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IHD Part 2 306 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Diabetes for dentists: What parameters are used to diagnose diabetes?

A

Symptoms and random plasma glucose > 11.1 mmol/l
Fasting plasma glucose > 7 mmol/l
HbA1c > 48 mmol/mol
No symptoms - OGTT (75g glucose) fasting > 7 or 2h value > 11.1 mmol/l

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2
Q

Diabetes for dentists: What are the presenting features of diabetes?

A

Thirst
- osmotic activation of
hypothalamus

Polyuria
- osmotic diuresis

Weight loss (weeing sugar out) and fatigue

  • dehydration (sugar isn’t metabolising the cells)
  • lipid and muscle loss

Pruritis vulvae and balanitis
- Vaginal candidiasis

Hunger- losing sugar calories

Blurred vision
- Altered acuity due to uptake of glucose/water into lens

nausea/ vomiting - breaking down fat to make ketones, blood becomes very acidic
Kussmaul breathing - build up of ketones in the blood

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3
Q

Diabetes for dentists: What are the clinical features of newly diagnosed type 1 diabetes?

A

Weight loss
moderate or large urinary ketones
Short history (weeks) of severe symptoms

Any 2 of these three features indicate Type 1 diabetes and are an indication for immediate insulin treatment at ANY age

Commonest age at diagnosis, 5-15y , but can occur at any age
Relatively rare (prevalence of 3/1000 among children and adolescents)
250,000 in the UK
An insulin deficiency disease (autoimmune destruction of the beta cell)
Treatment consists of restoring appropriate insulin concentrations

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4
Q

Diabetes for dentists: What are the aims of treatment in type 1 diabetes?

A

Relieve symptoms and prevent ketoacidosis

Prevent microvascular and macrovascular complications

Avoid hypoglycaemia

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5
Q

Diabetes for dentists: What microvascular complications are associated with diabetes?

A

Around 30% in the UK will develop diabetic nephropathy
- CV mortality withno nephropathy x2, but with nephropathy x30

Those with nephropathy tend to develop proliferative retinopathy and severe neuropathy (foot problems) with major effect on quality of life

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6
Q

Diabetes for dentists: What is the treatment of type 1 diabetes?

A

Insulin treatment
Twice daily mixture of short/medium acting insulin
Basal bolus, (once or twice daily medium acting insulin plus pre meal quick acting insulin)
Ability to judge carbohydrate intake
Awareness of blood glucose lowering effect of exercise

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7
Q

Diabetes for dentists: What are the symptoms of diabetes?

A 
Shaking
fast heartbeat
hunger
irritable 
headache
weakness fatigue
impaired vision
sweating
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8
Q

Diabetes for dentists: What is the dilemma for type 1 diabetics?

A

Setting higher glucose targets will reduce the risk of hypoglycaemia but increase the risk of diabetic complications

Setting lower glucose targets will reduce the risk of complications but increase the risk of hypoglycaemia

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9
Q

Diabetes for dentists: What is the pathogenesis of type 2 diabetes?

A 
Increased thrombogenesis 
Early hyperinsulinaemia 
Hypertension
Central obesity
Insulin resistance
hyperglycaemia
abnormal lipids (low HDL cholesterol hypertriglyceridaemia)

all lead to 3-4x major cardiovascular risk

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10
Q

Diabetes for dentists: What happens to insulin in type 2 diabetes?

A

Insulin resistance (probably inherited) which demands increased production of insulin to maintain normal glucose levels before the development of diabetes

Progressive failure of insulin secretion

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11
Q

Diabetes for dentists: What are the complications of type 2 diabetes?

A

Macrovascular affect the majority and are often advanced at diagnosis
Myocardial infarction, stroke, peripheral vascular disease
Microvascular affect 20-25% at diagnosis and are modified by underlying vascular disease
Life expectancy is shortened at diagnosis by about 5-10 years

retinopathy, coronary heart disease, peripheral vascular disease, ulceration and amputation, nervous system neuropathy, cerebrovascular disease

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12
Q

Diabetes for dentists: What is the treatment of type 2 diabetes?

A

Ideally consists of weight loss and exercise (improve insulin resistance) which if substantial will reverse hyperglycaemia
but most of those with Type 2 diabetes have been making the ‘wrong’ lifestyle choices all their lives

At present, management usually consists of medication to control BP, blood glucose and lipids

metformin - a biguanide which reduces blood glucose by improving glucose uptake without increasing body weight and also reduces CV disease in the longterm. Now initial treatment of choice for all those with Type 2 diabetes
side effects - abdo pain and diarrhoea limit dose

or sulphonylurea: Act by stimulating release of insulin from pancreatic beta cells so can cause weight gain and hypoglycaemia, examples gliclazide, glibenclamide

Tight control of BP and lipids has a greater effect in reducing the risk of macrovascular disease (and reduces microvascular complications) and is usually easier to achieve than blood glucose control

diet - eat less and reduce refined carbohydrates

last resort - insulin, Insulin secretion declines progressively in Type 2 diabetes, over 50% will need insulin

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13
Q

Diabetes for dentists: What other drugs can be used for type 2 diabetes?

A

Or possibly pioglitazone,
Or a DPPIV inhibitor, e.g., sitagliptin
Or a gliflozin, e.g., empagliflozin
Or a incretin mimetic (injection), e.g., exenatide or liraglutide

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14
Q

Diabetes for dentists: What is diabetic ketoacidosis?

A

Hyperglycaemia (use capillary sample but confirm with lab test)
Venous bicarbonate less than 15 mmol/l
Ketones

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15
Q

Diabetes for dentists: What are the causes of diabetic ketoacidosis?

A

infections
omission of insulin
new diagnosis

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16
Q

Diabetes for dentists: who is at risk of HHS and HONK?

A

Poorly controlled Type 2 diabetes

Newly diagnosed Type 2 diabetes patients, often elderly

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17
Q

Diabetes for dentists: What are the symptoms of diabetic ketoacidosis?

A

Tachypnea

blood clots

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18
Q

Diabetes for dentists: What are the autonomic symptoms and signs of hypoglycaemia?

A

Sweating
Tremor
Palpitations
below 3.8mmol glucose - body starts to make adrenaline , can cause person to eat but may not be able to if it is in sleep

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19
Q

Diabetes for dentists: What are the neuroglycopenic symptoms and signs of hypoglycaemia?

A

Loss ofconcentration
Drowsiness
Anger / sadness
Confusion

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20
Q

Diabetes for dentists: What is the management of hypoglycaemia? 999 emergency

A

conscious:
oral glucose - fast acting (lucozade) need something long acting as well like sandwich
Check blood glucose after 10 mins (further IV/PO glucose if needed)
identify cause
re-educate
adopt measures to avoid hypos

unconscious:
glucagon 1 mg (IM) - will break down glycogen in the liver to glucose
IV glucose (100 mls 10% dextrose)
Check blood glucose after 10 mins (further IV/PO glucose if needed)
identify cause
re-educate
adopt measures to avoid hypos

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21
Q

Diabetes for dentists: How do you monitor diabetes?

A 
Venous blood glucose
HbA1c
Capilliary blood glucose
Blood ketones
Urinary ketones
CGM/ libres
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22
Q

Diabetes for dentists: What are the links between diabetes and dentistry?

A

Increased rates of gingivitis / periodonitis (2-5 fold) / dental caries / candidiasis / endocarditis

Stress – both physical & emotional raises blood glucose levels

Beware of hypoglycaemic medications

Type 1 diabetes is autoimmune process, therefore Sjorgrens is more likely

Some studies suggest improvements in glycaemic control after periodontal intervention

Dentists can help in the early recognition of T2DM (and rarely T1DM)

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23
Q

Endocrinology disease pathology: What is an endocrine gland?

A

One whose secretions (hormones) pass

directly into the blood stream

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24
Q

Endocrinology disease pathology: What are hormones?

A

Influence target organs by binding to receptors

Receptors may be on cell surface or intranuclear

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25
Q

Endocrinology disease pathology: What are exocrine glands?

A

One whose secretions pass into the gut, respiratory tract or exterior of the body

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26
Q

Endocrinology disease pathology: What is a feedback mechanism?

A

low levels - produce more

once levels rise, feedback to stop producing more

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27
Q

Endocrinology disease pathology: What clinical symptoms can be due to endocrine disease?

A

Underproduction / non-functioning

Overproduction

Mass

Malignancy

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28
Q

Endocrinology disease pathology: Describe the hypothalamic pituitary axis

A

Hypothalamus - releasing hormones to pituitary which sends stimulating hormones to thyroid/adrenal - negative feedback to the hypothalamus

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29
Q

Endocrinology disease pathology: What is the normal weight and cortex proportion of an adrenal gland

A

4g

90% of total weight

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30
Q

Endocrinology disease pathology: What is Waterhouse - friderichsen syndrome?

A

defined as adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection. Typically, it is caused by Neisseria meningitidis

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31
Q

Endocrinology disease pathology: What are the effects of hypocorticalism?

A 
Skin pigmentation
Hypotension 
Muscle weakness 
Hypoglycaemia 
Hyponatraemia 
Hyperkalaemia
Renal dysfunction
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32
Q

Endocrinology disease pathology: What are the effects of Cushing’s syndrome?

A 
Obesity - trunk
neck enlargement 
swollen face
Hypertension 
Osteoporosis 
Hyperglycaemia 
Myopathy
Skin atrophy - fragile 
Polycythaemia
Susceptibility to infection
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33
Q

Endocrinology disease pathology: What is a phaeochromocytoma?

A

Tumour of catecholamine producing chromaffin cells

Paroxysmal hypertension

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34
Q

Endocrinology disease pathology: What are associated with phaeochromocytomas?

A 
Familial – autosomal dominant 
Neurofibromatosis
Von Hippel-Lindau disease
Medullary carcinoma of thyroid
Parathyroid adenomas
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35
Q

Endocrinology disease pathology:What is the behaviour in phaeochromocytoma?

A

Most are benign
5 – 10% are malignant
Metastasise to lymph nodes, lungs, liver
and bone

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36
Q

Endocrinology disease pathology: What diagnostic tools can you use for thyroid pathology?

A

Serum T3, T4, TSH, calcitonin

Ultrasound

Radioactive iodine uptake studies

FNA

Core biopsy

Excision biopsy / lobectomy

Bone scan

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37
Q

Endocrinology disease pathology: What are the causes of hypo and hyperthyroidism?

A 
Hypothyroidism
Iodine deficiency
Developmental
Autoimmune
Radiotherapy, radioiodine therapy
Drugs

Hyperthyroidism
Autoimmune
Toxic adenomas

Masses

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38
Q

Endocrinology disease pathology: What are the features of Hashimoto’s disease?

A

Middle aged, women

Auto-antibodies against Thyroglobulin and Thyroid peroxidase

Lymphocyte (CD8) mediated destruction of thyroid follicles - thyroxin in the body goes up and then keeps going down

Initial hyperthyroidism followed by hypothyroidism

Painless enlarged thyroid

need lifelong thyroxin replacement

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39
Q

Endocrinology disease pathology:What is the prognosis of Hashimoto’s?

A

Life long thyroxine

Risk of developing other autoimmune disease

Risk for thyroid malignancy

40
Q

Endocrinology disease pathology: What is grave’s disease?

A

when taking blood: Elevated T3 and T4. Low TSH

Increased uniform radio-iodine uptake

Treated with anti-thyroid medications, radio-iodine ablation and surgery

41
Q

Endocrinology disease pathology: What can a thyroid mass be?

A

cyst
dominant nodule in multi nodular goitre
benign neoplasms
malignant neoplasms

42
Q

Endocrinology disease pathology: What are the benign neoplasms of the thyroid?

A

Follicular adenoma
usually solitary encapsulated
Commoner than malignant neoplasms

43
Q

Endocrinology disease pathology: What are the malignant neoplasms?

A

Papillary adenocarcinoma
Follicular adenocarcinoma Medullary carcinoma
Anaplastic carcinoma Lymphoma

44
Q

Endocrinology disease pathology: What is papillary carcinoma?

A

60-70% of cases

Children and young adults

Lymphatic spread

Excellent prognosis

45
Q

Endocrinology disease pathology: What is medullary carcinoma?

A

5-10% of cases

Elderly, but familial cases earlier

Lymphatic and blood stream spread

Variable prognosis

46
Q

Endocrinology disease pathology: What is anapaestic carcinoma?

A

10-15% of cases

Elderly

Aggressive local spread

Very poor prognosis

47
Q

Endocrine disease medicine II: What makes up the endocrine system?

A

A. Endocrine glands are ductless glands that usually release a product into the bloodstream for transport to body targets

B. Hormones are chemical signals produced by an endocrine gland that act at some distance from the gland

C. Targets are organs, tissues or cells capable of responding to the hormone due to the presence of a receptor that binds the hormone

48
Q

Endocrine disease medicine II: What hormones does the thyroid produce?

A

– thyroxine (T4) and tri-iodothyronine (T3)
regulate basal metabolic rate
– calcitonin which has a role in regulating blood calcium level

49
Q

Endocrine disease medicine II: Why is the thyroid hormone unique?

A

it stores large amount of inactive hormone within extracellular follicles

50
Q

Endocrine disease medicine II: What is the surface anatomy of the thyroid gland?

A

• Clasps anterior and lateral
surface of pharynx, larynx, oesophagus and trachea “like a shield”
• Parathyroid glands usually lie
between posterior border of thyroid gland
and its sheath (usually 2 on each side of the thyroid)
• Internal jugular vein and common carotid artery lie postero-lateral to thyroid

51
Q

Endocrine disease medicine II: How do you measure thyroid hormones?

A

 Free Thyroxine (T4)
 Free Triiodothyronine (T3)
 Thyroid Stimulating Hormone(TSH)

52
Q

Endocrine disease medicine II: What is hypothyroidism?

A

Primary hypo:
- primary failure of thyroid, not enough t3 and t4, TSH increases to overcome, goitre (swelling in the neck)

secondary hypo:
Low TSH from the pituitary
T3 and T4 low
and/or low TRH

dietary iodine deficiency - low t3 and t4, increase TSH

53
Q

Endocrine disease medicine II: What are the symptoms of hypothyroidism?

A 
 weight gain 
 lethargy
 increased sleep 
 constipation
 cold intolerance 
 dry skin
 hair loss
 menorrhagia
 deafness
 muscle weakness
54
Q

Endocrine disease medicine II: What are the signs of hypothyroidism?

A 
 facial puffiness
 periorbital oedema
  bradycardia
 hoarseness
 delayed reflexes
55
Q

Endocrine disease medicine II: What are the primary causes of hypothyroidism?

A 
 Dyshormonogenesis
 Iodine Deficiency
 Autoimmunity
 Post Radioactive Iodine 
 Post Thyroidectomy
 Iodine Excess
56
Q

Endocrine disease medicine II: What are the secondary and tertiary causes of hypothyroidism?

A 
 Pituitary Tumours
 Pituitary Granulomas 
 Empty Sella
 Isolated TRH deficiency 
 Hypothalamic disorders
57
Q

Endocrine disease medicine II: What are the indications for screening of hypothyroidism?

A 
 Congenital hypothyroidism
 Treatment of hyperthyroidism
 Neck Irradiation
 Pituitary Surgery or Irradiation
 Patients on lithium and amiodarone
58
Q

Endocrine disease medicine II: How do you investigate and manage hypothyroidism?

A

 Thyroid function tests, Thyroid antibodies
 Treat with levothyroxine

needs to have recent thyroid function tests if doing tx on pt

59
Q

Endocrine disease medicine II: What are the dental complications in hypothyroidism?

A 
 Delayed eruption
 Enamel hypoplasia 
 Macroglossia
 Micrognathia
 Thick lips
 Dysgeusia
60
Q

Endocrine disease medicine II: What are the causes of hyperthyroidism?

A 
 Autoimmune thyroid disease
o Graves Disease
o Postpartum thyroiditis
 Toxic nodular goitre 
 Toxic adenoma
Rare:
 Amiodarone induced
 De Quervain’s thyroiditis  Thyrotroph adenoma
 hCG hyperthyroidism 
◦ Hydatidiform mole
◦ Choriocarcinoma
61
Q

Endocrine disease medicine II: What are the symptoms of hyperthyroidism?

A 
 Weight loss
 Heat intolerance
 Anxiety, irritability 
 Increased sweating 
 Increased appetite 
 Palpitations
 Loose bowels
62
Q

Endocrine disease medicine II: What are the signs of hyperthyroidism?

A 
 Goitre
 Tremor
 Warm moist skin 
 Tachycardia
 Eye signs
 Thyroid bruit
 Muscle weakness 
 Atrial fibrillation
63
Q

Endocrine disease medicine II: What are the clinical signs of Graves disease?

A

 Diffuse goitre
 Eye signs
 Pretibial myxoedema - redness and inflammation of the shins
 Vitiligo and features of other autoimmune disease/ coeliac etc
 FH of autoimmune thyroid disease

64
Q

Endocrine disease medicine II: How do you investigate Graves Disease?

A

 TSH receptor Abs
 TPO Abs
 Thyroglobulin Abs
 Thyroid Radioisotope scan

65
Q

Endocrine disease medicine II: What is the tx for Graves disease?

A

 Medical
Drug side effects e.g. nausea, vomiting, leucopenia leading to agranulocytosis, aplastic anaemia, drug fever, cholestatic jaundice

if it comes back
 Surgical
 Radioactive iodine

66
Q

Endocrine disease medicine II: What are the dental complications of hyperthyroidism?

A

 Accelerated dental eruption
 Maxillary or mandibular osteoporosis
 Increased susceptibility to caries
 Periodontal disease
 Increased sensitivity to epinephrine which may result in arrhythmias or palpitations
 Surgery, oral infection and stress may precipitate thyroid crises

67
Q

Endocrine disease medicine II: When would you refer thyroid nodules?

A 
 New onset - 50% of population have nodules anyway
 Increase in size
 Onset of pain
 Associated speech disturbance 
 Lymphadenopathy
 Patient / Doctor concern
68
Q

Endocrine disease medicine II: What hormones does the pituitary secrete?

A 
LH
FSH
PRL - dopamine inhibits constantly 
GH
TSH
ACTH
69
Q

Endocrine disease medicine II: What 3 ways can a person with a pituitary problem present?

A

Tumour mass effects
Hormone excess
Hormone Deficiency

70
Q

Endocrine disease medicine II: How do you investigate a pituitary problem?

A

Hormonal tests

• If hormonal tests abnormal or tumour mass effects perform MRI pituitary

71
Q

Endocrine disease medicine II: What are the effect of a pituitary tumour?

A

Cranial Nerve Palsy and Temporal Lobe Epilepsy
Headaches
CSF rhinorrhoea
Visual Field Defects

72
Q

Endocrine disease medicine II: What are the effects of a pituitary hormones deficiency?

A 
GH
Short stature
Abnormal body composition
Reduced Muscle Mass
Poor Quality of Life
Rx: Growth Hormone

LH/FSH
Hypogonadism Reduced Sperm Count Infertility Menstruation
Problems
Rx: Testosterone in males; oestradiol ± progesterone in females

TSH
Hypo Thyroidism
Rx: Levothyroxine

ACTH
Adrenal Failure Decreased Pigment
Rx: Hydro cortisone

ADH
iabetes Insipidus
(ADH deficiency - Decreased water absorption in kidney resulting in polyuria & polydipsia)
Rx: DDAVP

73
Q

Endocrine disease medicine II: What are the causes of hypopituitarism?

A

 Pituitary tumours - 10-20% of population asymptomatic
 Radiotherapy
 Trauma
 Infarction
 Infiltration e.g. sarcoidosis, haemochromatosis
 Infection e.g. tuberculosis, syphilis
 Sheehan’s syndrome (post partum pituitary necrosis)

74
Q

Endocrine disease medicine II: What is acromegaly?

A
  • Excessive growth hormone secretion with resultant high IGF-1 levels.
  • Prevalence of 40-60 cases/million population.
  • Incidence of 4 cases/million per year.
  • Equal sex incidence
  • Delayed diagnosis by 7 to 10 years
75
Q

Endocrine disease medicine II: What are the head related features of acromegaly?

A 
 Coarse facial features
 Enlargement of
supraorbital ridges
 Separation of teeth
 Prognathism
 Macroglossia
76
Q

Endocrine disease medicine II: What other features of acromegaly are there?

A 
 Coarse facial features
 Enlargement of
supraorbital ridges
 Separation of teeth
 Prognathism
 Macroglossia
77
Q

Endocrine disease medicine II: How do you investigate acromegaly?

A

IGF1, dynamic tests, MRI pituitary

78
Q

Endocrine disease medicine II: How do you treat acromegaly?

A

Surgical resection – TSS, TFS
- biochemical control
80% microadenomas
50% macroadenomas

Somatostatin analogues – 40% complete responders
 Pegvisomant reduces IGF-1 to levels > 90% Radiotherapy in unsuccessful surgery

79
Q

Endocrine disease medicine II: What are the dental related complications of acromegaly?

A

 Jaw Malocclusion - class III
 Difficulty in speech due to macroglossia  Teeth mobility
 Missing teeth
 Teeth separation
 Thickening of alveolar processes
 Enlarged posterior roots
 In 50% upper airways obstruction caused by pharyngeal hypertrophy and macroglossia with obstructive sleep apnoea.

80
Q

Endocrine disease medicine II: What is Cushing’s syndrome?

A 
Excess glucocorticoids due to
Pituitary tumor 70-80%
Adrenal tumor 10-20%
Ectopic ACTH tumor 10%
Iatrogenic
81
Q

Endocrine disease medicine II: What are the clinical features of Cushing’s?

A 
Weight gain 90% 
Menses probs 60% 
“Moon face” 75% 
Acne 40% 
HTN 75% 
Bruising 40% 
Striae 65% 
Osteopenia 40%
Glucose intol. 65% Hyperpig 20% 
Muscle weak 60% 
K+ meta. alk. 15%
 Plethora 60% 
Hirsutism 65% 
Edema 40%
82
Q

Endocrine disease medicine II: How do you investigate Cushing’s syndrome?

A

 Hormonal tests: Dynamic suppression tests (Dexamethasone suppression tests) measuring cortisol, ACTH

 Radiological (If hormonal tests are abnormal)  MRI pituitary (pituitary tumour)
 CT adrenals (adrenal tumour)
 CT chest, abdomen, pelvis (ectopic ACTH tumour)

83
Q

Endocrine disease medicine II: How do you treat Cushing’s syndrome?

A

 Surgery
 Drugs
 Consider radiotherapy for pituitary disease if surgery fails

84
Q

Endocrine disease medicine II: What is adrenal insufficiency?

A

Lack of cortisol production

Produce too much ACTH but glands not producing enough cortisol - leads to them being pigmented

85
Q

Endocrine disease medicine II: What is Addison’s disease?

A

primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones.

86
Q

Endocrine disease medicine II: What are the causes of primary adrenal insufficiency?

A 
 Autoimmune
Tuberculosis
Fungal infections
Adrenal hemorrhage
Congenital adrenal hypoplasia
 Sarcoidosis
 Amyloidosis 
Metastatic neoplasia
87
Q

Endocrine disease medicine II: What are the causes of secondary adrenal insufficiency?

A

 After exogenous glucocorticoids
 After treatment of Cushing’s
 Hypothalamic or pituitary tumours

88
Q

Endocrine disease medicine II: What are the clinical features of adrenal insufficiency?

A 
Weakness
Skin and mucous membrane pigmentation
Loss of weight, emaciation, anorexia, vomiting, diarrhea
Hypotension
Salt craving Hypoglycemic episodes
89
Q

Endocrine disease medicine II: How do you investigate adrenal insufficiency?

A

 Hormonal tests: - Dynamic stimulation tests (Synacthen test) measuring cortisol
- ACTH, adrenal antibodies

 Radiological (If hormonal tests are abnormal)  MRI pituitary (pituitary disease)
 CT or MRI adrenals (adrenal disease)  CXR if suspecting TB

90
Q

Endocrine disease medicine II: How to you treat adrenal insufficiency?

A

Hydrocortisone replacement treatment

91
Q

Endocrine disease medicine II: What is glucocorticoid cover for dental procedures?

A

 On treatment therapy e.g asthma, rheumatoid arthritis ◦ Prednisolone > 7.5mg
◦ Hydrocortisone > 30mg
◦ Dexamethasone > 0.75mg

 On replacement therapy
◦ Addison’s e.g. Hydrocortisone 20/10mg ◦ ACTH deficiency 10/5/5mg

Simple Procedures: double dose one hour before surgery, double dose oral medication for 24 hours

Major Procedures/GA: hydrocortisone 100mg im at induction and double dose oral medication for 24 hours

92
Q

Endocrine disease medicine II: How do you manage other endocrine disorders if doing dental tx?

A
  • Hyperthyroidism – render euthyroid
  • Phaeochromocytoma – treat before any surgery
  • Cushing’s – avoid infections and pathological fractures; steroid cover
  • Refer to endocrinologist
93
Q

Endocrine disease medicine II: What are the endocrine causes of hypertension?

A
  • Primary aldosteronism - producing too much aldosterone, retaining salt in the body, affects adrenal glands
  • Phaeochromocytoma - too much adrenaline
  • Acromegaly - too much gh
  • Cushing’s syndrome - too much cortisol
  • Hypothyroidism
  • Hyperthyroidism

first 4 most important

94
Q

Endocrine disease medicine III: What is the role of calcium?

A
  • Average person has 1kg of calcium
  • 99% in the skeleton
  • Ionised calcium in ECF <1%

– Cofactor in coagulation
– Skeletal mineralisation
– Membrane stabilisation • Neuronal conduction

95
Q

Endocrine disease medicine III: What are the actions of parathyroid hormone?

A

increase calcium reabsorption
decrease phosphate reabsorption
increase hydroxylation of 25-OH vit D

increase bone remodelling
bone resorption increases

….

96
Q

Endocrine disease medicine III: Management of hypocalcaemia

A

new slide put in

Miguel de bono

IHD Part 2 306 (23 decks)

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