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
associations
turner syndrome,
downs syndrome
pendred syndrome
CF
things to consider in pregnancy
prematurity risk increased, low birth weight, still birth risk increases, anaemia, eclampsia
management
levothyroxine 50-100ugram daily
what is the prognosis like?
excellent but if left untreated can cause dementia and heart disease
what is a goitre?
swelling of the thyroid gland
what can occur when it is symptomatic?
coughing dysphagia difficulty bbreathing hoareness tight feeling in throat
diagnosis
examination
USS
TFTs
treatment
depending on cause
radioidone
surgery
how many can be due to cancer
1 in 20
causes
thyroid cancer hyper and hypothyroidism thyroiditis drugs- lithium inadequate idione hormone changes in pregnancy RADIOTHERAPY
Whaht are the two types
diffuse- smooth all over
nodular- fluid filled cysts/lumpy like
how does this differ from a thyroid nodule
a thyroid nodule is usually a small fluidfilled sac/solidary mass in the neck usually noticed asesthetically
caused by same causes but also overgrowth of thyroid tissue, multiple nodular goitre
test with FNA/USS, Tft
DDx
dermatoid cyst lymphoma lymphadenopathy malignant tumour haemangioma
what is addisons disease
it is adrenal insufficiency resulting in a lack of cortisol and aldosterone
how many people in uk affected
who does it affect and what age
8,400 people in the UK
ffemmales
30-50 years of age
early signs then symptoms -severe
depression
flu like
low mood weight loss loss of apetite muscle weakness fatigue fainting cramps dizziness
the three Ts
tanned tearful and tired
cause
80% autotimmune in UK most common cause worldwide is TB can be caused by opportunist infections such as HIV lymphomas SLE waterhouse freiserichsen syndrome adrenal mets
treatment
15-25mg of hydrocortisone
staggered out over morning and afternoon
avoid at night as can cause insomnia
severe smyptoms can lead to
adrenal crisis a medical emergency
what can be seen on bloods
drop in glucose and sodium increase in pottasiumn eseophilia ca 2 drop and anaema ccan do ACTH TEST
which autoantibodies
21 hydroxylase adrenal antibodies
what is cushing syndrome?
the over production of cortisol
what can cause it?
tumour of adrenal gland
tumour in pituitary gland
steroid use
alcohol
symptoms
fat stored on tummy, back, shoulders with slim arms and legs
purple stretch marks
easy bruising huriritism irritability anxiety increase urinary high bp diabetes low libido MOON FACE plethora hyperpigmentation frontal balding
diagnosis
blood and urine for cortisol
ct scan
dethamexsone suppression test
treatment
surgery
radiotherapy
reduce dose of or stop steroid
difference between cushing syndrome and disease
Cushing disease is caused by a pituitary gland tumor (usually benign) that over-secretes the hormone ACTH, thus overstimulating the adrenal glands’ cortisol production. Cushing syndrome refers to the signs and symptoms associated with excess cortisol in the body, regardless of the cause
what is hyperparathyroidism
increased produced
of HPT hormone
who
post menopausal women
RF
MEN syndromes multiple endocrine neoplasia (MEN) R
causes
85% single PT adenoma
10-15% multigland hyperplasia
symptoms
BONES MOANS GROANS STONES bones-ache pains in larger joints stones-cal in renal stones moan- lethargy, depression, low mood groans-gi symptoms such as constipation nausea abdo pain
tests/diagnosis
USS CT/MRI hypercalacemia unexplained is suggestive but notdiagnositic with high PTH then diagnostic inmets - low PTH
treatment
parathyroidectomy
