Endocrinology Flashcards
3 basic problems with endocrine system?
- excess hormones - widespread effect
- reduced hormones - widespread effect
- physical gland enlargement - mass pressure/effect
pituitary gland produces what hormone that encourages the thyroid to produce T4/T3?
TSH
Thyroxine excess is a disease of the thyroid causing?
hyperthyroidism
thyrotoxicosis
Thyroxine lack is a disease of the thyroid causing?
hypothyroidism
Thyroid mass changes is a disease of the thyroid causing?
Goitre
incidence of hyperthyroidism?
2-3% of women
0.2% men
age common = 20-40 years
most common causes of hyperthyroidism?
autoimmune e.g graves disease = most common
goitre or toxic adenoma
pituitary driven
symptoms of hyperthyroidism?
sweating, heat intolerance
irrtable, poor sleep, anxiety, palpitations
excess appetite, weight loss, diorrhea
breathlessness
signs of hyperthyroidism?
warm moist skin tachycardia - irregular heart rate increased blood pressure, heart failure fine tremor goitre
what is graves disease?
eye disease exopthalmus opthalmaplegia lid lag/retraction loss of visual activity
signs of graves disease?
pretibial myxoedema
diagnose graves disease?
clinical
blood tests - thyroid function - low TSH, high T3/4, autoantibodies
radiology sometimes
management of graves disease?
anti thyroid drugs - carbimazole, propylthiouracid
beta blockers - control symptoms while other tx
surgery - control disease first, poss eye surgery
radioactive iodine - caution if youner/pregnant/breastfeeding
incidence of hypothyroidism?
2% women
0.2% men
mean age of diagnosis = 60 yrs
causes of hypothyroidism?
autoimmune most common = destructive
iatrogenic - surgery, radioiodine
iodine deficiency - rare - iodised salt/fish, poor mountainous areas
rarely pituitary disease
symptoms of hypothyroidism?
cold intolerance weight gain constipation hoarse voice puffed face/extremities mental slowness/poor memory hair loss
signs of hypothyroidism?
slow pulse large tongue deep voice thin/dry hair loss of eyebrows goitre coarsening of features acute - rare - coma - hypothermia
diagnosis of hypothyroidism?
clinical
blood tests - thyroid function tests - high TSH, low T4/T3
auto antibodies
radiology
management of hypothyroidism?
replacement
thyroxine
levothyroxine
what is goitre?
thyroid masses
types of goitre?
- no association with intrinsic thyroid disease - simple cysts/adenomas - iodine deficiency
- associated with intrinsic thyroid disease - autoimmune, toxic multi nodular goitre/adenoma
- Malignant = rare
Goitres can cause?
retro sternal extension = dysphagia/breathing difficulties
what is an ominous sign of goitre?
look for lymph node enlargement
goitre investigations?
radiology - ultrasound/radioisotope scans
fine needle aspiration
blood tests
treatment of goitre?
remove underlying cause
may need surgery
anti thyroid drug carbimazole can cause what orally?
neutropenia
taste distrubances
types of adrenal disease?
- excess corticosteroid - Cushings
- deficient corticosteroid production - Addisons
what is Cushings syndrome?
excess ACTH caused by pituitary adenoma
or ectopic production by lungs = cancer
excess corticosteroids caused by?
adrenal adenomas
carcinomas
iatrogenic
Cushings syndrome has what systemic risk factors?
can cause high bp
diabetes
pt prone to infection
what is Addison’s disease?
- caused iatrogenically by withdrawl of steroids after long term use
- hypopituitarism - b/c cancer, infection, vascular, trauma
- adrenal destruction - b/c autoimmune disease
what is chronic addisons?
general malaise
what is acute addisons?
response to stress
infection/trauma/surgery
life threatening
=> shock, hypoglycaemia, vomiting, abdominal pain
signs of addisons?
hyperpigmentation
buccal mucosa scars, pressure points, skin creases
treatment of addisons?
replacement therapy = baseline tx
hydrocortisone - glucocorticoid 20mg am 20mg pm
flufrocortisone - mineralcorticoid
what is an acute addisonian crisis?
medical emergency need fluid replacement glucose hydrocortisone injection treat if infection is present hospital
dentally look out for what with addisons pt? cushings?
addisons - hyperpigmentation
cushings - oral infections/poor wound healing
what is an excess of growth hormone?
acromegaly
caused by pituitary adenoma - rare = 2-3/million
signs of acromegaly?
large tongue excess hair spade like hands/feet - myopathy/arthritis pronounced supraorbital ridge broad nose prognathism inderdental seperation thick greasy skin diabetes high bp heart failure
treatment of acromegaly?
medically - somatostatin analouges
surgery - compressing nearby structures, also radiotherapy
types of diabetes?
type 1 - IDDM 10% autoimmune young pts
type 2 - NIDDM 90% - insulin resistance/deficiency - more likely if obese >40 yrs. 10% are over 70
what does diabetes cause an increased risk of?
increased risk of all infections
what is seen on skin/mouth with diabetes?
boils, abscesses, cellulitis, candidosis
what kind of diseases are seen commonly with diabetic pt’s?
diabetic retinopathy
diabetic nephropathy
diabetic neuropathy - loss of sensation, loss of bowel/bladder/sexual function, muscle weakeness/pain
what type of heat condition is common with diabetic pts?
atherosclerosis
foot problems with diabetes?
atherosclerosis
neuropathy
infections
treat type 1 with?
insulin
type 2 treat with?
sometimes insulin initially dietary sulphonylureas biguanides glitazones
emergencies with diabetes - high blood sugar?
DKA
HONK - hyperosmolar non ketotic coma
low blood sugar?
hypoglycaemia
what is DKA?
insulin not taken in because no food intake
inadequate insulin in acute physiological stress = infection/surgery
what is dka often a combo with?
gastroenteritis
impaired consciousness, dehydration, ketones on breath
