Endocrinology Flashcards
acute presentation of type 1 DM
dehydration, ketonuria, hyperventilation (acidosis), abdo pain, vomiting, fetor hepaticus (breath smells like pear drops)
general symptoms of DM
polyuria, polydipsia, polyphagia, lethargy, infections, weight loss
what test results are indicative of diabetes
venous glucose >7mmol fasting or 11/1mmol random
HbA1c >48
Oral Glucose Tolerance test >11.1
How should DM be monitored
pt should self monitor glucose, 4 samples 2 days a week
HbA1c monitored either 6 or 2 monthly
annual eye, foot and neuro screening
what should be in place before medications is prescribed
once lifestyle changes have been made, medication alone will not obtain good glycaemic control
management of DM
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
name and describe some causes of hypothyroidism
iodine deficiency - most common, presents with goitre Hashimoto's thyroiditis - autoimmune primary atrophic hypothyroidism iatrogenic hypopituitarism
presentation of hypothyroidism
weight gain, fatigue, cold intolerance, constipation, menorrhagia, dry skin, loss of outer 3rd of eyebrow
what TFT results would suggest hypothyroidism
High TSH (primary, if secondary would be low) Low T3 and T4 thyroid antibodies (anti-TPO) seen in 90% cases of autoimmune thyroiditis
name and describe some causes of hyperthyroidism
Graves’ disease - autoimmune, causes thyroid enlargement
Toxic thyroid adenoma
Toxic multinodular goitre
pituitary adenoma
TFT results in hyperthyroidism
Low TSH (raised if pituitary problem) High T3 and T4
Presentation of hyperthyroidism
heat intolerance, increased appetite, weight loss, sweating, palpitations, diarrhoea, tremor, irritability, mood swings, oligomenorrhoea
signs of Graves’ disease
Exophthalmos
pretibial myxoedema
thyroid acropachy
thyroid bruit
treatment of hyperthyroidism
Carbimazole
Radio-iodine
surgery - thyroidectomy (beware laryngeal nerve damage)
what features of a goitre would prompt a 2 week referral
paediatric case
unexplained hoarseness, voice changes
rapidly enlarging goitre
cervical lymphadenopathy
common causes of goitre?
nodule, cyst, colloid, hyperplastic nodule, cancer
Hashimoto’s or Graves’
What is Cushing’s syndrome
prolonged exposure to elevated levels of endogenous / exogenous glucocorticoids (cortisol)
how are glucocorticoids produced?
Hypothalamus»_space; Corticotrophin releasing factor (CCF)»_space; pituitary»_space; Adrenocorticotrophic hormone (ACTH)»_space; Adrenal Gland»_space; corticosteroids
How are the causes of Cushing’s syndrome classified
ACTH dependent (90%) Non-ACTH dependent
What are some ACTH dependent causes of Cushing’s syndrome
ACTH producing pituitary adenomas - 90%
ectopic ACTH producing tumours (small cell lung cancer)
What are some non-ACTH dependent causes of Cushing’s syndrome
Adrenal adenoma/carcinoma
iatrogenic - log term treatment with corticosteroids
Presentation of Cushing’s syndrome
truncal obesity, moon face, proximal muscle wasting, diabetes, thin skin, gonadal dysfunction, amenorrhoea, hirsutism, osteopenia
How is Cushing’s syndrome investigated?
overnight dexamethasone suppression test
should lower levels of ACTH, if not, Cushing’s likely
Management of Cushing’s syndrome
gradually stop external corticosteroids (to avoid Addisonian crisis)
removal of ACTH producing tumour
