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Thyroid treatment withdrawn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
Investigations for cushing’s syndrome?
24 hour urine cortisol - high Overnight dexamethasone suppression test - no cortisol suppression ACTH level - high Petrosal ACTH sampling MRI brain FBC - polycythaemia, neutrophilia, eosinophilia Electrolytes - Hypokalaemia Hyperglycaemia
Signs of Acromegaly?
Enlarged hands Thickened ulnar nerve Proximal myopathy Acanthosis nigricans Skin tags Greasy skin Frontal bossing Hirsuitism Macroglossia Prognathism Husky voice Bitemporal hemianopia CN III, IV, VI and V palsies Papilloedema Diffuse thyroid goitre Cardiac failure Abdominal organomegaly OA of knees and hips Entrapment neuropathy Hypertension Hyperglycaemia
Signs of activity of Acromegaly?
Skin tag number Excessive sweating Glycouria Visual field impairment Development of CN III, IV, VI and V palsies Enlarging thyroid goitre Hypertension Headache Increasing ring size Increasing shoe size Increasing denture size
Investigations for Acromegaly?
IGF-1 plasma level
Glucose tolerance test -no suppression
MRI brain
Clinical signs of Addisons disease?
Pigmentation - buccal and gums, palmar, elbows, genitals Vitaligo Ear lobe calcification Postural drop Hyperglycaemia and glycosuria
Autoimmune associations with Addisons disease?
Hypoparathyroidism Mucocutaneous candidiasis T1 DM Hashimoto's thyroiditis Grave's Disease Primary ovarian failure Pernicious anaemia Vitiligo Alopecia Hypophysitis Myasthenia Gravis
Causes of Addison’s Disease?
Iatrogenic - steroid use Autoimmune adrenal disease Polylglandular syndromes TB Histoplasmosis Amyloidosis Sarcoidosis Metastatic disease Demylinating disease Drugs - heparin, ketoconazole Pituitary or hypothalamic disease
Investigations for Addisons disease?
Short synacthen test Long synacthen test ATCH level FBC - Lymphocytosis, eosinophilia Electrolytes - hypoNa, HypoK, Hyperchloraemia, hypercalcaemia Hypoglycaemia
Clinical signs of DM?
Obesity Hair loss Necrobiosis lipoidica Pigmentation Atrophy Ulceration Muscle wasting Proximal myopathy Charcot's joint Loss of peripheral pulses Peripheral neuropathy Argyll-Robertson pupils III, IV and VI palsies Fundi examination Hepatomegaly from NASH Fat hypertrophy Hyperglycaemia and glycosuria HTN
Features of automatic neuropathy?
Postural hypotension Loss of sinus arrhythmia Valsalva manoeuvre --> NO pulse slowing Loss of sweating Erectile dysfunction Nocturnal diarrhoea Urine retention Incontinence
Features of diabetic retinopathy?
Dot and blot haemorrhages Hard exudates Cotton wool spots Microaneurysms Dilated veins Proliferation of new vessels Vitreous haemorrhage Scar formation Retinal detachment Laser scars
