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Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Symptoms and signs of Hyperthyroidism

A

Symptoms

  • Nervous, anxious, increased perspiration
  • Heat intolerance, hyperactivity
  • Palpitations
  • Diarrhoea
  • Wieght loss despire increase in appetite
  • oligomenorrhoea

Signs

  • Tachycardia or atrial arrhythmia
  • Systolic hypertension - wirth wide pulse pressure
  • Warm, moist skin
  • Lid lag
  • Hand tremor
  • Muscle weakness

Graves Disease

  • Ophthalmopathy –> Exophthalmos, periorbital oedema –> lid lag, lid retration, diplopia
  • Goitre
  • Pretibial myxedema (hyaluronic acid in the subcutis of the shins)
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2
Q

Causes of hyperthyroidism

A

Primary hyperthyroidism

  1. Graves Diseae
  2. Hyperfunctional Multinodular Goitre
  3. Hyperfuctnional thyroid adenoma (most carcinomas are not functional)
  4. Hashitoxicosis (early phase of hashimotos)
  5. Iodine overload
  6. Drugs - lithium, thyroixine
  7. Paraneoplastic syndrome (germ cell tumour e.g. teratoma)

Secondary hyperthyroidism

  1. Pituitary adenoma –> increase production of TSH
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3
Q

How do you differentiation secondary and primary hyperthyroidism through investigations

A
  1. Serum free T4, T3 –> elevated in hyperthyroidism
  2. TSH –> suppressed in primary disease, not suppressed in TSH mediated disease (secondary)
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4
Q

What are the investigations for thyroid disease

A

Blood tests

  • Free T4, T3
  • TSH
  • Serum thyroglobulin levels (Tg) –> low levels if exogenous thyroid hormone
  • Serum thyroid antibodies
    i) Thyroid receptor antibodies –> Grave’s Disease
    ii) Thyroid peroxidase –> Hashimotos, Graves
    iii) Thyroglobulin antibodies –> Hashimotos, Graves, T1DM, thyroid cancer

Imaging

  • Thyroid U/S
  • Thyroid scintigraphy (nuclear medicine scan)
  • -> Normal thyroid - diffuse uptake of RAI
  • -> Graves - enlarged gland with increased RAI uptake
  • -> Toxic MNG - multiple nodules both hot and cold
  • -> adenoma - hot nodule
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5
Q

Treatment of hyperthyroidism

A

First line of Graves and MNG:

  • Carbimazole 10-45mg orally, daily 2-3 doses (inhibits thyroperoxidase)

Second line of Graves and MNG:

  • Propylthiouracil 200-600mg orally, daily 2-3 doses (inhibits thyroperoxidase and periopheral deiodination of T4)

Sympatheric NS treatment e.g. tremor, tachycardia, eyelid retraction

  • Propranolol 10mg orally

Other treatments:

  • Thyroidectomy and replace T4
  • Irradiate gland and replace T4
  • Potassium iodide (prevent peripheral deiodination of T4)

Adverse effect of thyroid drugs –> agranulocytosis

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6
Q

Causes of hypothyroidism

A

Primary

  • Hashimoto’s - autoimmune thyroiditis
  • Iodine deficiency/ Maternal def.
  • Surgery/ irradiation

Secondary

  • pituitary adenoma
  • pituitary apoplexy
  • Sheehan’s syndrome
  • head trauma
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7
Q

Symptoms and signs of hypothyroidism

A
  • Weakness, lethargy
  • Weight gain
  • Dry skin
  • cold intolerance
  • Constipation
  • Depression
  • Ammenorrhoea
  • Facial oedema
  • Bradycardia
  • Goitre
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8
Q

Two serious complications of hypothyroidism in childhood and adulthood

A

Childhood –> Cretinism (Impaired development of skeleton and CNS)

  • Short stature, course facial features, protruding tongue and severe mental impairment

Adulthood –> Myxoedema

  • Slowing of physical and mental activity
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9
Q

Treatment of hypothyroidism

A

Thyroxine (T4) 30-100ug/day

*T3 is available as IV formulation, for rapid treatment of life threatening hypothyroidism

Adverse effects - sinus tachycardia, arrhythmias, angina, restlessness, tremor

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10
Q

Causes of hypernatraemia

A

Hypovolemic

  • Dehydration (poor flood intake, diarrhoea)
  • Diuretics, osmotic diuretics (hyperglycaemia, uraemia)

Euvolemic

  • Diabetes inspidus

Hypovolemic

  • Primary hyperaldosteonism
  • Cushing’s syndrome
  • Iatrogenic - excess NaCl
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11
Q

Clinical features of sodium imbalance

A

Mild

  • Anorexia
  • N + V
  • Headache
  • Muscle cramps

Moderate

  • Muscle weakness
  • Lethargy
  • Confusion

Severe

  • Seizures
  • Altered consiousness

Symptoms also depend on the onset of sodium imbalance

  • Acute onset (<48hrs) usually symptomatic event even with mild sodium derangements

Subacute (>48hrs) usually asymptomatic unless severe derangements are present

Orthostatic hypotension, oliguria, impaired thirst

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12
Q

Investigations and results for hypernatraemia

A
  • Serum sodium concentration - increased
  • Serum osmolarity - increased
  • Haematocrit - increased in hypovolaemia, dehydration
  • Urinalysis - osmolarity > 800mOsmol/kg in extra-renal loss and < 800mOsmol/kg in renal loss
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13
Q

Treatment of hypernatraemia

A
  1. Treat underlying cause
  2. Patients with serum sodium values <>160mEq/L require intensive care
  3. Careful correction of sodium levels: maximum correction within 24 hours is 10mEq/L (rate of correction: 0.5-1mEq/L per hour)
  • Effects of rapid correction - Rapid decrease in serum sodium à risk of cerebral oedema

Correct free water deficit

  • Mild hypernatraemia à oral rehydration
  • Moderate to severe hypernatraemia à hypotonic saline or 5% dextrose

Hypovolaemia hypernatraemia

  • Fluid resuscitation
  • Once adequately resuscitation à correct free water deficit

Euvolemic hypernatremia

  • Correct free water deficit

Hypervolemic hypernatraemia

  • Loop diuretic + 5% dextrose
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14
Q

Causes of hyponatraemia

A
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15
Q

Investigations in hyponatraemia

A

Blood tests

  1. Serum Sodium
  2. Serum osmolality
  3. Haematocrit
  • ¯ - possibly fluid overload
  • ­ - hypovolaemia, dehydration

Urine examination

  1. Urine sodium concentration
  • >20Eq/L implies renal sodium loss
  • <20Eq/L implies extra renal sodium loss
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16
Q

Treatment for hyponatraemia

A
  1. Treat underlying cause
  2. Patients with serum sodium values < 120mEq/L require intensive care
  3. Careful correction of sodium levels: maximum correction within 24 hours is 10mEq/L (rate of correction: 0.5-1mEq/L per hour)
  • Effects of rapid correction - Rapid increase in sodium levels à risk of central pontine myelinolysis

Hypovolemic hyponatraemia

  1. Mild – moderate –> normal saline
  2. Severe symptoms –> hypertonic saline

Euvolemic hyponatraemia

  1. Mild – moderate –> fluid restriction
  2. Severe à hypertonic saline

Hypervolaemia hypnatraemia

  1. Mild – moderate à fluid restriction +/- loop diuretic
  2. Severe –> isotonic saline
17
Q

Symptoms of T1DM

A
  • polydipsia
  • polyuria
  • weight loss
  • blurred vision
  • nausea and vomiting
  • abdominal pain
  • lethargy
18
Q

Acute complications of T1DM and T2DM

A
  1. DKA –> T1DM
  2. Hypoglycaemia –> over treatment
  3. Hyperglycaemic hyperosmotic state –> T2DM
19
Q

Chronic complications of Diabetes

A

1) Predisposition to infection
2) Microangiopathy

  • Diabetic nephropathy - decreased GFR + albuminuria
  • Neuropathy - peripheral and autonomic
  • Retinopathy - proliferative and non-proliferative

3) Macroangiopathy

  • CVD, cerebrovascular disease
  • PAD
  • HTN
  • Diabetic foot
20
Q

Investigations for diabetes

A
  1. Fasting and random plasma glucose
  • Fasting glucose - (>7mmol/L – should be between 3.5-5.5mmol/L)
  • Casual - 11.0mmol/L
  1. Plasma or urine ketones
  2. HbA1c
  • >6.5%
    iv. Urinalysis
21
Q

Treatment for T1DM

A
  • Diet and Exercise - Low GI foods
  • Monitoring - finger-prick blood test, specialist
  • Insulin
    First line –> Basal-bolus regiment
  • Bolus - Aspart 100 units/mL
  • Basal - Glargine 100 units/mL
    Total insulin 0.5-0.8units/kg for an adult
    Side effects –> hypoglycaemia, weight gain, injection site scaring

Can also add sotaglifozin –> SGLT1/2 inhibitor

22
Q

Causes of DKA

A
  • Insufficient insulin replacement
    • Under administration – insulin pump failure, forgotten injection, non-compliance
    • Undiagnosed, untreated diabetes
  • Increased insulin demand
    • Stress –> infection, illness, surgery, trauma, MI
    • Drugs etc. –> Glucocorticoid therapy, cocaine use, alcohol abuse
23
Q

Symptoms and signs of DKA

A

Symptoms

  • Nausea and vomiting
  • Fatigue
  • Abdominal pain
  • Ketotic breath
  • Laboured Breathing
  • LOC
  • Polydipsia and polyuria

Signs

  • Dry mucus membranes
  • Decreased skin turgor
  • Tachycardia, tachypnoea
  • Abdominal tenderness
24
Q

Investigation results in DKA

A
  1. Plasma glucose - elevated
  2. ABG and electolytes
    - pH < 7.3
    - Increased pO2, K+
    - decreased pCO2, bicarbonate, K+
  3. Capillary or serum ketones - elevated
25
Q

Management of DKA

A
  1. Fluids - correct fluid loss and dehydration
  2. IV insulin - correction of BSL and ketone
  3. K+ correction and other electrolytes
26
Q

Causes of Hypoglycaemia

A

Diabetics

  • Too much insulin
  • Delaying or missing a meal
  • Unplanned physical activity 

  • Drinking alcohol 


Non-diabetic 


  • Growth hormone deficiency and adrenal deficiency 

  • Endogenous excess of insulin – insulinoma
27
Q

Symptoms of hypoglycaemia

A
  • shaking, trembling
  • sweating, paleness
  • hunger
  • light headedness, headache, dizziness
  • pins and needles around mouth
  • LOC
  • confusion
28
Q

Treatment for hypoglycaemia

A

Mild –> sweat snack

Severe –> glucose 15-20g IV or glucagon 0.1-1mg IM/ SC

29
Q

Treatment of type 2 diabetes

A
  • 1st line - Metformin - CrCL > 60mL/min - 500mg orally BD, increasing dose up to 2g daily
  • Add on Sulfonylurea - gliclazide 40mg orally OD or BD up to 320mg
  • Consider bariatric surgery

Non-Pharm

  • lifestyle measures - dieat and exercise
  • reduce CVD risk factors
30
Q

What is hyperglycaemic hyperosmotic state?

A

A serious metabolic complication of diabetes characterised by severe hyperglycaemia, hyperosmolar, and volume depletion in the absence of severe ketoacidosis, occurs most commonly in older people with T2DM. the result is severe dehydration due to severe osmotic diuresis due to hyperglycaemia.

31
Q

Investigations for hyperglycaemic hyperosmotic state

A
  1. Plasma glucose – elevated
  2. Serum ketones – not elevated
  3. Serum osmolality – elevated
  4. Urinalysis – positive for glucose, positive for leukocytes and nitrates in absence of infection, negative or only mildly positive for ketones
32
Q
A

Medicine (11 decks)

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