Endocrinology Flashcards
Cushing’s syndrome
Causes: ectopic ACTH, exogenous steroids, ACTH-independent (adrenal hyperplasia, benign adenoma)
Centripetal obesity, bruising, dark palmar creases
Recent onset diabetes mellitus
Cushing’s disease
Pituitary adenoma
Long synATCHen test: some suppression after a while
Nephrogenic diabetes insipidus causes
Hereditary
Hypercalcaemia
Lithium
Thiazide diuretic
Psychogenic polydipsia
Schizoprenia
Urine osmolality increases concentration with water deprivation
SIADH
Hyponatraemia
High urine osmolality
Generalised weakness, hyporeflexia, ataxia, lethargy, confusion
Kallmann’s syndrome
Isolated hypogonadotrophic hypogonadism
Anosmia/hyposmia
Colour blindness
Cleft palate
Acromegaly
Coarse features: thick jaw, prominent brow bone, large hands/feet
Insidious onset
Growth hormone-secreting pituitary
Addison’s disease
Adrenal insufficiency GI disturbance, weight loss, postural HTN Hyperkalaemia Hyponatraemia Lacking aldosterone
Addisonian crisis
Abdo pain, CNS signs (confusion, ataxia, reduced GCS), fatigue, weakness, hypotension, hypoglycaemia
Management: 100mg IV hydrocortisone stat
IV fluids (NaCl) 1L per hour until stabilised
100ml 20% dextrose stat 10-15mins then 10% 100ml/hr if needed
Treat precipitating event
Conn’s syndrome
Hypokalaemia Hypernatraemia High bicarbonate (HCO3) Aldosterone-producing adenoma Metabolic alkalosis
MEN1
Parathyroid tumour
Pituitary adenoma
Pancreatic tumour (Zollinger-Ellison syndrome)
MEN 2a
Medullary thyroid tumour (amyloidosis)
Phaeochromocytoma
Primary hyperparathyroidism
MEN 2b
Phaeochromocytoma
Medullary thyroid tumour (amyloidosis)
Marfan’s syndrome
Organ fibrosis
Hyperthyroidism
Increased metabolism
Insomnia, palpitations, weight loss, diarrhoea, increased appetite, tremor
Grave’s disease
Exophthalmos Pretibial myxoedema (shin rash) TSH-receptor antibodies Diffuse goitre Diffuse radioisotope uptake
Hashimoto’s disease
Autoimmune hypothyroidism
Weight gain, lethargy, constipation
Anti-thyroglobulin, anti-microsomal, anti-thyroid peroxidase, anti-TSHr
De Quervain’s thyroiditis
Prodromal flu-like illness (influenza, coxsackie, mumps) Raised ESR Inflammation = hyperthyroidism Exhaustion of thyroxine = hypothryoidism Recovery = euthyroid
Riedel’s thyroiditis
Slow growing
Hard, immobile, enlarged
Biopsy: fibrotic tissue
Difficulty breathing and swallowing
Anaplastic carcinoma
Rare, elderly
Rapidly enlarging
Fixed to skin
Papillary carcinoma
Adolescents and young adults
Biopsy: Orphan Annie eyes, psammoma (sandy) bodies
Lymphadenopathy
Follicular carcinoma
Middle aged
Spread to lung/bone
Medullary carcinoma
Tumour marker: calcitonin
MEN2
Toxic multinodular goitre
Lumpy, irregular thyroid
Plummer’s syndrome
Autonomous hyperfunctioning nodules
Nodular radioisotope uptake scan
Primary hyperparathyroidism
Increased PTH, Ca2+
Hypercalcaemia: stones, bones, abdo groans, psychic moans
Polyuria, polydipsia
Secondary hyperparathyroidism
High PTH
Low serum Ca2+
Chronic kidney disease, vitamin D deficiency
Tertiary hyperparathyroidism
Prolonged secondary hyperparathyroidism
Hypercalcaemia
Loss of feedback = autonomous production
Hypercalcaemia
Ca2+ 2.2-2.6 mmol/L
Bones, moans, stones, groans Hyperparathyroidism, malignancy, vitamin D intoxication or sarcoidosis
Multiple myeloma
Hypocalcaemia
Ca2+ 2.2-2.6 mmol/L
CKD, parathyroid failure, post-thyroidectomy, hypomagnesaemia
Hypoparathyroidism
Trousseau’s sign
Chvostek’s sign
Weakness, cramps
Nelson’s syndrome
Bilateral adrenalectomy and Cushing’s
T1DM
Weight loss, fatigure, polyuria, polydipsia
Pear-drop breath
Ketoacidosis and kussmal breathing
DKA
Hyperglycaemia, ketoacidosis, ketouria
Dehydration, confusion, abdo pain
Nausea, vomiting, sweet-smelling breath
Hypoglycaemia
Neuroglycopenia: irritable, tired, drowsy
