Endocrinology Flashcards
Addisons:
Presentation
Tired Tearful Lethargic Nausea Vomiting/diarrhoea Pigmented buccal area or palmar creases Weight loss Pain
Addisons:
Bloods
⬇️Na ⬆️K ⬆️Ca Uraemia Anaemia
Synacthen test
Give 250mg of syncathen (synthetic cortisol) measure after 30 mins. If >550ml then not addisons
Addisons:
Treatment
Hydrocortisone replacement, 10mg in the morn then 5mg lunch 5mg evening. If come in actually unwell immediately x4 their normal dose stat.
Addison’s disease:
Causes
TB
Autoimmune
Adrenal metastases
DKA:
Sx
Drowsiness, vomiting, dehydration, abdo pain, polyuria, polydypsia, anorexia, deep breathing in type 1 (rarely type2)
Triggered by chemo, new drug, UTI/infection , surgery, MI, pancreatitis
DKA:
Diagonsis
DKA:
Management
If plasma glucose >20 give 4-8u soluble insulin
Fluid and K+ replacement
LMWH until mobile, - immobile + high plasma osmolality
DKA:
Investigations
Glucose U+E (potassium) ABG ( for ph and bicarbonate) Amylase Osmolality FBC Cultures (underlying inf)
SIADH:
Diagnosis
Concentrated urine ie Na+ >20, osmolality >500
In presence of hypo atresia
SIADH:
Causes
Malignancy - SCLC, pancreas, prostate, thymus, lymphoma
CNS - meningitis, access, stroke, SAH/SDH, injury
Chest - TB, pneumonia, abscess, aspergillosis
Endocrine - hypothyroid ( not true SIADH)
Drugs - opiates, psychotropics, SSRIs
HIV
SIADH:
Tx
Treat cause
Restrict fluid
If severe, salt +- loop diuretic
Diabetes insipidus
Loads of dilute urine due to either not enough ADH from posterior pituitary or impaired response of the kidney to ADH
Diabetes insipidus:
Symptoms
Polyuria, polydypsia, dehydration - uncontrollable thirst
Diabetes insipidus:
Causes
Congenital, tumour (craniopharyngoma, pituitary) Trauma Haemorrhage Infection (meningitis) Lithium Chronic renal disease
Diagnosis with water deprivation test
What fasting blood level confirms diabetes?
> 7
What level of blood glucose after glucose load confirms diabetes?
> 11
Subacute (De Quervains) thyroiditis
Hyperthyroidism following viral illness
Painful goiter
Self limiting, steroids if severe or hypothyroid develops
⬇️ TSH
⬆️ T4
⬆️ESR
HONK
Triad of:
hyperglycaemia + dehydration + Mild/absent ketonuria
Tx: slowly replace fluid, insulin sliding scale
Causes of hypothyroidism
Iodine deficiency (developing world)
Hashimotos
De Quervains (painful)
Thyroid adenomas
HONK
Triad of:
hyperglycaemia + dehydration + Mild/absent ketonuria
Tx: slowly replace fluid, insulin sliding scale
Causes of hypothyroidism
most to least common
Iodine deficiency (developing world)
Hashimotos
De Quervains (painful)
Thyroid adenomas
Side effects of Gliptins
Weight neutral
No hypos
When to add GLP1?
e.g exenatide
if already on triple therapy ( e/g metformin+gliptin+sulfonylurea)
Or BMI more than 35
When do you treat subclinical hypothyroidism?
TSH >10
Thyroid antibody +ve
Autoimmune disorder
Previous tx of Graves
otherwise risks leading to overt hypothyroid
Side effects of radioiodine tx of hyperthyroid
Pregnancy (up to 6m after tx)
Thyroid eye disease may worsen
V likely to be hypothryoid in future
MODY
TD2M before 25 yr old Autosomal dominant HNF alpha mutation V sensitive to sulfonylureas, shouldnt need insulin No ketosis
Unwell Addisons pt
Double glucocorticoids (hydrocortisone) Keep mineralcorticoid (fludrocortisone) the same
CI to glitazones
Heart failure
Addisons features
hypoglycaemia
hyponatraemia
hyperkalaemia
acidosis
De Quervains
Hyperthyroid
Tender goitre
Reduced iodine uptake
Self limiting
Primary Hyperparathyroidism
elderly females unquenchable thirst - bones, moans, groans Raised calcium Low phosphate normal/ high PTH level usually from solitary adenoma
Secondary hyperparathyroidism
High PTH Low calcium High phosphate High vit D ax w CKD Parathyroid gland hyperplasia from low calcium
Normal/high PTH
Raised Calcium
Low Phosphate
Primary Hyperparathyroidism
Normal/high PTH
Low Calcium
High Phosphate
Secondary hyperaparthyroidism
Tertiary Hyperparathyroidism
High PTH Normal/high calcium Low Phosphate ALP High Vit D normal or low Ongoing hyperplasia after corrected CKD
Multiple Endocrine Neoplasia II
thyroid carcinoma
parathyroid adenoma
phaeochromocytoma
TFTs Thyrotoxicosis/Graves
TSH - Low
T4 - High
TFTs
Primary Hypothyroid
TSH - high
T4 - Low
TFTs
Secondary Hypothyroidism
TSH - low
T4 - low
TFTs
Sick Euthyroid
TSH - low
T4 - low
T3 - low
hx of illness
TFTs
Subclinical hypothyroidism
TSH - high
T4 - normal
Cushings metabollic affect
hypokalaemic metabollic alkalosis
