Endocrinology Flashcards
What are the findings, investigation and management for Addison’s Disease?
Fatigue Anorexia, weight loss Hyperpigmentation - present in mucosa and sun-exposed areas, palmar creases Nausea, vomiting,hypotension Uncommonly: salt craving
Hyponatremia and hyperkalemia in a patient with lethargy is highly suggestive of Addison’s disease
Morning serum cortisol - decreased
Short synACTHen test - elevated (will be decreased in secondary or tertiary adrenal insufficiency) - better test to do
Adrenal crisis = hydrocortisone sodium succinate
Glucocorticoid + mineralocorticoid = pred/ cortisone/hydrocortisone
What are the investigations for cushings syndrome?
late-night salivary cortisol
1 mg overnight low-dose dexamethasone suppression testing
24-hour urinary free cortisol
48-hour 2 mg dexamethasone suppression testing).
What are the findings, investigation and management for diabetic ketoacidosis
Occurs in T1 diabetics
Nausea/vomiting Abdominal pain Dehydration Hyperventilation Reduced consciousness - coma/delerium
VENOUS blood gas - metabolic acidosis
Blood ketones
1L of saline (0.9% sodium chloride)
Add potassium to SECOND IV fluids if potassium is low.
Serious Complication of DKA is cerebral oedema - headache, nausea/vomiting, seizures
What are the findings in hypercalcemia of malignancy? How do you treat it?
Stones thrones bones groans and psychiatric overtones
Nausea, loss of appetite, CONSTIPATION
Bone pain
Fatigue, confusion, coma
POLYURIA (induces nephrogenic diabetes insipidus), polydipsia
Muscle weakness
Moderate to severe = IV saline + IV bisphosphonates/ denosumab + treat malignancy
What is hyperosmolar hyperglycemic state? How do you manage it?
profound hyperglycaemia (glucose >30 mmol/L), HYPEROSMOLARITY (>320 mOsm/kg), and VOLUME DEPLETION in the absence of significant ketoacidosis (pH >7.3 and bicarbonate >15 mmol/L)
Occurs in T2DM
IV saline - mixed with potassium if necessary
Then insulin
Treat precipitating illness, thromboprophylaxis(LMWH)
What are the findings, investigation and management for primary hyperparathyroidism
Hypercalcemia symptoms, especially myalgia, fatigue, confusion, memory loss, kidney stone
RFs - lithium treatment, MEN syndrome
Serum calcium and PTH - elevated
Parathyroidectomy
Acute hypercalcemia = IV Fluids, followed by bisphosphonates if calcium remains high
What are the examination and investigation findings is secondary hyperparathyroidism?
Features of CKD or malabsorption syndromes
Muscle cramps/bone pain due to osteomalcia
Hypocalcemia signs - perioral tingling or paresthesias in toes/fingers, chvostek’s sign, trousseau’s sign,
Low calcium, high PTH, high phosphate
What causes tertiary hyperparathyroidism? What are the examination findings?
Refractory autonomous hyperparathyroidism resulting from chronic kidney disease. PTH and Ca are both high. Phosphate high
Parathyroid surgery indicated
What is the treatment for graves disease?
Antithyroid drug - carbimazole
Radioactive iodine + prednisolone
Thyroid surgery
Thyroid storm is treated with - antithyroid drugs(e.g. Carbimazole, PTU), corticosteroids, beta blockers, iodine solution
What are the different causes of thyrotoxicosis?
graves, thyroid nodules(thyroid adenoma, toxic multinodular goitre), early thyroiditis, amiodarone, iodine load
How do you investigate a toxic thyroid adenoma?
Thyroid ultrasound - shows nodule = a single hyperfunctioning area with suppression of contralateral gland
radioactive iodine therapy I-131. Antithyroid drugs if pregnant
How do you investigate and manage toxic multinodular goitre?
Serum testing to confirm hyperthyroid
I-123 thyroid scan - multiple hot and cold areas.
radioactive iodine therapy I-131. Antithyroid drugs if pregnant
Summarise the examination findings, investigations and management for Subacute granulomatous thyroiditis
Inflammation of the thyroid characterised by a triphasic course of transient thyrotoxicosis, followed by hypothyroidism, followed by a return to euthyroidism.
History and Examination
Thyroid pain and tenderness. Often following flu-like illness e.g. fever
Enlarged thyroid
Investigation
Serum thyroid hormones
Radioactive iodine uptake = low
Management - self limiting = NSAIDs
What are the findings, investigation and management for thyroid cancer?
asymptomatic thyroid nodule detected by palpation or ultrasound.
Uncommonly: voice hoarseness, difficulty swallowing
PAPILLARY THYROID CANCER most common- TSH normal/ euthyroid
- use thyroglobulin as tumour marker
Follicular thyroid cancer 2nd most common
- use thyroglobulin as tumour marker
Medullary thyroid cancer
- hypocalcemia due to high calcitonin
- associated with MEN2a and MEN2b
- use calcitonin as tumour marker
anaplastic thyroid cancer
- very aggressive
Ultrasound - nodules
Fine needle aspiration
Total thyroidectomy followed by radioactive iodine ablation and TSH suppression.
What is the management for T1DM?
What test distinguishes from type 2?
Basal insulin - detemir, glargine
Bolus insulin = “LAG” = lispro, aspart, glulisine
Anti GAD-65
What is the first line management for T2DM?
what if patients diabetes is uncontrolled and they have atherosclerotic cardiovascular disease?
First line = lifestyle changes to reach HBA1C goal
If still above this = metformin
with cardiovascular disease and persistently high HBA1C give:
- empagliflozin (SGLT2) or
- Liraglutide (GLP-1)
Define hypothermia
a core body temperature <35°C (<95°F).
Define heat stroke
Core body temp >40 degrees celsius
State some symptoms of hypoglyceamia
Causes?
Treatment of hypoglycaemia with impaired consciousness?
- Sweating
- Tremor
- Confusion
- Blurred vision
- excess insulin
- insulinoma (MEN 1 & 2 = RFs)
IM Glucagon
What are the symptoms of hypothyroidism? How do you manage it?
weakness, lethargy, depression, and mild weight gain.
dry skin, thick tongue, eyelid oedema, bradycardia, constipation may occur
Macrocytic anemia
Levothyroxine
What are the causes of hypothyroidism?
hashimotos(anti-thyroid peroxidase antibodies)
post-partum, cretinism, SG thyroiditis
Define obesity
defined as a BMI ≥30 kg/m²)
Causes and symptoms of hypoparathyroidism?
Investigation and management?
Leads to hypocalcemia: neuromuscular irritability(tingling of fingers, toes, mouth) intermittent muscle spasms(tetany) - trousseau’s sign, Chvostek’s sign
Causes include:
Surgical excision of parathyroid gland - often incidental
Systemic diseases - hemochromatosis, wilson’s disease, metastatic cancer
APS-1 - triad of candidiasis, autoimmune hypoparathyroidism, addisons disease
Thymic aplasia/ Di George syndrome
Investigation
Low PTH and Low Ca
Management
Calcium and calcitriol
What are the findings, investigation and management for osteomalacia?
diffuse bony pain usually with a history of limited sunlight exposure.
Proximal muscle weakness, spinal tenderness to percussion, pseudofractures, and skeletal deformities are found commonly.
Investigation
Serum vitamin D = low
Serum calcium = low/normal
Serum PTH - high
Management
Calcium + vitamin D
What is the most common cause of hypercalcemia?
Primary hyperparathyroidism
