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Year 3 > Endocrine Core Conditions > Flashcards

Endocrine Core Conditions Flashcards

1
Q

How many people in the UK have type I DM?

A

1 in 300

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2
Q

What % of DM is type I?

A

5-10%

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3
Q

Who gets Type I DM?

A

Childhood disease
Peak presentation at puberty
First degree relative affected increases risk by 6%
MZ twins have 30% concurrence

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4
Q

Causes of type I DM?

A

Autoimmune (HLA associated immune-mediated organ specific disease)
Polygenic susceptibility
Anti-islet cell Ab is in circulation

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5
Q

Risk factors for Type I DM?

A

FHx
Genetics
Other autoimmune diseases (Grave’s, Hashimoto’s, thyroiditis, Addison’s, MS, pernicious anaemia)

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6
Q

Symptoms of Type I DM?

A 
Polyuria
Thirst 
Weight loss 
Regular thrush 
Blurred vision 
Cramps 
Skin infections 
Ketonuria 
Retinopathy
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7
Q

Differentials for Type I DM?

A 
Type II DM 
Diabetic ketoacidosis
Lead nephropathy 
Drug induced glucose intolerance 
Beign renal glycosuria 
Pancreatitis
CF
Prader-Willi syndrome 
Salicylate poisoning
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8
Q

Investigations for Type I DM?

A 
Urinalysis 
GTT
HbA1c
U+Es, eGFR
TFTs
Lipid profile
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9
Q

Treatment for Type I DM?

A

SC Insulin injection

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10
Q

Types of insulin?

A

Rapid acting analogue (before, with or after food)
Long acting analogue (once a day - background)
Short acting (15-30 mins before the meal)
Medium acting and long acting (once or twice a day)
Mixed insulin (short and medium acting)
Mixed analogue (medium and rapid)
Insulin pump therapy is an alternative to SC injections

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11
Q

Who gets Type II DM?

A

> 40y/o
Increasingly common
Elderly
Asian men

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12
Q

Causes of Type II DM?

A 
Pancreas doesn't produce enough insulin
Body is insulin resistant 
Genetics 
80% concordance MZ twins 
BMI >30 
High fat/salt diet 
Pregnancy 
Glucocorticosteroids
Thiazides 
Atypical antipsych
Cushing's 
Hyperthyroidism 
Phaeochromocytoma 
Pancreatic surgery
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13
Q

Risk factors for Type II DM?

A 
Increasing age 
FHx
Ethnicity (South Asian, Afro-Caribbean)
Obese
Lack of exercise
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14
Q

Symptoms of Type II DM?

A 
Polyuria 
Thirst 
Weight loss 
Fatigue
Recurrent thrush 
Blurred vision 
Cramps 
Skin infections 
Check BP, eyes, peripheral pulses and feet for ulcers
Acanthosis nigricans
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15
Q

Differentials for Type II DM?

A 
Type I DM
Gestational DM
Lead nephropathy 
Drug induced glucose intolerance 
Benign renal glycosuria
CF
PWS
Salicylate poisoning
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16
Q

Investigations for Type II DM?

A 
Urinalysis 
GTT
HbA1c 
U+E, eGFR 
TFTs 
Lipid profile
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17
Q

Treatment for Type II DM?

A 
Lifestyle changes 
Metformin 
Gliclazide 
Glitaxones 
Gliptins 
GLP-1 agonists 
Arcabose 
Nateglinide
Repglidine 
Insulin (final step)
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18
Q

Who gets hypothyroidism?

A

F»M
Mean age at diagnosis is 60
2.5% of pregnant women affected
Autoimmune hypothyroidism is more common in Japan

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19
Q

Causes of hypothyroidism?

A 
Usually primary disease of thyroid (can be secondary to hypothalamic pituitary disease)
Autoimmune (Hashimotos)
Iodine deficiency 
Dyshormonogenesis
Antithyroid drugs 
Other drugs (lithium, amiodarone, interferon)
Congenital (no thyroid)
Post infection sub acute thyroiditis 
Post surgery/irradiation 
Tumour infiltration
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20
Q

Risk factors of hypothyroidism?

A 
Female
>60 y/o
Other autoimmune diseases 
FHx of autoimmune disease 
Radioactive iodine treatment 
Anti-thyroid medications 
Partial thyroidectomy 
Pregnancy or <6months post partum
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21
Q

Symptoms of hypothyroidism?

A 
Tired
Cold 
Constipation
Weight gain 
Hair thinning 
Dry skin 
Intellectual slowing 
Decreased appetite 
Deep hoarse voice 
Changes in period (heavy/painful)
Impaired hearing 
Decreased libido 
Myxodema 
Bradycardia 
Delayed reflexes 
Carpal tunnel 
Serous cavity effusions
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22
Q

Differentials for hypothyroid?

A 
Addison's 
Sleep apnoea 
Autoimmune thyroid disease 
Pregnancy 
Cardiac tamponade 
Chronic fatigue 
Depression 
Dysmenorrhoea 
Fibromyalgia 
Familial hypercholesterolaemia
Mediastinal tumours 
Menopause 
Ovarian insufficiency 
Prolactin deficiency
23
Q

Investigations for hypothyroidism?

A 
TFTs
Anti-TPO Abs 
Antithyroglobulin Abs in 90-95% of autoimmune thyroiditis 
Raides CK 
Raised cholesterol/triglycerides 
Anaemia 
One sided goitre (imaging)
24
Q

Treatment for hypothyroidism?

A

Levothyroxine and liothyronine

25
Q

How common is hyperthyroidism?

A

400 per 100,000

26
Q

Who gets hyperthyroidism?

A

20-50 year olds

27
Q

Causes of hyperthyroidism?

A

60-80% due to Grave’s
Toxic multinodular goitre
Solitary toxic nodule
Uncommon acute thyroiditis, pregnancy, neonatal thyrotoxicosis, drugs (amiodarone, exogenous iodine)

28
Q

Risk factors for hyperthyroidism?

A 
FHx
High iodine intake 
Smoking
TRauma 
Toxic multinodular goitre
Contrast agents 
Childbirth 
HAART
29
Q

Symptoms of hyperthyroidism?

A 
Weight loss 
Heat intolerance 
Palpitations 
Tremor 
Agitated 
Decreased appetite
Weakness
Fatigue 
Diarrhoea 
Lowered libido 
Reduced periods 
Palmar erythema 
Tachycardia 
AF/HF
Hair thinning 
Diffuse alopecia 
Urticaria 
Pruritus 
Brisk reflexes 
Goitre 
Lid lag 
Gynaecomastia
30
Q

Differentials for hyperthyroidism?

A 
Goitre
Grave's 
Plummer-Winson syndrome 
Malignancy 
Anxiety
31
Q

Investigations for hyperthyroidism?

A

TFTs
TPO and thyroglobulin present in Grave’s
TSH receptor Abs
Thyroid US

32
Q

Treatment for hyperthyroidism?

A

Anti-thyroid drugs (carbimazole, methimaxole, propylthiouracil)
Radio-iodine
Thyroidectomy

33
Q

Which sex is more likely to develop a goitre?

A

Females

34
Q

Causes of goitre?

A 
Diffuse smooth goitre may be physiological (puberty, pregnancy)
Autoimmune (Grave's, Hashimoto's)
Acute thyroiditis
Iodine deficiency 
Dyshormonogenesis 
Goitrogens (sulphonylureas)
Reidel's thyroiditis 
Cysts 
Adenomas 
Cancer 
TB/sarcoidosis
35
Q

Risk factors for goitre?

A 
Pregnancy
Menopause 
Lithium 
Eating too much iodine 
Exposure to radiation 
Lack of dietary iodine 
Female 
Increasing age 
FHx
36
Q

Symptoms of goitre?

A 
Neck swelling 
Painless (unless inflamed)
Dyspnoea 
Dysphagia 
Coughing 
Tight feeling in throat 
Hoarse/vocal changes 
Bruit (thyrotoxicosis)
Retrosternal extension if inferior border cannot be palpated
37
Q

Investigations for goitre?

A

Exam
TFTs
Thyroid Abs
USS
CXR for tracheal compression
If there is 1 nodule (or 1 dominant) fine needle aspiration
Radioactive thyroid scan (hot v cold nodules - cold = 10% chance of malignancy)

38
Q

Treatment for goitre?

A

Depends on cause

Treat underlying cause

39
Q

What % of thyroid nodules are benign?

A

95%

40
Q

Who gets thyroid nodules?

A

F>M

Uncommon in children and adolescents

41
Q

Causes of thyroid nodules?

A 
Iodine deficiency 
Pregnancy 
Female 
Lithium 
Menopause 
Malignancy 
Benign thyroid disease
FHx
42
Q

Symptoms of thyroid nodules?

A 
Asymptomatic 
Pain/compression of trachea 
Swallow water whilst palpating 
Note movement, asymmetry 
Check for regional lymphadenopathy
43
Q

Differentials for thyroid nodules?

A 
Non-toxic goitre
Grave's/Hashimoto's
Solitary thyroid nodule 
Carcinoma 
Thyroid lymphoma 
Acute suppurative thyroiditis
44
Q

Investigations for thyroid nodules?

A 
Physical exam
TFTs
Thyroid Abs
USS 
CXR 
Fine needle aspiration 
Radioactive thyroid scan
45
Q

Treatment for thyroid nodules?

A

Based on cause

Benign + asymp = no treatment needed

46
Q

Who is more likely to develop Cushing’s?

A 
Obese 
DM
HTN
Osteoporosis
F>M 
25-40 y/o
47
Q

ACTH dependent causes of Cushing’s?

A

Pituitary dependent
Ectopic ACTH producing tumours
ACTH administration

48
Q

Non ACTH dependent Cushing’s?

A

Adrenal adenomas
Adrenal carcinomas
Glucocorticoid administration
Alcohol induced pseudo-Cushing’s

49
Q

Risk factors for Cushing’s?

A 
Female 
Lung cancer (ectopic ACTH)
Prolonged use of corticosteroids in asthma/RhA
50
Q

Symptoms of Cushing’s?

A 
Central weight gain 
Depression 
Psychosis/insomnia 
Low libido 
Thin skin, easy bruising 
Poor wound healing 
Purple/red striae 
Kyphosis 
Back pain 
Polyuria 
Growth arrest in children 
Muscle weakness
 Hair growth 
Acne 
Amenorrhoea 
Moon face 
Plethora
Frontal balding 
HTN 
Glycosuria
51
Q

Differentials for Cushing’s?

A 
Chronic anxiety/depression
Prolonged excess alcohol 
Obesity 
Poorly controlled DM 
HIV
52
Q

Investigations for Cushing’s?

A 
24 hour urinary free cortisol
48 hour low dose dexamethasone suppression test and late night salivatory cortisol 
FBC, U+E
Adrenal CT/MRI 
Hypokalaemia with ectopic ACTH 
Plasma ACTH 
CRH test for pituitary dependent Cushing's 
CXR for lung malignancy
53
Q

Treatment for Cushing’s?

A

Surgical treatment for adrenal tumours
Drugs (metyapone, ketoconazole, mitotane)
Pit radiotherapy
Complications of surgery: Nelson’s, loss of hormonal function

Year 3 (9 decks)

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