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Yr3 Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Describe the clinical features of hypoglycaemia

A

Autonomic – sweating, anxiety, hunger, tremor, palpitations, dizziness
Neuroglycopenic – confusion, drowsiness, visual trouble, seizures, coma

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2
Q

List common causes of hypoglycaemia

A

Main cause – insulin or sulfonylurea treatment in a diabetic
EXogenous drugs
Pituitary insufficiency
Liver failure
Addison’s disease
Islet cell tumours
Non-pancreatic neoplasms

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3
Q

Describe investigations for hypoglycaemia

A

BM during attack & lab glucose if in hospital
Take a drug history & exclude liver failure
72h fasting, bloods – glucose, insulin, c-peptide & plasma ketones if symptomatic

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4
Q

Describe the treatment for hypoglycaemia

A

Conscious – 15-20g of quick-acting carbohydrate snack & recheck BM after 10-15 mins
Conscious but uncooperative – squirt glucose gel between teeth and gums
Unconscious patients – IVI glucose or give glucagon IV/IM

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5
Q

Describe the clinical features of hyponatraemia

A

Early – headache, nausea, vomiting, general malaise
Late – confusion, agitation, drowsiness
Acute severe – seizures, respiratory depression, coma & death -> requires urgent treatment under senior supervision

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6
Q

Describe investigations for suspected hyponatraemia

A

Full history & examination – drug history and hydration status
Urine osmolality, urine sodium, TFTs & assessment of cortisol reserve (0900 cortisol/synacthen test)

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7
Q

Describe the management of hyponatraemia

A

Correct underlying cause
Asymptomatic chronic hyponatraemia – fluid restriction is often sufficient
Acute/symptomatic hyponatraemia – cautious rehydration with 0.9% saline (do not correct rapidly as cerebral pontine myelinolysis may occur)
Vasopressor receptor antagonists – promote water excretion without loss of electrolytes & are effective in treatment hypervolaemic & euvolaemic hyponatraemia
Emergency – seek expert help, consider hypertonic saline

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8
Q

Describe the clinical features of hypernatraemia

A

Lethargy
Thirst
Weakness
Irritability
Confusion
Coma

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9
Q

List causes of hypernatraemia

A

Fluid loss without water replacement
Diabetes insipidus
Osmotic diuresis
Primary aldosteronism
Iatrogenic eg. incorrect IV fluid replacement

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10
Q

Describe the management of hypernatraemia

A

Give water orally if possible, if not give glucose
Use 0.9% saline IV if hypovolaemic

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11
Q

Describe the clinical features of hypokalaemia

A

Muscle weakness
Hypotonia
Hyporeflexia
Cramps
Tetany
Palpitations
Light-headedness
Constipation

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12
Q

Describe the treatment of hypokalaemia

A

Mild – give oral K+ supplement
Severe – give IV potassium, don’t give K+ oliguric

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13
Q

Describe the clinical features of hyperkalaemia

A

Fast irregular pulse
Chest pain
Weakness
Palpitations
Light-headedness

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14
Q

Describe the management of hyperkalaemia

A

Polystyrene sulfonate resin (calcium resonium) binds K+ in the gut, preventing absorption and bring K+ levels down over a few days
Emergency – calcium gluconate, insulin & glucose, salbutamol

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15
Q

Outline the different causes of hypercalcaemia

A

Primary hyperparathyroidism – hypercalcaemia with non-suppressed PTH until proved otherwise
Malignancy – hypercalcaemia with suppressed PTH

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16
Q

Describe the clinical features of hypercalcaemia

A

Asymptomatic
Tiredness, generalised aches & pains
Polyuria and polydipsia
Abdominal pain and constipation
Kidney stones

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17
Q

Describe the investigations done for hypercalcaemia

A

Ca2+
PTH
ALP – high ALP reflects increased bone turnover
Renal ultrasound – nephrocalcinosis

18
Q

Describe the treatment of hypercalcaemia

A

Depends on the underlying cause
Hyperparathyroidism – parathyroidectomy if Ca2+ > 2.85 mmol/L, young; calcimimetic drugs (cinacalcet)

19
Q

Describe the common causes of hypocalcaemia

A

1) Post-surgical hypoparathyroidism
2) Vitamin D deficiency
3) Hypomagnesaemia

20
Q

Describe the clinical features of hypocalcaemia

A

Acute severe hypocalcaemia – laryngospasm, prolonged QT interval, seizures
Muscle cramps
Carpo-pedal spasm
Peri-oral and peripheral paraesthesia
Neuro-psychiatric symptoms

21
Q

Describe the treatment for hypocalcaemia

A

Calcium replacement
Reverse the underlying cause
Hypoparathyroidism – treated with 1-alfacalcidol or calcitriol
Magnesium deficiency – precipitating drugs should be stopped and IV magnesium replacement started

22
Q

Describe diabetes insipidus

A

Caused by vasopressin deficiency (cranial DI) or vasopressin resistance (nephrogenic DI)
Leads to passing of large volumes of dilute urine with profound unquenchable thirst

23
Q

Describe investigations to do for suspected diabetes insipidus

A

Low urine osmolality
High serum osmolality
Water deprivation test (measures urine osmolality):
1) cranial diabetes insipidus: low after deprivation, high after ADH
2) nephrogenic diabetes insipidus: low after deprivation, low after ADH
3) primary polydipsia: high after deprivation, high after ADH

24
Q

Describe the management for diabetes insipidus

A

If possible, treat underlying cause
Mild cases can be treated conservatively
Desmopressin (synthetic ADH) can be used in:
1) CDI to replace ADH
2) NDI in higher doses under close monitoring

25
Q

Describe Addison’s disease

A

Primary adrenal insufficiency
Arises as a result of destruction of the adrenal gland OR genetic defects in steroid synthesis

26
Q

Describe the clinical presentation of Addison’s disease

A

Non-specific – fatigue, weakness, anorexia, weight loss, nausea
Glucocorticoid loss – hypoglycaemia & increased pigmentation
Mineralocorticoid loss – dizziness and postural hypotension
Androgen deficiency – reduced libido and loss of axillary and pubic hair

27
Q

Describe the investigations for suspected Addison’s

A

Hyponatraemia, hyperkalaemia, raised urea, hypoglycaemia & mild anaemia
Confirmatory tests – low 9am cortisol & simultaneously raised ACTH concentration -> Synacthen test is needed for confirmation

28
Q

Describe the management for Addison’s

A

Lifelong glucocorticoid and mineralocorticoid replacement
-hydrocortisone and fludrocortisone
Should double dose of glucocorticoid at times of illness
Provided steroid emergency card

29
Q

Describe the clinical features of Cushing’s syndrome

A

Central obesity
Dorso-cervical fat pad
Increased roundness of the face
Plethora (red face)
Thin skin
Easy bruising

30
Q

Describe investigations to do for suspected Cushing’s

A

24 hour urine free cortisol – elevated
Low dose dexamethasone suppression test – failure to suppress cortisol
Overnight dexamethasone suppression test – failure to suppress cortisol

31
Q

Describe the different causes of Cushing’s syndrome

A

3 potential causes are pituitary, adrenal or ectopic ACTH
1) ACTH is low, adrenal tumour is likely -> negative feedback by high cortisol levels
2) If ACTH is normal or high, diagnosis is pituitary or ectopic
High dose DST leads to some cortisol suppression in Cushing’s disease but not in ectopic

32
Q

Describe the management of Cushing’s syndrome

A

Adrenal tumour – laparoscopic adrenalectomy
Ectopic ACTH – appropriate treatment of the underlying malignancy and medical control of cortisol levels
Cushing’s disease – trans-sphenoidal removal of the pituitary adenoma

33
Q

List common causes of hyperthyroidism

A

Graves’ disease – autoimmune disease & due to presence of TSH receptor stimulating antibodies
Nodular hyperthyroidism – autonomous secretion of T3/T4 either from a solitary toxic nodule/numerous nodules situated within a toxic multi-nodular goitre
Thyroiditis – inflammation causing a release of thyroxine

34
Q

Outline common clinical manifestations of hyperthyroidism

A

Weight loss with increased appetite
Insomnia
Irritability
Anxiety
Heat intolerance
Palpitations
Tremor

35
Q

List investigations to do for suspected hyperthyroidism

A

TFTs – increased T3, T4 & undetectable TSH
Thyroid ultrasound
Nuclear imaging (iodine uptake isotope scan)
1) Graves’ = uniform increased uptake
2) Nodular disease = increased uptake only in the autonomous nodule
3) Thyroiditis = absent uptake

36
Q

Describe the management for hyperthyroidism

A

Medication – carbimazole & propylthiouracil (NB: can cause agranulocytosis – urgent FBC if unexplained fever or sore throat)
Surgery
Radioactive iodine

37
Q

List the common causes of hypothyroidism

A

Hashimoto’s thyroiditis
Pregnancy/post-partum
Drugs – amiodarone & lithium

38
Q

Describe the common clinical features of hypothyroidism

A

Weight gain
Cold intolerance
Depression
Constipation
Fatigue

39
Q

List investigations done for suspected for hypothyroidism

A

TFTs – low T3/T4 & increased TSH
TPO antibodies – strongly positive in Hashimoto’s thyroiditis

40
Q

Describe the treatment options for hypothyroidism

A

Thyroxine replacement

Yr3 Medicine (10 decks)

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