Endocrinology

Question 1

thyrotoxicosis

Answer 1

the clinical state associated with excess thyroid hormone activity, usually due to inappropriately high-circulating thyroid hormones. The clinical presentation varies, ranging from asymptomatic to life-threatening thyroid storm.

Question 2

thyrotoxicosis presentation

Answer 2

hyper active
resting tremor
NO tenderness to thyroid (goiter is smooth but no actual inflammation- otherwise itd be sub acute thyroiditis)

heat intolerance, palpitations, anxiety, fatigue, weight loss, muscle weakness, and, in women, irregular menses.
tremor, tachycardia, lid lag, and warm moist skin.

Question 3

Graves’ disease

Answer 3

autoimmune disease attack on thyroid
antibodies produced against thyroid and eyes

Question 4

proptosis

Answer 4

symptom of graves’ disease
eyes pushed forwards
lid retracted
can lead to loss of vision
pressure on optic nerves

paralysis of eye muscle
double vision

Question 5

CRP result

Answer 5

marker for inflammation
normal for Graves’
high for thyroiditis

Question 6

T3 , T4 and TSH in Graves’

Answer 6

higher production of T3 in circulation
high T4
LOWER TSH

Question 7

hyperthyroidism and symptom

Answer 7

overactive thyroid
aka thyrotoxicosis
increased activity of the sympathetic nervous system
increased activity of muscle that controls the upper lid
upper lids retracted
lid lag

Question 8

thyroid physiology

Answer 8

hypothalamus releases TRH

anterior pituitary releases TSH

T3 and T4 released in thyroid in negative feedback loop
inhibits TSH or TRH

Question 9

thyrotoxicosis due to Graves’ disease

Answer 9

immune system producing autoimmune antibodies directed against TSH receptor

mimics TSH but constant stimulation

increases synthesis of thyroid hormones
leads to goiter formation

runs in families
female side

Question 10

symptoms of hyperthyroidism

Answer 10

hyperactivity
heat intolerance
fatigue
weight loss
(despite always hungry)
diarrhoea
tachycardia
tremor
goiter
warm, moist skin
lid lag

Question 11

causes of thyrotoxicosis

Answer 11

graves’ (TSH receptor stimulating antibody)
toxic nodule
toxic multinodular goitre
factitious thyrotoxicosis (external supplementation)

thyrotoxicosis associated with subacute thyroiditis is diff

Question 12

detection of thyrotoxicosis

Answer 12

TSH receptor antibody

positive for graves
negative use other scans/goiter

Question 13

treatment of Graves’

Answer 13

1) peripheral adrenergic blockade:
propranolol (BB)
blocks tachycardia and tremor

diltiazem (calcium antagonist) if asthma

2) inhibit hormone synthesis of TPO thyroid peroxidase:

CBZ or PTU
risk of liver problems

3) removal of thyroid:
thyroxine for life

Question 14

myxoedema

Answer 14

swelling of skin
excess deposition of glycans

Question 15

hypothyroidism
things to look for in blood test

Answer 15

cortisol level too high = cushings
too low = addisons

TSH raised
low T4 T3

Question 16

hypothyroidism causes

Answer 16

subclinical disease -> myxoedema coma

primary disease most common:
autoimmune
latrogenic (caused by medicine)

elderly obese females

radiotherapy damaging thyroid for throat cancer

Question 17

hypothyroidism symptoms

Answer 17

myxoedema

nervous system:
forgetfulness, slow
carpal tunnel

cardiovascular:
bradycardia
decreased cardiac output
dependent oedema

Gastrointestinal:
constipation
ascitic fluid

renal:
hyponatremia
decreased glomerular filtration
reduced excretion of water

pulmonary:
respiratory compromise with hyperventilation
airway obstruction

musculoskeletal:
muscle cramps
myopathy

anaemia:

skin and hair:
loss of lateral eyebrows
dry cool skin
puffy face

metabolism:
hypothermia
intolerance to cold
weight gain

reproductive system:
heavy periods

Question 18

diagnosis of hypothyroidism

Answer 18

high TSH and low T4 = primary hypothyroidism

low/normal TSH and low T4 = secondary
pituitary disease
critically ill

Question 19

myxoedema treatment

Answer 19

levothyroxine
check cortisol level first
lower dose if old
hypothyroidism may be protecting them from heart failure due to slowed metabolic rate

Question 20

hyperpigmentation

Answer 20

caused by ACTH
Addison’s disease
primary adrenal insufficiency

Question 21

lab results suggesting adrenal insufficiency

Answer 21

low na high K = aldosterone deficiency
less reabsorption of Na, more excretion of K

low cortisol
high ACTH to compensate

Question 22

adrenal insufficiency

Answer 22

an absolute or relative deficiency of adrenal hormones
cortisol
aldosterone
androgen

Question 23

cortisol

Answer 23

glucocorticoid
Cortisol is a steroid hormone that is produced by your 2 adrenal glands, which sit on top of each kidney. When you are stressed, increased cortisol is released into your bloodstream

immune response
stress factors cause adrenal cortex to release cortisol

Question 24

aldosterone

Answer 24

Aldosterone (ALD) is a hormone that helps regulate your blood pressure by managing the levels of sodium (salt) and potassium in your blood and impacting blood volume.

retains Na, loses K

Question 25

Primary adrenal insufficiency (Addison’s disease) and
lab results diagnosis

Answer 25

autoimmune usually
whole cortex/adrenals is damaged
pituitary is fine

low cortisol
ACTH high
pigmentation
low aldosterone
Na low
K high
hypovolaemia (Na and water loss)

Question 26

secondary adrenal insufficiency

Answer 26

pituitary disease (pituitary releases ACTH)

low cortisol
ACTH low
no pigmentation
normal aldosterone
Na low
K normal
euvolaemia (normal fluid level in body)

Question 27

Addison’s symptoms

Answer 27

weakness
pigmentation
weight loss
vomiting/anorexia
hypotension
abdominal pain
salt craving
diarrhoea…

Question 28

causes of Addison’s

Answer 28

idiopathic- autoimmune, antibodies against adrenal cortex

infectious- viral, fungal

latrogenic- adrenals removed
haemorrhage

Question 29

causes of secondary adrenal insufficiency

Answer 29

exogenous glucocorticoids (medicine induced) (suppression of adrenal axis by negative feedback on ACTH)

pituitary insufficiency- ACTH deficiency, tumour, haemorrhage

hypothalamic insufficiency

head trauma

autoimmune disease

pituitary tumors or infection

bleeding in the pituitary

genetic diseases that affect the way the pituitary gland develops or functions

surgical removal of the pituitary to treat other conditions

Question 30

signs of excess glucocorticoids cushing’s syndrome

Answer 30

obesity
muscle weakness
skin ulcers
osteoporosis
hypertension

Question 31

adrenal crisis

Answer 31

Acute adrenal crisis is a medical emergency caused by a lack of cortisol. Patients may experience lightheadedness or dizziness, weakness, sweating, abdominal pain, nausea and vomiting, or even loss of consciousness.

long term steroid usage
infections
stress of surgery

Question 32

adrenal crisis pathophysiology

Answer 32

inadequate response to stress
causes
hypotension:
decreased myocardial contractility
hypovolemia (low extracellular fluid)

hypoNa, hypoK, hyperCa

hypoglycemia

Question 33

adrenal crisis treatment

Answer 33

give steroids

hypotension: fluid resuscitation, saline for Na loss

glucose infusion for hypoglycaemia

correct hyperkalaemia

correct hormone deficiency:
hydrocortisone

Question 34

prevention of adrenal crisis

Answer 34

acute illness: double dose of oral hydrocortisone (normal steroids)

severe:
IV hydrocortisone

emergency kit injection when waiting for ambulance