Endocrine/ rheum Flashcards
What skin changes do you get in dermatomyosis?
Get weakness + skin changes:
photosensitive
macular rash over back and shoulder
heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers
‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
nail fold capillary dilatation
In a patient on long term hydrocortisone and fludrocortisone who has N+V what should you do re their medications
A person with Addisons’ who vomits should take IM hydrocortisone until vomiting stops
Fludrocortisone is a mineralocorticoid that is used to manage Addison’s. However, it is extra glucocorticoid (hydrocortisone) that is required in this situation
Cushings syndrome causes?
ACTH dependent causes
Cushing’s disease (80%): pituitary tumour secreting ACTH producing adrenal hyperplasia
ectopic ACTH production (5-10%): paraneoplastic
ACTH independent causes
iatrogenic: steroids - most common overall cause
adrenal adenoma (5-10%)
adrenal carcinoma (rare)
What is limited vs diffuse cutaneous systemic sclerosis?
Limited cutaneous systemic sclerosis
scleroderma - face + distal limbs
anti-centromere antibodies
a subtype of limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
Diffuse cutaneous systemic sclerosis:
scleroderma affects trunk + proximal limbs
most common: anti scl-70 antibodies (AKA anti-topoisomerase-1 antibodies); less common: anti-RNA polymerase
commonly die from resp complications - ILD + pulmonary hypertension
other complications: renal disease + HTN
poor prognosis
What is hyperaldosteronism? How do you ix? How do you mx?
Primary hyperaldosteronism AKA conns syndrome
Causes
bilateral idiopathic adrenal hyperplasia: 60-70%
adrenal adenoma: 20-30%
familial etc
Features
hypertension, hypokalaemia, metabolic alkalosis
Investigations
plasma aldosterone/renin ratio -
should show high aldosterone levels alongside low renin levels (negative feedback due to sodium retention from aldosterone)
high resolution CT Abdo and adrenal vein sampling is used to differentiate between unilateral and bilateral sources of aldosterone excess
if the CT is normal adrenal venous sampling (AVS) can be used to distinguish between unilateral adenoma and bilateral hyperplasia
Management
adrenal adenoma: surgery
bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone
What is Pagets disease of the bone? Sx? management and ix (and blds)?
Paget’s disease is a disease of osteoclasts -> increased + uncontrolled bone turnover.
Presentation: typically older male with bone pain and an isolated raised ALP, (e.g. pelvis, lumbar spine, femur)
untreated features: Bowing of tibia, Bossing of skull
Can rarely cause high-output HF
Investigations: Raised ALP, normal Ca and Phosphate.
x-rays- osteolysis in early disease → mixed lytic/sclerotic lesions later
skull x-ray: thickened vault, osteoporosis circumscripta
Management: only treat if sx/ fracture/ deformity.
bisphosphonate (either oral risedronate or IV zoledronate)
What raises ALP in relation to bones?
When bones have increased remodelling ALP rises as it is realeased by ostoblasts eg in osteomalacia, hyperparathyrdoisism, bones mets, pagets, bone fracture
What is blood test for sjogrens Vs polymyo/dermatomyositis?
Sjogrens - Anti Ro (more common) and anti La (less common)
anti-mI2 (more common), Anti-Jo1 (less common)- Polymyo/Dermatomyositis
What can you test for to differentiate type 1 vs type 2 diabetiics? What will these levels be like?
c-peptide is low in t1DM as no insulin is being made
What is MODY (mature onset diabetes of young)?
Maturity-onset diabetes of the young is an autosomal-dominant disease, and it is characterised by the development of type 2 diabetes mellitus in patients younger than 25 years old. In this condition, C-peptide remains in the normal range and beta-cell antibodies are negative.
How do you diagnose diabetes?
If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
If the patient is asymptomatic the above criteria apply but must be demonstrated on two separate occasions.
What is the most common cause of hyperthryoidism
graves disease
When are topical NSAIDs particularly useful for OA?
Topical NSAIDs may be particualrly beneficial for patients with OA of the knee or hand
What is T score on BMD indicates need for treatment?
Less than -1.5
The first-line treatment is alendronate. Patients should also be calcium and vitamin D replete.
Osteomalacia vs pagets vs primary/ secondary/ teriatry parathyroid?
Osteomalacia- low vit d, low calcium, low phos. High ALP, high PTH
(the bone is trying but has poor supplies)
Pagets - Isolated ALP rise
(bone is just doing its own thing)
Primary hyperparathyroid- high ca, low phos, high ALP, PTH can be high or normal
(the parathyroid is demanding calcium to the blood, so bones have to break down)
Secondary hyperparathyroidism - chronic disease, usually CKD. Calcium low due to disease, and phosphate raised –> PTH raised in response. ALP also raised.Low Vit D as kidneys cant make.
Tertiary hyperparathyroidism - hyperplasia of the parathyroid glands after the cause of secondary hyperparathyroidism has been corrected. Calcium remains high, but PTH would be elevated, rather than normal.
When should bisphosphonates be started without a DEXA scan?
fragility fracture + >= 75 years of age are presumed to have underlying osteoporosis and should be started on first-line therapy (an oral bisphosphonate), without the need for a DEXA scan.
treatment for PHaeochromocytoma
- give (alpha blocker)PHenoxybenzamine before beta-blockers
- Needs medication before eventual surgery
What steroid use (dose and length) puts you at risk of osteoporosis and requires bisphos?
7.5mg a day for 3 or more months.
Describe subacute thyroiditis?
Subacute thyroiditis AKA De Quervain’s thyroiditis, will have tender thyroid
Post viral. 4 phases.
phase 1 (lasts 3-6 weeks): hyperthyroidism,painful goitre,raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: normal
Ix: thyroid scintigraphy:globally reduced uptake of iodine-131
Mx: self-limiting, analgesia, steroids if severe - particularly in hypothyroid
How do you mx Gastrointestinal autonomic neuropathy?
management options include metoclopramide, domperidone or erythromycin (prokinetic agents)
Mx of prolactinoma
1st line medical - dopamine agonist (e.g. cabergoline, bromocriptine)
2ns line - surgery- if medication fails
