Endocrinology Flashcards
pain in thumb, index finger and forearm
tingling in the arm
what is it ?
carpal tunnel syndrome
hypothyroidism
what is bilateral adrenal hyperplasia
common form of secondary hypertension
patient will be hypertensive but have a low k+ level
features of SIADH
- low serum osmolarity
- high urine osmolarity
- high urine sodium
parathyroidism
the parathyroid hormone PTH is released by the parathyroid gland
has calcium and vitamin D receptors
when PTH is released
- renal phosphate exertion increases
- plasma calcium increases
- absorption of calcium in the gut increases
hyperparathyroidism - impacts
major cause of hypercalacaemia
primary hyperparathyroidism - mainly due to cancer
secondary - CKD causes calcium levels to drop so PTH gets raised to compensate for this
what is the most common cause of hypokalaemia?
hypothermia
- causes low levels of potassium due to a trans cellular shift of potassium when body temperature is low
- it is the most common reversible cause of cardiac arrest
- give patient potassium
what is antiphospholipid syndrome
when the immune system accidentally makes antibodies which attack tissues
this causes blood clots in the arteries and veins
can cause miscarriage in pregnancy
which medications can cause Cushings syndrome
corticosteroids like prednisolone can cause too much cortisol
which medication can cause hyperkalaemia
spironolactone - it is a potassium sparing diuretic
which medication can cause hyponatraemia
omeprazole
PPI
PPIs can affect the normal function of the kidneys and therefore affect the electrolytes
they can also affect ADH
what are the side effects of carbimazole - a hyperthyroidism drug
it can cause neutropenic sepsis
so always check FBC
what is hyperaldosteronism
it is when the adrenal glands release too much aldosterone
it presents with high blood pressure and low potassium
symptoms of worsening palpitations and tremors. He is found to have a goitre with a bruit and is referred to the Endocrinologists. His blood test reveal that he has developed thyrotoxicosis
what is the drug?
amiodirone
it has a high iodine content
what is serotonin syndrome
it is when there is too much serotonin in the blood
this can cause symptoms such as diarrhoea
tremors
mental state changes eg confusion
what is addinosinan crisis
when someone takes steroids long term and then suddenly stops - the body naturally stops making steroids because of the external input of it
when steroids are stopped, there is a sudden decrease in steroids
causes the crisis
low aldosterone
low sodium
high potassium
what is the management for addisonian crisis
IV hydrocortisone - increase glucocorticoids which increase serum cortisol
What is the investigation for Cushing’s disease?
Low-dose dexamethasone suppression test
what are the symptoms of Addisons disease
GI symptoms
hypotension
fatigue
What infections can be a cause of Addisons disease
TB
which hypertension medication can cause hyper and hypothyroidism
amiodarone
why does amiodarone cause hypo and hyperthyroidism
Amiodarone contains high amounts of iodine - interferes with the production of thyroid hormones - hypothyroidism (Wolf Chailkoff)
amiodarone can cause hyperthyroidism - structural similarity of amiodarone to thyroid hormones, which can result in overstimulation of the thyroid gland (Jodd Basedow)
most common cause of hyperthyroidism in pregnancy
graves disease
symptoms of Cushings disease
- bruising
- obesity
- hypertension
investigation of Cushings disease
to identify if there is an excess of cortisol
24 hour urinary free cortisol
Low-dose Dexamethasone suppression test
Localisation:
Plasma ACTH
High-dose dexamethasone suppression test
investigation for Addisons disease
9am cortisol
having low levels in the morning means adrenal insufficiency
what is the investigation for Conns disease (hyperaldoesterone)
aldosterone/renin ratio
it can present with weakness, thirst and low potassium
what is the cause of primary hyperparathyroidism
this is when the hyperparathyroid gland produces more PTH - causes hypercalcaemia
what is the cause of secondary hyperparathyroidism
there is increased secretion of PTH in response to low calcium because of kidney, liver, or bowel disease.
what is the cause of tertiary hyperparathyroidism
there is autonomous secretion of PTH, usually because of chronic kidney disease (CKD).
what changes does hypothyroidism cause to the voice
causes voice hoarseness
T4 and T3 normal function
increases metabolism
so everything speeds up
dry skin
hair loss
anxiety
palpitations
menstrual cycles - amennoreha
examination findings od hyperthyroidism
tachycardia - vital signs
general insectpion - will be thin and wearing less clothes as they will be feeling hot
hands - dry skin, tremor, swelling of the hands and sweaty hands
eyes - bulging eyes - exopthamlosis
opthalmaplegia - one eye lags behind
hypertension medication that can cause hyperthyroidism
amiodarone
it contains iodine can cause toxicity - as it increases the acidity of thyroid gland
first line treatment of hyperthyroidism
symptomatic - propanol
prophylactic - carbimazole - common side effect is lower neutrophils
curative - surgery
hypothyroidism features
everything slows down
decreased basal metabolic rate
periods become heavier
hypothyroidism examinations
bradycardia
wear a lot of clothes will feel cold
be heavier
goitre in the neck
and oedema in the legs
what is myxoedema coma
extreme symptoms of hypothyroidism
usually in the elderly
very long standing hypothyroidism
due to physiological stress
hyponatreamia
and hypoglycaemia
very cold temp
management of myxoedema coma
iv levothyroixine
rise glucose levels
corticosteroids
what is thyroid storm
extreme symptoms of hyperthyroidism
high temp
high glucose
high levels of sodium
sweaty
tachycardia
clinical presentation of hyperaldosteronism
poorly controlled hypertension
hypokalaemia
metabolic alkalosis
how do ace inhibitors affect aldosterone
they block aldosterone so less aldosterone therefore hyperkalaemia
testing for hyperaldosteronins
bloods
urea and elerolyets
ABG
renin:aldoserone ratio
imaging - CT abdo
management of primary hyperadostrone
give potassium sparing diuretic like spironolactone
what is Addisons disease
primary adrenal insufficiency
low production of aldosterone and cortisol
can be autoimmune or TB causes
presentation of Addisons disease
salt craving due to low sodium
high potassium - muscle weakness
reduced cortisol - reduced appetite and weight loss
hyperpigmentation - deu to increased ACTH
presentation of Addisons disease
salt craving due to low sodium
high potassium - muscle weakness
reduced cortisol - reduced appetite and weight loss
hyperpigmentation - deu to increased ACTH
presentation of Addisons disease
salt craving due to low sodium
high potassium - muscle weakness
reduced cortisol - reduced appetite and weight loss
hyperpigmentation - deu to increased ACTH
presentation of Addisons disease
salt craving due to low sodium
high potassium - muscle weakness
reduced cortisol - reduced appetite and weight loss
hyperpigmentation - deu to increased ACTH
