Endocrinology and Autoimmune Flashcards
Does Grave’s disease cause hypo/hyperthyroidism?
hyperthyroidism
what are the symptoms of Grave’s disease?
thyrotoxicosis
pretibial myxoedema
eye signs - exophthalmos and ophthalmoplegia
What is the management of thyrotoxicosis (grave’s)?
propanolol
carbimazole
radioiodine
What are the causes of thyrotoxicosis?
grave’s disease
toxic multi nodular goitre
What causes grave’s disease?
TSH receptor stimulating antibodies - autoimmune
Does Hashimoto’s thyroiditis cause hypo/hyperthyroidism?
hypothyroidism
What causes Hashimoto’s?
anti TPO antibodies - autoimmune
what are the symptoms of Hashimoto’s?
hypothyroidism
firm, non-tender goitre
what is the treatment for hashimotos and hypothyroidism?
levothyroxine (t4)
What is the requirement when taking levothyroxine?
taken before eaten or drunk anything
How is Riedel’s thyroiditis presentented and managed?
middle aged woman with hard, fixed painless goitre
levothyroxine
How does subacute thyroiditis present?
follows viral infection
painful goitre
4 phases - initially hyper the prolonged hypo
What are the causes of hypothyroidism?
hashimoto's riedel's subacute thyroiditis iodide deficiency pituitary tumours pituitary lesions
What are the TSH and free T4 levels for subclinical, primary and secondary hypothyroidism?
SC - high TSH, normal free T4
1 - high TSH, low free T4
2 - low TSH, low free T4
What are the TSH and free T4 levels for subclinical, primary and secondary hyperthyroidism?
SC - low TSH, normal free T4
1 - low TSH, high free T4
2 - high TSH, high free T4
What is the difference between Cushing’s disease and Cushing’s syndrome?
disease - symptoms caused by pituitary tumour secreting ACTH, causes adrenal hyperplasia
syndrome - symptoms mimic disease - long therm corticosteroids, adrenal carcinoma (not pituitary)
What are the signs and symptoms of cushing’s?
weight gain buffalo hump moon face mood changes central obesity irregular periods hyperglycaemia hypernatraemia hypokalaemia
what is the investigation and its results for cushing’s?
dexamethosone test
not suppressed at low dose, but suppressed at high dose = pituitary tumour
if not suppressed, suggests ectopic production such as small cell lung cancer
what is the management for cushing’s?
stop iatrogenic medications
surgery to remove the tumour
What causes Addison’s?
autoimmune destruction of adrenal glands
causes hypoadrenalism
What are the signs and symptoms of addison’s?
lethargy nausea and vomiting salt craving hyperpigmentation hypotension vitigo hypoglycaemia hyponatraemia hyperkalaemia metabolic acidosis
what are the investigations for Addison’s?
ACTH stimulation
serum/urinary cortisol
What is an addisonian crisis and how is it treated?
shock
pyrexia
collapse
fluids and hydrocortisone
what is the management of Addison’s?
hydrocortisone (glucocorticoid) and fludrocortisone (mineralocorticoid)
What are the different layers of the adrenal gland and what do they secrete?
medulla - catecholamines - adrenaline and noradrenaline
zona reticularis - androgens - sex hormones
zona fasicularis - glucocorticoids - cortisol
zona glomerulosa - mineralocorticoids - aldosterone
Lupus (SLE): clinical features
butterfly rash photosensitive rash discoid rash arthralgia/arthritis fatigue weightloss raynauds alopecia female aged 15-45 high ESR, normal CRP
lupus: management
serositis/arthritis - NSAIDs, hydroxychloroquine, or corticosteroids.
more severe disease - cyclophosphamide or mycophenolate mofetil plus corticosteroids.
causes and differences between acromegaly and gigantism
excess growth hormone
acromegaly - after puberty - grow outwards
gigantism - before puberty - grow up and out
