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ENDOCRINOLOGY& DIABETES > Endocrine disease (medicine) II > Flashcards

Endocrine disease (medicine) II Flashcards

1
Q

What are endocrine gland?

A

ductless glands that usually release a product into the bloodstream for transport to body targets

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2
Q

What are hormones?

A

Hormones are chemical signals produced by an
endocrine gland that
act at some distance from the gland

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3
Q

What are targets?

A

Targets are organs, tissues or cells capable of responding to the hormone due to the presence of a receptor that binds the hormone

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4
Q

What is the largest endocrine gland?

A

Thyroid gland

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5
Q

What does the thyroid gland produce?

A

Produces hormones
– thyroxine (T4) and tri-iodothyronine (T3)
regulate basal metabolic rate
– calcitonin which has a role in regulating blood calcium levels

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6
Q

Why is the thyroid gland a unique endocrine gland?

A

It stores large amounts of inactive hormone within extracellular follicles

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7
Q

Surface anatomy of the thyroid gland?

A

Clasps anterior and lateral
surface of pharynx, larynx, oesophagus
and trachea “like a shield”
• Parathyroid glands usually lie
between posterior border of thyroid gland
and its sheath (usually 2 on each side of the thyroid)
• Internal jugular vein and common carotid artery lie
postero-lateral to thyroid

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8
Q

What to measure regarding thyroid issues?

A 
Free Thyroxine (T4)
Free Triiodothyronine (T3)
Thyroid Stimulating Hormone(TSH)
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9
Q

Causes of hypothyroidism?

A

Primary failure of thyroid gland = decreased T3 and T4, Increased TSH
Goitre present

2ndry to hypothalamic or pituitary failure = low T3 and T4, low TSH and/or decreased TRH
No goitre

Dietary iodine deficiency = low T3 and T4, increased TSH, goitre present

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10
Q

Clinical features of hypothyroidism relating to the thyroid gland’s hormones?

A 
weight gain
 lethargy
 increased sleep
 constipation
 cold intolerance
 dry skin
 hair loss
 menorrhagia
 deafness
 muscle weakness
 facial puffiness
 periorbital oedema
 bradycardia
 hoarseness
 delayed reflexes
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11
Q

Causes of hypothyroidism?

A 
Primary
 Dyshormonogenesis
 Iodine Deficiency
 Autoimmunity
 Post Radioactive Iodine
 Post Thyroidectomy
 Iodine Excess
2ndry and tertiary:
 Pituitary Tumours
 Pituitary Granulomas
 Empty Sella
 Isolated TRH deficiency
 Hypothalamic disorders
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12
Q

Indications for thyroid screening?

A

Congenital hypothyroidism
Tx of hyperthyroidism
Neck irradiation
Pituitary surgery/irradiation

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13
Q

Investigations and management of thyroid issues?

A

Thyroid function tests, thyroid antibodies

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14
Q

Dental complications in hypothyroidism?

A 
Delayed eruption
 Enamel hypoplasia
 Macroglossia (large tongue)
 Micrognathia (undersized jaw)
 Thick lips
 Dysgeusia (disruption of taste)
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15
Q

Causes of hyperthyroidism relating to the hormones?

A

Abnormal thyroid stimulating immunoglobulin
(eg. Grave’s disease) = High T3 and T4, low TSH, goitre present

2ndry to excess hypothalamic or pituitary secretion = increased T3 and T4, TSH and/or TRH, goitre present

Hypersecreting thyroid tumour = increased T3 and T4, low TSH, no goitre

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16
Q

Causes of hyperthyroidism?

A 
 Autoimmune thyroid
disease
o Graves Disease
o Postpartum thyroiditis
 Toxic nodular goitre
 Toxic adenoma

Rare:

  • Amiodarone induced
  • hCG hyperthyroidism
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17
Q

Clinical features of hyperthyroidism?

A 
 Weight loss
 Heat intolerance
 Anxiety, irritability
 Increased sweating
 Increased appetite
 Palpitations
 Loose bowels
 Goitre
 Tremor
 Warm moist skin
 Tachycardia
 Eye signs
 Thyroid bruit
 Muscle weakness
 Atrial fibrillation
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18
Q

Diagnosis of graves disease - clinical features?

A 
 Diffuse goitre
 Eye signs
 Pretibial myxoedema
 Vitiligo and features of
other autoimmune
disease
 FH of autoimmune
thyroid disease
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19
Q

Graves disease investigations

A 
 TSH receptor Abs
 TPO Abs
 Thyroglobulin Abs
 Thyroid Radioisotope
scan
20
Q

Tx of graves disease?

A 
 Medical
Drug side effects e.g. nausea, vomiting,
leucopenia leading to agranulocytosis,
aplastic anaemia, drug fever, cholestatic
jaundice
 Surgical
 Radioactive iodine
21
Q

Dental complications of hyperthyroidism?

A 
 Accelerated dental eruption
 Maxillary or mandibular osteoporosis
 Increased susceptibility to caries
 Periodontal disease
 Increased sensitivity to epinephrine which may
result in arrhythmias or palpitations
 Surgery, oral infection and stress may
precipitate thyroid crises
22
Q

Why refer someone regarding their thyroid nodules?

A 
 New onset
 Increase in size
 Onset of pain
 Associated speech disturbance
 Lymphadenopathy
 Patient / Doctor concern
23
Q

Pituitary dysfunction investigations?

How do pituitary dysfunctions present?

A 
Hormonal tests
• If hormonal tests
abnormal or tumour
mass effects perform
MRI pituitary

Present as tumour mass effects, hormone excess and hormone deficiency

24
Q

Causes of hypopituitarism?

A 
 Pituitary tumours
 Radiotherapy
 Trauma
 Infarction
 Infiltration e.g. sarcoidosis, haemochromatosis
 Infection e.g. tuberculosis, syphilis
 Sheehan’s syndrome (post partum pituitary
necrosis)
25
Q

What is acromegaly?

A

Excessive GH secretion with high IGF-1 levels

26
Q

Clinical features of acromegaly?

A 
Head related:
 Coarse facial features
 Enlargement of
supraorbital ridges
 Separation of teeth
 Prognathism (class III skeletal)
 Macroglossia
Other features:
 Headaches
 Spade-like hands
 Joint pains
 Excess sweating
 Hypertension
 Impaired glucose
tolerance
27
Q

Investigations of acromegaly?

A

IGF1, dynamic tests, MRI pituitary

28
Q

Tx of acromegaly?

A 
Surgical resection – TSS, TFS
- biochemical control
 Somatostatin analogues 
 Pegvisomant reduces IGF-1 to levels > 90%
 Radiotherapy in unsuccessful surgery
29
Q

Dental complications of acromegaly?

A 
 Jaw Malocclusion
 Difficulty in speech due to macroglossia
 Teeth mobility
 Missing teeth
 Teeth separation
 Thickening of alveolar processes
 Enlarged posterior roots
 In 50% upper airways obstruction caused by
pharyngeal hypertrophy and macroglossia
with obstructive sleep apnoea.
30
Q

Presentation of local mass effects?

A

Headaches, visual field defects, cranial nerve palsy and temporal lobe epilepsy

31
Q

What does a lack of GH result in?

A

Short
Abnormal body composition
Poor QoL

Rx: GH

32
Q

Lack of LH/FSH results in?

A

Hypogonadism
Reduced sperm count
Infertility
Menstruation

Rx: testosterone (males),
progesterone and oestradiol in females

33
Q

Lack of TSH results in?

A

Hypothyroidism

Rx: levothyroxine

34
Q

Lack of ACTH results in?

A

Adrenal failure
Reduced pigment

Rx: hydrocortisone

35
Q

Lack of ADH results in?

A

Diabetes insipidus
Decreased water absorption in kidney = polyuria, polydipsia

Rx: DDAVP

36
Q

Adrenal disorders - what causes excess glucocorticoids (cushing’s syndrome)?

A

Pituitary tumor 70-80%
Adrenal tumor 10-20%
Ectopic ACTH tumor 10%
Iatrogenic

37
Q

Clinical features of cushing’s syndrome? (excessive cortisol - adrenal gland)

A 
Weight gain
Moon face
Acne
Bruising
Osteopenia
Glucose intolerance
Hyperpigmentation
38
Q

Investigations of cushing’s syndrome?

A 
Hormonal tests (dynamic suppression tests, measuring cortisol, ACTH)
Radiological if hormonal tests abnormal = MRI pituitary, CT adrenals, CT chest
39
Q

Tx of cushing’s?

A

Surgery
Drugs
Consider radiotherapy for pituitary disease if surgery fails

40
Q

Causes of adrenal insufficiency?

A 
Primary:
 Autoimmune
 Tuberculosis
 Fungal infections
 Adrenal hemorrhage
 Congenital adrenal
hypoplasia
 Sarcoidosis
 Amyloidosis
 Metastatic neoplasia
2ndry:
After exogenous
glucocorticoids
 After treatment of
Cushing’s
 Hypothalamic or
pituitary tumours
41
Q

Clinical features of adrenal insufficiency?

A

Weakness
Skin and mucous membrane pigmentation (darker gingival margin)
Loss of weight, emaciation, anorexia, vomiting, diarrhea
Hypotension
Salt craving
Hypoglycemic episodes

42
Q

Investigations of adrenal insufficiency?

A

Hormonal tests - dynamic stimulation tests measuring cortisol, ACTH, adrenal antibodies

Radiological if abnormal hormonal tests:

  • MRI pituitary
  • CT or MRI adrenals
43
Q

Tx of adrenal insufficiency?

A

Hydrocortisone replacement tx

44
Q

Glucocorticoid cover for dental procedures?

A 
 On treatment therapy e.g asthma, rheumatoid arthritis
◦ Prednisolone > 7.5mg
◦ Hydrocortisone > 30mg
◦ Dexamethasone > 0.75mg
 On replacement therapy
◦ Addison’s e.g. Hydrocortisone 20/10mg
◦ ACTH deficiency 10/5/5mg

Simple Procedures: double dose one hour before surgery,
double dose oral medication for 24 hours

Major Procedures/GA: hydrocortisone 100mg im at induction and double dose oral medication for 24 hours

45
Q

Endocrine causes of hypertension?

A
  • Primary aldosteronism
  • Phaeochromocytoma
  • Acromegaly
  • Cushing’s syndrome
  • Hypothyroidism
  • Hyperthyroidism
46
Q

How to manage hyperthyroidism, Phaeochromocytoma, Cushing’s?

A

Hyperthyroidism – render euthyroid
• Phaeochromocytoma – treat before any surgery
• Cushing’s – avoid infections and pathological fractures; steroid cover
Refer to endocrinologist

ENDOCRINOLOGY& DIABETES (4 decks)

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