Endocrinology Flashcards
Random plasma glucose > …. Is indicative of diabetes
11.1 mmol/l
Fasting plasma glucose > …. Is diagnostic of diabetes
7.0mmol/l
How is a glucose tolerance test performed
Fast overnight, 75g glucose in 300ml water in morning, measure venous plasma glucose before and 2h after drink
When is glucose tolerance test indicated?
Gestational diabetes or borderline
What results indicate normal glucose tolerance
Fasting < 7 and 2h after < 7.8
What gtt results suggest impaired glucose tolerance
Fasting <7 2h after 7.8-11.0
What gtt tests indicate diabetes
Fasting >7.0, 2h after >11.1
What are the features of impaired glucose tolerance
Risk factor for future dm, same risk of cv disease but not micro vascular complications, some pts with liver disease, some obese, some on drugs which impair glucose tolerance
Signs of hyperthyroidism
Being restless, nervous, emotional, irritable, sleeping poorly and ‘always on the go’.
Tremor of your hands.
Losing weight despite an increased appetite.
Palpitations.
Sweating, a dislike of heat and an increased thirst.
Diarrhoea or needing to go to the toilet to pass faeces more often than normal.
Shortness of breath.
Skin problems such as hair thinning and itch.
Menstrual changes - your periods may become very light or infrequent.
Tiredness and proximal muscle weakness may be a feature.
A swelling of your thyroid gland (a goitre) in the neck may occur.
Eye problems if you have Graves’ disease. (See below under ‘What are the causes of hyperthyroidism?’.)
Typical features of addisons
Hyperpigmentation is usually generalized but most often prominent on the sun-exposed areas of the skin, extensor surfaces, knuckles, elbows, knees, and scars formed after the onset of disease. Scars formed before the onset of disease (before the ACTH is elevated) usually are not affected. Palmar creases, nail beds, mucous membranes of the oral cavity (especially the dentogingival margins and buccal areas), and the vaginal and perianal mucosa may be similarly affected.
Hyperpigmentation, however, need not be present in every long-standing case and may not be present in cases of short duration.[6]
Other skin findings include vitiligo, which most often is seen in association with hyperpigmentation in idiopathic autoimmune Addison disease. It is due to the autoimmune destruction of melanocytes.
Almost all patients complain of progressive weakness, fatigue, poor appetite, and weight loss.
Prominent gastrointestinal symptoms may include nausea, vomiting, and occasional diarrhea. Glucocorticoid-responsive steatorrhea has been reported.[7]
Dizziness with orthostasis due to hypotension occasionally may lead to syncope. This is due to the combined effects of volume depletion, loss of the mineralocorticoid effect of aldosterone, and loss of the permissive effect of cortisol in enhancing the vasopressor effect of the catecholamines.
Myalgias and flaccid muscle paralysis may occur due to hyperkalemia.[8]
Patients may have a history of using medications known to affect adrenocortical function or to increase cortisol metabolism.
Other reported symptoms include muscle and joint pains; a heightened sense of smell, taste, and hearing; and salt craving.
Patients with diabetes that previously was well-controlled may suddenly develop a marked decrease in insulin requirements and hypoglycemic episodes due to an increase in insulin sensitivity.[9]
Impotence and decreased libido may occur in male patients, especially in those with compromised or borderline testicular function.
Female patients may have a history of amenorrhea due to the combined effect of weight loss and chronic ill health or secondary to premature autoimmune ovarian failure. Steroid-responsive hyperprolactinemia may contribute to the impairment of gonadal function and to the amenorrhea.
Features of adrenal crisis
Sometimes, however, the signs and symptoms of Addison’s disease may appear suddenly. In acute adrenal failure (addisonian crisis), the signs and symptoms may also include:
Pain in your lower back, abdomen or legs Severe vomiting and diarrhea, leading to dehydration Low blood pressure Loss of consciousness High potassium (hyperkalemia) Hypovolaemia
Causes of hyperthyroid
Graves, toxic multinodular goitre (elderly and iodine deficient areas), adenoma, ectopic thyroid tissue from ovarian teratoma/metastatic thyroid ca, iodine excess
Causes of hypothyroidism
Autoimmune Hashimotos (goitre plus maybe hyperthyroid phase), primary atrophic (no goitre)
Iodine defficiency,
post thyroidectomy/radioiodine
Drug induced (carbimazole, lithium, amioderone(
