Endocrine History And Exam Flashcards
Parathyroid: Hypercalcemia
Causes: hyperparathyroidism or malignancy
Symptoms: bones, groans, abdominal moans, and psychiatric groans
- CNS: lethargy, weakness, confusion, coma
- renal: polyuria, dehydration, nocturnal, renal stones, renal failure
- GI: constipation, nausea, anorexia, gastric ulcer, pancreatitis
- cardia: syncope from arrhythmias
Thyroid
Butterfly shaped gland in neck
Release thyroxine (T4) and tri-iodothyronine (T3)
T4 converted to T3 in cells (biologically active from of thyroid hormone)
T3 and T4 secretions regulated by TSH secreted by pituitary
T3 and T4 increase => TSH should decrease
T3 and T4 decrease => TSH should increase
Hypothyroidism
High TSH
Low T3 and T4
Causes:
- Hashimoto’s thyroiditis - autoimmune (most common cause of hypothyroidism) (initial presentation of hyperthyroidism
- medications (i.e., lithium)
- pregnancy (during or after)
- treatment for hyperthyroidism
- thyroidectomy
Symptoms:
- constipation
- depression
- fatigue
- pale, dry skin
- sensitivity to cold
- elevated cholesterol levels
- dry, brittle nails and hair
- weight gain
Hyperthyroidism
Low TSH
High T3 and T4
Causes:
- Graves’ Disease - autoimmune (most common cause of hyperthyroidism)
- toxic modular or multinodular goiter
- Thyroiditis (autoimmune or viral)
- excessive consumption of iodine or meds (amiodarone)
- pregnancy or 1st year after birth (some women)
Symptoms:
- fatigue or muscle weakness
- hand tremors
- mood swings
- nervousness or anxiety
- rapid heart rate
- heart palpitations or irregular heartbeat
- skin dryness
- trouble sleeping
- weight loss
- increased frequency of bowel movements
- light or missing periods
- irritability
- thinning of hair
- heat intolerance
Myxedematous Facies
Hair dry, coarse, sparse
Lateral eyebrows thin
Periorbital edema
Puffy dull face with dry skin
Chronic hypothyroidism
Addison’s Disease/Adrenal Insufficiency
Primary Causes (90% of cases)
- 70% autoimmune
- 20% due to TB
- chronic infections, surgical removal, cancer cells affecting adrenals
Secondary Causes (lack of ACTH)
- suddenly stopping exogenous glucocorticoids
- surgical removal of ACTH-producing tumors from pituitary
- pituitary gland suddenly stops producing ACTH (as in cancerous processes)
Symptoms:
- chronic worsening fatigue and muscle weakness
- weight loss, loss of appetite
- N/V/D in about 50% of cases
- skin darkening, especially on stars, skin folds, pressure points, mucus membranes
- salty food craving
- hypotension
- irritability
- hypoglycemia (uncommon in adults)
- menstrual irregularities
Addisonian Crisis/Acute Adrenal Insufficiency
Usually appears at time of stress (illness, surgery)
Sudden penetrating pain of back, extremities, vomiting, diarrhea
If left untreated could lead to death
Cushing Syndrome
Affects women more than men
Endogenous and exogenous causes
Cushing’s disease = most common endogenous form
Endogenous Causes: overproduction of cortisol (glucocorticoid)
- pituitary tumor (Cushing’s disease)
- adrenal tumor
- other unknown
Exogenous Causes: taking medications containing glucocorticoids (hydrocortisone)
Symptoms:
- fatigue and sleeping problems
- headaches
- back aches
- swelling
- irritability
- repeated infections and poorly healing wounds
- acne
- hair loss
Signs:
- round (moon-shaped) and/or red face
- purplish streaks across skin (striae)
- unusual buildup of fatty tissue between shoulder blades (buffalo hump)
- unusual buildup of fatty tissue in abdominal area with thin arms and legs
- easy bruising
- excess facial/body hair growth (hirsutism) in women
Diabetes Mellitus
Symptoms:
- urinating often
- feeling very thirsty
- feeling very hungry (even though you are eating)
- extreme fatigue
- blurry vision
- cuts/bruises that are slow to heal
- weight loss - even though your are eating more (type 1)
- tingling, pain, numbness in hands/feet (type 2)
- retinopathy
Parathyroid: Hypocalcemia
Causes:
- hypoparathyroidism (most common)
Symptoms:
- neuropsych: seizures, dementia, anxiety, depression, extrapyramidal symptoms, papilledema
- neuromuscular: paresthesias around mouth, fingers/toes, muscle stiffness, myalgias, spasms
- CV: CHF, hypotension, prolonged QT interval
- autonomic: biliary colic, brochospasm, diaphoresis
- other: cataracts, dry coarse skin, hyperpigmentation, eczema, steatorrhea
Chiovstek Sign
Trousseau’s Sign
