Endocrine Conditions(FCM) Flashcards
What is the most common cause of Addisons disease? (primary adrenal insufficiency)
Destruction of the adrenal glands.
It can also be due to atrophy of the adrenal glands
What is Addisons disease and how might a patient present?
Addisons is a rare conditions caused by the destruction/ atrophy of the adrenal glands.
It is characterised by low cortisol levels but high levels of Adrenocorticotropic Hormone (ACTH) being produced by the pituitary gland.
Patients may present with:
- lethargy
- weakness
- hyponatraemia
- hyperkalaemia
- hyperpigmentation (on exam look for palmar creases)
- hypotension
- hypoglycaemia
How do you treat Addisons disease ? and what would you do in addisonian crisis?
Replace sterioids
(IV or IM hydrocortisone BD)
Crisis-
Immediate admission. treat with IV hydrocortisone 100mg.
Explain Type 2 diabetes
This is caused by insulin resistance as a result of increased adipose tissue in the blood.
it is characterised by persistent hyperglycaemia of random plasma glucose of >11.1 mmol/L
What are the main symptoms of T2DM?
- Polydipsia
- Polyuria
- Unexplained weight loss
- Recurrent infections
- Tiredness
- on examination: acanthosis nigricans
How do you manage T2DM?
- MEDICATION
(Standard release Metformin 500mg OD with breakfast to be increased each week.
Then if needed……. 500mg BD morning and evening meal for 1/52 then 500mg TDS with meals. MAXIMUM 2g per day.
Also advise the prescriptions are free)
CONTRAINDICATIONS:
- renal dysfunction
- acute metabolic acidosis
DESMOND
(Diabetes education program. Must offer around the time of diagnosis)
- PROVIDE RESOURCES
(Diabetes UK) - LIFESTYLE MEASURES
(Diet, exercise, weight loss, offer vaccination against influenza and pneumococcus
- Encourage high fibre, low dairy, oily fish, veg and whole-grains. Have carbs before alcohol)
- MONITORING
( HbA1c should be monitored every 3-6 months until stable on medication then every 6 months)
What is volume depletion (1A) and what is the main cause of it?
The reduction in extracellular fluid that occurs when salt and fluid losses exceed intake
Main causes:
- Haemorrhage
- Vomiting
- Diarrhoea
- Diuresis
- Third space sequestration (when IV fluid shifts out the circulation and into the blood and spaces between the organs and tissues)
How would you manage volume depletion (1A)
- Fluid resuscitation
500ml crystalloid (Hartmann's) bolus over 15 mins or 250ml If older or the ptx has HF.
Reassess then give up to 2L max before seeking senior advice
BUT!
Don’t wait until SBP is <90 especially if the patient is tachycardic.
Symptoms of Hypercalcaemia?
Bones, stones, thrones, groans and (psychiatric) moans
- Bone pain, myalgia
- kidney stones
- Constipation, polyuria, dehydration, N+V
- Abdominal pain
- Anxiety, depression, memory loss, poor sleep, unsteady gait
Management of Hypercalcaemia?
IF ACUTE:
- IV Saline 4-6L in 24hrs
- IV Bisphosphonates if rehydration fails
IF CHRONIC
- treat the long term cause
Causes of Hypercalcaemia?
*** Most common cause is primary hyperparathyroidism
- Addisons
- Thyrotoxicosis
- Vitamin D excess
- Sarcoidosis
- TB
- Drugs (Thiazides, lithium)
remember to check PTH levels (for hyperparathyroidism)
Management for hypocalcaemia?
ACUTE:
- 10ml of 10% IV calcium gluconate over 10 minutes followed by slow infusion
- Monitor ca2+ twice daily
CHRONIC:
- calcium +Vitamin D (adcal) chewy tablets OD
What is diabetes insipidus?
An endocrine condition which caused by either an abnormal quantity (cranial cause) or response (nephrogenic cause) to ADH.
How is Cranial and nephrogenic Diabetes insipidus managed?
Cranial:
- Desmopressin
- Sodium needs to be monitored due to risk of hyponatraemia
Nephrogenic:
- Correct any electrolyte abnormality
- High dose desmopressin or Thiazide like diuretics or NSAID’s
Symptoms of Diabetes insipidus ? (5 things)
- Large volumes of dilute urine (>3 litres in 24hrs)
- Low urine osmolality <300mOsmol/kg
- High serum osmolality >300mOsmol/kg
- Nocturia
- Excessive thirst
What is a prolactinoma ?
A benign adenoma in the pituitary gland, that causes the pituitary gland to secrete excess prolactin.
Causes of diabetes insipidus? (both Cranial - 4 things and nephrogenic - 3 things)
Cranial:
- Head trauma
- Inflammatory conditions e.g sarcoidosis
- Cranial infection e.g meningitis
- Vascular conditions e.g sickle cell
Nephrogenic:
- Drugs e.g lithium
- Electrolyte imbalances
- Chronic renal disease
What causes primary and secondary hypothyroidism ?
Primary:
- Thyroid insufficiency.
- TSH will be high but T3+T4 will be low
Secondary:
- Pituitary problem.
- Both TSH, T3+T4 will be low
How do you treat hyperkalaemia?
You need to consider the cause and severity of the hyperkalaemia
- Stop drugs responsible
- IV insulin - to get K+ into cells +can use salbutamol nebs
- Remove K+ from the blood using furosemide or if severe renal impairment then dialysis
Characteristics of addisonian crisis?
- Hypotension
- Hypoglycaemia
- Hyperkalaemia
Most common cause of diabetes insipidus?
Lithium
