Endocrine disorders Flashcards
Which drugs can be used to treat hyperthyroidism?
Carbimazole
Methimazole
Propylthiauracil
What risks should be explained to a patient starting on carbimazole?
Risks of haematological disturbances, especially neutropenia (low neutrophil count) which increases risk of infection.
Warning signs include:
- sore throat, mouth ulcers, bruising, fever
Describe the contraindications of carbimazole
Contraindication: Severe haematological disorders
Caution:
Pregnancy and breast feeding (Propylthiouracil is the firstline preference)
Hepatic impairment
Renal impairment (Propylthiouracil)
Describe the mechanism of carbimazole
Carbimazole is metabolised to methimazole. This acts by inhibiting thyroid peroxidise and thereby the production of thyroid hormones.
Describe the signs and symptoms of low growth hormone levels
Retarded growth, abnormal fat distrubution
Can potentially cause dwarfism
How is growth hormone deficiency treated?
Treat the underlying cause
Give an example of something that can cause a deficiency of growth hormone
Hypothyroidism
What condition is caused by congenital hypothyroidism?
Cretinism - impaired mental and physical development
What is the common name for autoimmune thyroiditis? What endocrine condition does this cause?
Hashimoto’s disease
Primary hypothyroidism
Describe the signs and symptoms of hypothyroidism
Low metabolic rate Low body temperature, cold intolerance Tiredness, lethargy Weight gain Dry skin, hair
What tests should be done if hypothyroidism is suspected?
TFTs - FT3, FT4, TSH
Serology for TPO autoantibodies
How is hypothyroidism treated?
Give oral Levothyroxine (T4)
Describe the signs and symptoms of hypocalcaemia
SPASMODIC: Spasms (e.g. Trousseau’s sign) Paraesthesiae / Prolonged QTc interval / Papilloedema Anxious, irritable, irrational Seizures Muscle tone increase in smooth muscle – colic, wheeze, dysphagia Orientation impaired, confusion Dermatitis Impetigo herpetiformis Cardiomyopathy / Cataract
What tests should be done in a patient with suspected hypocalcaemia?
Blood test for serum calcium level PTH level ECG FBC, U&E, albumin Vitamin D, magnesium, phosphate
How is hypocalcaemia managed?
Oral or IV calcium (depending on severity)
What disease causes low levels of aldosterone and cortisol?
Addison’s disease
Describe the symptoms of aldosterone deficiency
Polyuria Hypovolaemia High serum potassium Low serum sodium (Can lead to hypotension)
Describe the symptoms of cortisol deficiency
Fatigue, nausea, weight loss, irritability, depressions Hyperpigmentation Buccal pigmentation Hypotension Hypoglycaemia
What tests should be done in a patient with suspected adrenal insufficiency?
Routine bloods Random cortisol (<700 nmol/l) Short synacthen test ACTH levels Adrenal antibodies
How is Addison’s disease treated?
Give oral glucocorticoid (hydrocortisone) and oral mineralcorticoid (fludrocortisone) replacement
What is a life-threatening complication of Addison’s disease? Describe the clinical signs/symptoms.
Addisonian crisis
Hypotension, tachycardia
What causes Addisonian crisis?
Addisonian crisis happens in patients with chronic adrenal insufficiency when subject to an intercurrent illness or stress, e.g. burns, infection, pregnancy, allergy, MI.
Explain why patients in Addisonian crisis become hypotensive
Low aldosterone: Sodium (and therefore water) are not sufficiently reabsorbed by the kidney, so are excreted, which leads to hypovolaemia and therefore hypotension.
Low cortisol: cortisol has a permissive effect on catecholamine action, therefore low cortisol levels mea that catecholamines do not work as effectively. This prevents the blood vessels from constricting enough to raise the blood pressure, so exacerbate the hypotension.
Explain why patients in Addisonian crisis become tachycardic
Tachycardia is to compensate for the low blood pressure (caused by hypovolaemia) to maintiain sufficient cardiac output.
