Endocrinology Flashcards
Differentials for a neck examination?
Thyroid disease SVC obstruction Cervical lymphadenopathy Carotid aneurysm or bruit JVP abnormalities Trachial deviation
Causes of a diffuse goitre?
Idiopathic Puberty Pregnancy and post-partum Graves disease Thyroiditis - hashimotos, subacute thyroiditis, chronic fibrosis Simple goitre Goitrogens - iodine excess and drugs Inborn errors of thyroid hormone synthesis - Pendred's syndrome
Causes of primary thyrotoxicosis?
Graves disease Toxic adenoma or MNG Hasimotos thyroiditis, subacute thyroiditis Iodine excess Excess thyroid hormone replacement Post partum thyroiditis Drugs - amiodarone or Li
Causes of secondary thyrotoxicosis?
Pituitary TSH Ectopic TSH Hydatidiform mole or choriocarcinoma Struma ovarii Factitious
Signs of graves disease?
Exophthalmos
Inferior oblique muscle power loss - loss of convergence
Goitre
Pretibial myxoedema
Signs of hypocalcaemia?
Chvostek’s sign - tapping facial nerve –> twitch
Trousseau’s sign - pump up sphygmomanometer above systolic BP –> main d’accoucheur - strongly adducted thumb and bent MCP joints of fingers
Primary causes of hypothyroid WITHOUT a goitre?
Idiopathic atrophy
Treated hyperthyroidism
Agenesis
Primary causes of hypothyroid WITH a goitre?
Chronic thyroiditis Drugs - Li and amiodarone Endemic iodine deficiency Iodine-induced hypothyroidism Inborn errors - enzyme deficiency
Secondary causes of hypothyroidism?
Pituitary lesions
Tertiary causes of hypothyroidism?
Hypothalamic lesions
Transient causes of hypothyroidism?
Thyroid treatment withdrawn
Subacute thyroiditis
Postpartum thyroiditis
Causes of anaemia in patients with hypothyroidism?
Chronic disease Folate deficiency Pernicious anaemia Iron deficiency Haemolysis
Neurological associations of hypothyroidism
Entrapment - carpal tunnel, tarsal Delayed relaxation of reflexes Nerve deafness Peripheral neuropathy Proximal myopathy Hypokalaemic periodic paralysis Eaton-Lambert syndrome Cerebellar syndrome Psychosis Coma Cerebrovascular disease Muscle cramps
Signs of panhypopituitarism?
Short stature Pale skin Lack of hair Fine skin wrinkles No secondary sexual characteristics Fat abdomen Bitemporal hemianopia Gynaecomastia Slow relaxation of ankle jerks Postural drop in BP Scar of pituitary surgery
Signs of cushing’s disease?
Central obesity and thin limbs Skin bruising and atrophy Poor wound healing Pigmentation - ATCH tumour Purple striae Proximal myopathy Plethora Hirsuitism Moon shaped face Bitemporal hemianopia Buffalo lump Kyphoscoliosis Hypertension
