endocrine core conditions Flashcards
what is diabetes? how does it differ in type 1 and type 2?
lack or reduced efficacy of endogenous insulin
in type 1 this is a result of beta cell destruction in the islet of langerhan cells causing reduced insulin production usually autoimmune
type 2 diabetes it is a result of increase insulin resistance / beta cell dysfunction and thus reduces insulin secretion
risk factors for type 1 and 2 and who it affects
type 1 - usually In infancy, HLA D3 and D4 association been found and high concordance rates in fraternal and identical twins. 10% increase risk if family member posses it.. can be seen in adults, latent type 1 (1.5)
type 2- usually in adult hood (40 +) but seen increasingly these days in teens, Asians, elderly and men are more at risk
associated with alcohol intake, poor diet, obesity
other causes
cushing syndrome
steroids/ anti hiv drugs
pancreatitis
symptoms
polyuria tiredness polydyupsia - excess thirst weight loss hypoglycaemia increased incidence of vaginal thrush
what diagnostic tests can be done
HB1AC
glucose monitoring plasma - over 11 mmol/L or 7mmol/L if fasting
urine dipstick
what is the oral glucose tolerance test
patient fasts over night, given 75mg of glucose in 300ml of water In morning.
measure blood glucose before and 2 hr after test
if 11.1mol/L or more after 2 hr, significant
management
type 1 - insulin twice daily
type 2 - lifestyle factors changes-diet controlled
or medications needed
metformin (bugiainde) increase insulin sensitivity - NO HYPO possible
gitazine -pioglitazone - increase sensitivity
sulfonylureas -gluclazide - increased insulin sensitivity
others- glucagon like peptide analogues, sulfonylureas receptor binders- increase insulin release
other factors to consider
monitoring eye, neuro changes, kidney function, ulcers
cataracts
MI stroke risk
what is hyperthyroidism?
hyperthyroidism is the excess of thyroid hormone produced.
how common is hyperthyroidism?
0.75% of the population
but increases amongst older women
10x more common in females over males
common in countries with high idione deficency such as Denmark
what can cause it?
risk factors
graves disease - most common cause toxic nodular goitre solitary thyroid nodule thyroiditis drugs- lithium, nsaids, amidorone autoimmune disease increased thyroid intake RF-smoking, femle, FH, smoker, Diabetes type 1
presentation
weight loss heat intolerance sweating increased apettite diarrheea oligomenorrhoea infertility irritability palpitations/tachycardia lethargy difficult concentrating tremor eye buldging pretibal myxodema lid lag lid retraction loss of libido gynaecomastica proximal myopathy brisk reflex
what can be seen in thyroid crisis
insomnia
marked fever, tachycardia, palpitations sweating
vomiting
diarrhoea
investigations
TFT idione radioactive scan USS of thyroid autoimmune antibodies CRP ESR raised
treatment
treatment is carbimazole 20mg BD
radioidione
thyroidectomy
beta blockers- for tachycardia
which other AI seen with it?
type 1 diabetes
what would be seen on tft?
primary t3/t4 elevated, tsh low
secondary both TSH and T3/T4 elevated this is rare
what is subclinical hyperthyroidism?
normal t3/t4
low TSH
only treat if symptomatic
monitor
what is hypothyroidism?
who does it affect
it is a lack of thyroid hormone affect 2% of population 6x more common in women usually 40 plus can be seen in infancy and is the most common paed thyroid problem. if not treated can lead to intellectual impairment
presentation?
menorrhagia -heavy periods cold intolerance dry brittle hair weight gain fatigue lethargy increase appetite constipation hoarse voice reduce memory myalgia dementia cramps LOW MOOD reduced/slowed relfxes, ataxia, thin dry skin cold hands odema ascites/pitting odema puffy face neuropathy
diagnosis
TFT
Scan -USS
cholesterol triglyceride- elevated
what would TFT test show?
primary -low T3/T4 elevated TSH
secondary both TSH and t3/t4 low (TSH may be normal)
causes
reduced intake
hashimoto disease
primary atrophic hypothyroidism -atrophy caused be diffuse lumphoctic infilteration
commonly seen with diabetes, addisons as well
drugs- lithium, amidorone
