Endocrinology

Question 1

acute presentation of type 1 DM

Answer 1

dehydration, ketonuria, hyperventilation (acidosis), abdo pain, vomiting, fetor hepaticus (breath smells like pear drops)

Question 2

general symptoms of DM

Answer 2

polyuria, polydipsia, polyphagia, lethargy, infections, weight loss

Question 3

what test results are indicative of diabetes

Answer 3

venous glucose >7mmol fasting or 11/1mmol random
HbA1c >48
Oral Glucose Tolerance test >11.1

Question 4

How should DM be monitored

Answer 4

pt should self monitor glucose, 4 samples 2 days a week
HbA1c monitored either 6 or 2 monthly
annual eye, foot and neuro screening

Question 5

what should be in place before medications is prescribed

Answer 5

once lifestyle changes have been made, medication alone will not obtain good glycaemic control

Question 6

management of DM

Answer 6

Control CV risk with ACEi, statin, low dose aspirin
Type 1 - insulin (short or long acting)
Type 2 - metformin, sulfonylurea (gliclazide), thiazolidinediones (glitazones). may eventually need insulin. bariatric surgery can be curative

Question 7

name and describe some causes of hypothyroidism

Answer 7

iodine deficiency - most common, presents with goitre
Hashimoto's thyroiditis - autoimmune
primary atrophic hypothyroidism
iatrogenic
hypopituitarism

Question 8

presentation of hypothyroidism

Answer 8

weight gain, fatigue, cold intolerance, constipation, menorrhagia, dry skin, loss of outer 3rd of eyebrow

Question 9

what TFT results would suggest hypothyroidism

Answer 9

High TSH (primary, if secondary would be low)
Low T3 and T4
thyroid antibodies (anti-TPO) seen in 90% cases of autoimmune thyroiditis

Question 10

name and describe some causes of hyperthyroidism

Answer 10

Graves’ disease - autoimmune, causes thyroid enlargement
Toxic thyroid adenoma
Toxic multinodular goitre
pituitary adenoma

Question 11

TFT results in hyperthyroidism

Answer 11

Low TSH (raised if pituitary problem)
High T3 and T4

Question 12

Presentation of hyperthyroidism

Answer 12

heat intolerance, increased appetite, weight loss, sweating, palpitations, diarrhoea, tremor, irritability, mood swings, oligomenorrhoea

Question 13

signs of Graves’ disease

Answer 13

Exophthalmos
pretibial myxoedema
thyroid acropachy
thyroid bruit

Question 14

treatment of hyperthyroidism

Answer 14

Carbimazole
Radio-iodine
surgery - thyroidectomy (beware laryngeal nerve damage)

Question 15

what features of a goitre would prompt a 2 week referral

Answer 15

paediatric case
unexplained hoarseness, voice changes
rapidly enlarging goitre
cervical lymphadenopathy

Question 16

common causes of goitre?

Answer 16

nodule, cyst, colloid, hyperplastic nodule, cancer

Hashimoto’s or Graves’

Question 17

What is Cushing’s syndrome

Answer 17

prolonged exposure to elevated levels of endogenous / exogenous glucocorticoids (cortisol)

Question 18

how are glucocorticoids produced?

Answer 18

Hypothalamus&raquo_space; Corticotrophin releasing factor (CCF)&raquo_space; pituitary&raquo_space; Adrenocorticotrophic hormone (ACTH)&raquo_space; Adrenal Gland&raquo_space; corticosteroids

Question 19

How are the causes of Cushing’s syndrome classified

Answer 19

ACTH dependent (90%)
Non-ACTH dependent

Question 20

What are some ACTH dependent causes of Cushing’s syndrome

Answer 20

ACTH producing pituitary adenomas - 90%

ectopic ACTH producing tumours (small cell lung cancer)

Question 21

What are some non-ACTH dependent causes of Cushing’s syndrome

Answer 21

Adrenal adenoma/carcinoma

iatrogenic - log term treatment with corticosteroids

Question 22

Presentation of Cushing’s syndrome

Answer 22

truncal obesity, moon face, proximal muscle wasting, diabetes, thin skin, gonadal dysfunction, amenorrhoea, hirsutism, osteopenia

Question 23

How is Cushing’s syndrome investigated?

Answer 23

overnight dexamethasone suppression test

should lower levels of ACTH, if not, Cushing’s likely

Question 24

Management of Cushing’s syndrome

Answer 24

gradually stop external corticosteroids (to avoid Addisonian crisis)
removal of ACTH producing tumour

Question 25

parathyroid adenoma causes…?

Answer 25

Hyperparathyroidism

Question 26

What does parathyroid hormone (PTH) do?

Answer 26

increases concentration of calcium in the blood by removal from bones and kidneys resorbing it from the urine and decreases phosphate
normally secreted in response to low calcium levels

Question 27

presentation of hyperparathyroidism

Answer 27

Stones - renal
Bones - osteoporosis
Moans - (psych) lethargy, fatigue
Groans - (abdo) constipation, indigestion, N+V

Question 28

what is secondary hyperparathyroidism

Answer 28

Low calcium, high PTH

caused by vitamin D deficiency or chronic renal failure

Question 29

What is Addison’s disease

Answer 29

Adrenal insufficiency
Primary - glands cannot produce enough steroid hormones
Secondary - inadequate pituitary/ hypothalamic stimulation

Question 30

causes of Addison’s disease

Answer 30

typically autoimmune - associated with Graves’, Hashimoto’s, DM, pernicious anaemia, coeliac disease
TB, metastases, lymphoma

Question 31

presentation of Addison’s disease

Answer 31

Long term - abdominal pain, weakness, weight loss
Acutely - postural hypotension, loss of consciousness, vomiting, back pain
Darkening of the skin may also occur

Question 32

symptoms of acute Addison’s disease (Addisonian crisis)

Answer 32

hypotension, hypovolaemic shock, acute abdo pain, low grade fever, vomiting

Question 33

what will the blood tests show in Addison’s disease

Answer 33

reduced sodium, potassium
Renin high, aldosterone low
Cortisol low

Question 34

Management of Addison’s disease

Answer 34

Hydrocortisone (cortisol)

Fludrocortisone (aldosterone)