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Year 3 Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are symptoms of hyperthyroidism?

A 
Weight loss with increased appetite 
Diarrhoea 
Heat intolerance 
Anxiety 
Amenorrhoea
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2
Q

What are some signs of hyperthyroidism?

A 
Tachycardia 
Palmar erythema 
Goitre 
Thin hair 
Lid lag
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3
Q

What signs are specific to Graves’ disease?

A

Eye disease - exophthalmos, ophthalmoplegia
Pretibial myxoedema
Thyroid acropachy - clubbing, painful swelling of toes and fingers

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4
Q

What test results indicate hyperthyroidism?

A

Elevated T3 and T4 with undetectable TSH

Subclinical hyperthyroidism - low TSH with normal T3 and T4

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5
Q

What are some causes of hyperthyroidism?

A 
Graves’ disease 
Toxic multinodular goitre 
Toxic adenoma 
Post-partum 
Subacute de Quervians thyroiditis - post viral, self limiting
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6
Q

What is the pathophysiology of Graves’ disease?

A

Due to presence of TSH stimulating antibodies

This causes thyroid enlargement and increased hormone production

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7
Q

What antibodies can be measured in hyperthyroidism?

A

Anti-thyroid peroxidase
Anyithyroglobulin
TSH receptor antibodies

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8
Q

What imaging can be done to assess hyperthyroidism?

A

USS

Thyroid uptake scan - to assess areas of overactivity

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9
Q

What is the medical treatment of hyperthyroidism?

A

Carbimazole - reduce according to TFTs after 4 weeks

Also needs propanolol to control Sx until this works

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10
Q

What should pts be told about when taking thionamides (carbimazole)?

A

Risk of agranulocytosis - decreased WBC
Stop taking if they develop sore throat, fever, mouth ulcers
Requires urgent FBC

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11
Q

What is the definitive treatment of hyperthyroidism?

A

Radioactive iodine

Thyroidectomy

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12
Q

What are some complications of hyperthyroidism?

A 
Heart failure 
Angina 
AF 
Ophthalmopathy 
Thyroid storm
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13
Q

What are symptoms of hypothyroidism?

A 
Tiredness 
Weight gain with decreased appetite 
Cold intolerance 
Dry skin 
Hair loss
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14
Q

What are signs of hypothyroidism?

A

Dry skin and hair
Myxoedema
Bradycardia
Carpal tunnel

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15
Q

What test results are seen in primary hypothyroidism?

A

Elevated TSH

Low T3 and T4

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16
Q

What test results are seen in secondary hypothyroidism?

A

Low TSH
Low T3 and T4

Due to hypopituitarism

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17
Q

What are some causes of hypothyroidism?

A

Primary atrophic hypothyroidism
Hashimoto’s disease
Iodine deficiency
Iatrogenic - post thyroidectomy, radioactive iodine

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18
Q

What is the treatment of hypothyroidism?

A

50-100 mcg of levothyroxine
Adjust at 6 weeks according to TFTs

Elderly - 25mcg levothyroxine
Adjust at 4 weeks according to TSH

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19
Q

What is the treatment of hypothyroidism?

A

50-100mcg levothyroxine - adjust according to TSH levels

Elderly/ischaemic heart disease - start on 25mcg

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20
Q

What is Cushing’s syndrome?

A

Chronic glucocorticoid excess

Loss of the normal negative feedback mechanisms, and loss of normal circadian rhythm release of steroids

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21
Q

What are ACTH dependent causes of Cushing’s?

A

Cushing’s disease - bilateral adrenal hyperplasia due to an ACTH secreting pituitary adenoma
Ectopic ACTH secretion - eg from small cell lung ca

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22
Q

What are some ACTH independent causes of Cushing’s?

A

Iatrogenic - steroid treatment

Adrenal adenoma

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23
Q

What are symptoms of Cushing’s syndrome?

A

Central weight gain
Mood change - depression
Proximal muscle weakness
Acne

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24
Q

What are signs of Cushing’s disease?

A 
Dorso-cervical fat pad 
Round shaped face
Hypertension 
Abdominal striae 
Bruising 
Thin skin
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25
What investigations can be done for Cushing's syndrome?
Overnight dexamethasone suppression test | 24hr urinary cortisol
26
What is the overnight dexamethasone suppression test?
Give 1mg dexamethasone at midnight Measure serum cortisol at 8am If levels aren't suppressed this indicates Cushing's
27
What can confirm a pituitary cause of Cushing's?
Normal or high ACTH Some cortisol suppression in high dose DST Should also have an MRI of pituitary gland Can do inferior petrosal sinus sampling
28
What can confirm adrenal causes of Cushing's?
Low ACTH CT of adrenal glands Adrenal vein sampling
29
What is the treatment of Cushing's disease?
Trans-sphenoidal removal of pituitary adenoma May require adrenalectomy - requires lifelong hydrocortisone and fludrocortisone
30
What is primary adrenocortical insufficiency (Addisons disease)?
Autoimmune destruction of the adrenal cortex => glucocorticoid and mineralocorticoid insufficiency
31
What are symptoms of Addisons disease?
``` Lethargy and fatigue Weakness Weight loss Tanned Myalgia/arthralgia Abdo pain, vomiting ```
32
What are the effects of low mineralocorticoids in Addisons?
Postural hypotension | Dizziness
33
What are the effects of low glucocorticoids in Addisons?
Hypoglycaemia | Skin pigmentation - synthesis of ACTH results in production of hormone which increases melanin production
34
What is the effect of low androgen production in Addisons?
Reduced libido and loss of axillary and pubic hair in women Not as much of an effect in men - androgens produced in testes
35
What are the investigations for Addisons disease?
Hyponatraemia, hyperkalaemia Raised urea Hypoglycaemia Mild anaemia Low 9am cortisol Positive synacthen test
36
What is the synacthen test (short ACTH simulation test)?
Measure plasma cortisol Give IM synacthen - ACTH analogue Addisons is excluded with cortisol rise of >550nmol/L
37
What is the treatment for Addisons?
Steroid replacement Hydrocortisone - glucocorticoid replacement Fludrocortisone - mineralocorticoid replacement
38
How would a pt with an Addisonian crisis present?
Shock - tachycardia, hypotension, oliguria, confused, comatose
39
What are some precipitating factors of an Addisonian crisis?
Infection, trauma, surgery, missed medication
40
What is the initial management of an Addisonian crisis?
Bloods - cortisol, ACTH, U&Es (hyperkalaemia, hyponatraemia) 100mg IV hydrocortisone IV fluid bolus - 500ml 0.9% saline Monitor BMs Blood, sputum or urine culture if suspecting infection
41
What is Conn's syndrome?
Primary hyperaldosteronism Excess release of aldosterone outside of RAAS => Na retention and therefore water retention Causes hypertension
42
When should you suspect Conn's syndrome?
Hypertension in a pt <40 yrs Hypertension which doesn't respond to treatment Hypertension associated with hypokalaemia
43
What is a Phaeochromocytoma?
Cathecholamine secreting tumour of the chromaffin cells in the adrenal medulla
44
How does a Phaeochromocytoma present?
Fight or flight response - palpitations, sweating, anxiety, hypertension
45
What are some complications of a Phaeochromocytoma?
Hypertensive crisis Hyperglycaemia Arrhythmias Sudden death
46
What investigations are done for a Phaeochromocytoma?
24 hr urinary metanephrines Localise with CT abdomen, can also do MIBG scan to locate
47
What is the treatment for a Phaeochromocytoma?
Needs to be removed Requires alpha blocker (eg phenoxybenzamine) at diagnosis Do this before beta blocker to avoid hypertensive crisis. Beta blockers can be used to control reflex tachycardia
48
What is type 1 diabetes?
Insulin deficiency as a result of autoimmune destruction beta islet cells Often presents before puberty
49
What is type 2 diabetes?
Insulin resistance | Typically occurs in older, overweight pts
50
How is diabetes diagnosed?
Symptoms of hyperglycaemia with a single raised venous glucose (fasting - >7mmol, random >11mmol) Raised venous glucose on two separate occasions HbA1c >48mmol/6.5%
51
What are symptoms of hyperglycaemia?
Polydipsia, polyuria, weight loss, lethargy
52
What lifestyle advice should be given for diabetes?
Exercise => inc insulin sensitivity | Healthy diet
53
What is the general management of T2DM?
1) Lifestyle modification, diet controlled 2) Metformin 3) Dual therapy 4) Triple therapy 5) Use insulin, or metformin+SU+GLP1 mimetic
54
What are some oral hypoglycaemic agents?
``` Metformin Gliptin - sitagliptin Sulphonylurea - gliclazide Glitazone SGLT inhibitors - glifozin ```
55
What is the MOA of metformin?
Inc insulin sensitivity Dec hepatic gluconeogenesis Dec intestinal absorption of glucose SE: nausea, abdo pain, diarrhoea
56
What is the MOA of gliptins?
Inc insulin production | Dec release of glucagon
57
What is the MOA of sulphonylureas?
Inc insulin secretion - blocks ATP sensitive K channels SE: hypoglycaemia, monitor BMs
58
What is the MOA of glitazones?
Inc insulin secretion SE: hypoglycaemia, fluid retention, fractures Need to monitor LFTs
59
What is the MOA of SGLT inhibitors?
Increase urinary excretion of glucose via Na/glucose co-transporter SE: thrush, UTI, polyuria
60
What advice should be given to someone taking insulin?
Modify diet, avoid binge drinking Measure BMs at least four times a day, inc before meals and before driving Rotate site of injection before injection Need to educate on self adjustment on doses according to exercise, calorie intake, finger prick results
61
What are some regimens for insulin?
Basal bolus BD biphasic regimen Once daily before bed long acting (T2DM)
62
What is the target for fasting glucose when on insulin?
4-7mmol
63
What advice should be given to people on insulin when they are ill?
``` Don't stop taking insulin Maintain calorie intake Increase monitoring of BMs, inc insulin if increasing Look for ketonuria Admit if vomiting, ketotic or dehydrated ```
64
What are some chronic complications of DM?
``` Cardiovascular disease Nephropathy Diabetic neuropathy Diabetic foot/ulcers Retinopathy ```
65
What are the stages of diabetic retinopathy?
Background retinopathy Pre-proliferative retinopathy Proliferative retinopathy Maculopathy
66
What are the blood pressure targets in DM?
T1DM - 135/85 T2DM - 140/ 80 If there is end organ damage => 130/80
67
How should diabetic nephropathy be managed?
Start ACE-i/ARB Refer if UA:CR >7
68
How does diabetic neuropathy present?
Decreased sensation in stocking distribution Absent ankle reflex Charcot joint
69
How is diabetic neuropathy managed?
Paracetamol => tricyclic => duloxetine, pregabalin => opiates
70
What are acute complications of DM?
Hypoglycaemia DKA Hyperosmolar hyperglycaemic State
71
How does hypoglycaemia present?
Confusion, drowsiness | Sweating, tachycardia
72
How is hypoglycaemia managed?
Conscious - quick acting carb (orange juice) and recheck BMs after 15mins Unconscious or not responding - IV glucose
73
What causes DKA?
Excess glucose which is unable to be used due to lack of insulin Only way to provide energy is ketosis Inefficient, produces acetone
74
How does DKA present?
Drowsiness, abdo pain, vomiting, dehydration | Deep breathing - Kussmaul breathing
75
What are some predisposing factors to DKA?
Infection | Inadequate insulin - non-compliance or undiagnosed
76
What investigations are needed in DKA?
ECG, CXR Urine dipstick Bloods - glucose, VBG, U&E,
77
What is the management of DKA?
A-E assessment 1L 0.9% saline over 1hr (500ml 15 mins if BP <90 systolic) Start on fixed rate insulin => aim for fall in blood ketones, or rise in venous bicarb Check BMs hourly Continue fluids, assess need for K+ Treat underlying cause
78
What are complications of DKA?
Cerebral oedema Hypokalaemia VTE Aspiration pneumonia
79
How does HHS present?
One week of dehydration and glucose >30mmol No ketonaemia, pH >7.3 Osmolality >320
80
How is HHS managed?
Slow rehydration with 0.9% saline Replace K+ when passing urine Keep blood glucose 10-15mmol for first 24 hrs to avoid cerebral oedema Treat underlying cause
81
What are symptoms of HHS?
Generalised weakness, muscle cramps | Focal neurological signs
82
What are some causes of HHS?
Infection AKI Hyperthyroidism Drugs
83
What is the pathophysiology of HHS?
Hyperglycaemia => osmotic diuresis => loss of Na and K | Severe volume depletion => raised serum osmolarity

Year 3 Medicine (11 decks)

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