, palpitations, sweating, headache
Investigation - 24hr urine catecholamines x 3
Treatment - alpha blocker (phenoxybenzamine)

47
Q

What are the different types of thyroid cancer?

A

Papillary - 70%
Follicular - 20%
Medullary - 5%
Anaplastic - <5%

48
Q

Diabetes insipidus

A

Kidney’s can’t conserve water - frequent urination, pronounced thirst
Investigation - water deprivation test
Treatment - desmopressin

49
Q

Syndrome of inappropriate ADH secretion (SIADH)

A

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

50
Q

Congenital adrenal hyperplasia

A

21-hydroxylase

1st/2nd Year Revision (15 decks)

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