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ENDOCRINOLOGY by Dr Cinitia Flashcards

1
Q

Hypothyroidism (Hashimoto Thyroiditis) CLINICAL FEATURES

A

Bilateral, firm, rubbery goitre

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2
Q

Hypothyroidism (Hashimoto Thyroiditis) FIRST INVESTIGATION (3):

A
  1. TSH
  2. US If nodule
  3. CT Scan if goitre is causing compression
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3
Q

Hypothyroidism (Hashimoto Thyroiditis) BEST INVESTIGATION (3):

A

1.Antithyroglobulin (TgAb)
2.Antithyroid peroxidase Ab (TPO)
3.Biopsy: Chronic lymphocytic thyroiditis

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4
Q

Hypothyroidism (Hashimoto Thyroiditis) TREATMENT

A
  1. Tx if TSH>7.
    Monitor tx at 3m, 6m, 1y. You start with low dose and you increase it progressively.
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5
Q

Myxedema coma CLINICAL FEATURES

A

Hypotension, hypoventilation, hypoglycaemia, hyponatraemia

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6
Q

Myxedema coma TREATMENT

A

IV Levothyroxine + IV hydrocortisone

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7
Q

Congenital hypothyroidism CLINICAL FEATURES

A

Macroglossia, harsh cry, dry skin, umbilical hernia

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8
Q

Congenital hypothyroidism FIRST INVESTIGATION

A

Neonatal Heel prick TSH is (NEXT) if hypotonic kid with large open ant fontanelle

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9
Q

Congenital hypothyroidism TREATMENT

A

Start thyroxine before 2 weeks of age

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10
Q

Subclinical hypothyroidism CLINICAL FEATURES

A

High TSH and normal T3, T4

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11
Q

Subclinical hypothyroidism FIRST INVESTIGATION

A

TSH

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12
Q

Subclinical hypothyroidism TREATMENT

A
  • TSH 5-10: Review TSH in 3 months
  • TSH>10: Levothyroxine
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13
Q

Sick Euthyroid Syndrome CLINICAL FEATURES

A

Decrease conversion from T4 to T3 so T3 will be low and T4, TSH, and reverse T3 could be normal or even high

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14
Q

Hyperthyroidism CLINICAL FEATURES

A

Fine tremor, proximal myopathy, frozen shoulder

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15
Q

Hyperthyroidism FIRST INVESTIGATION

A
  1. TSH
  2. Radioactive iodine uptake: -
    Low uptake: Thyroiditis -
    High uptake:
    Homogeneous (Graves), heterogenous (multiple- toxic multinodular goitre, single area-toxic adenoma)
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16
Q

Hyperthyroidism TREATMENT (4)

A

1.Carbimazole (Agranulocytosis)
2.Propylthiouracil (Risk of liver dx)
3.Surgery
4.Radioactive iodine (If CIs to surgery)

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17
Q

Graves Disease FIRST INVESTIGATION

A

TSH

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18
Q

Graves Disease BEST INVESTIGATION

A

TSH receptor antibody, anti- TPO

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19
Q

Graves Disease TREATMENT

A

Same than above + Tx of vision threatened:
1. IV Methylprednisolone
2. Oral high dose prednisolone

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20
Q

Hyperthyroidism in pregnancy TREATMENT

A
  1. Propylthiouracil in 1st trimester
  2. Carbimazole in 2nd/3rd trimester
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21
Q

Subacute thyroiditis (De Quervains) CLINICAL FEATURES

A

Pain/Tenderness, fever

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22
Q

Subacute thyroiditis (De Quervains) FIRST INVESTIGATION

A
  1. TSH
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23
Q

Subacute thyroiditis (De Quervains) BEST INVESTIGATION

A
  1. ESR>50mm/Hr
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24
Q

Subacute thyroiditis (De Quervains) TREATMENT

A
  1. Analgesia: NSAIDs
  2. Severe: Oral prednisolone.
  3. If constitutional symptoms: BB
    NOT antithyroid medication
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25
Thyroid Storm CLINICAL FEATURES
Anxiety, weight loss, hyperpyrexia, tachycardia
26
Thyroid Storm TREATMENT
Hospital admission: IV saline, IV steroids
27
Thyroid Nodule CLINICAL FEATURES
Moves with swallowing, can cause compression.
28
Thyroid Nodule FIRST INVESTIGATION
1. TSH - TSH Normal or High: Next: US. Next: FNA - TSH Low: Next T3 & T4. Next: Radioisotope scan and US. If cold nodule: FNA
29
Thyroid Nodule BEST INVESTIGATION
1. FNAC
30
Retrosternal Goitre CLINICAL FEATURES
Compression
31
Retrosternal Goitre FIRST INVESTIGATION
1. X-ray
32
Retrosternal Goitre BEST INVESTIGATION
CT of neck and upper chest
33
Retrosternal Goitre TREATMENT
Total thyroidectomy
34
Thyroid Cancer CLINICAL FEATURES (4)
- Hoarseness - Psammoma bodies: PapillaryThyroid Ca - Follicular cells: always do excisional biopsy bc it’s hard to diff between non and carcinoma. - Parafollicular C cells (secrete calcitonin): Medullary thyroid Ca. MEN2. - Rapidly growing: Anaplastic
35
Thyroid Cancer FIRST INVESTIGATION
1. TFT
36
Thyroid Cancer BEST INVESTIGATION
1. FNAB
37
Hyperparathyroidism CLINICAL FEATURES
HyperCalcaemia (Stones, polyuria, hypoPh, constipation, psych disturbance)
38
Hyperparathyroidism FIRST INVESTIGATION
1. Ca
39
Hyperparathyroidism BEST INVESTIGATION
1. PTH
40
Hyperparathyroidism TREATMENT
Qx for Ca<0.25, nephrolithiasis, bone erosions, reduction in bone mass, reduction of Cr clearance.
41
Diabetes Mellitus Type 1 FIRST INVESTIGATION (2)
Urine Dipstick for sugar. Other: Abs against Hashimoto
42
Diabetes Mellitus Type 1 BEST INVESTIGATION
FSB
43
Diabetes Mellitus Type 1 TREATMENT (4)
1.  Admission 2.  Insulin 3.  Follow up w/ HbA1c e/3m (<7%) 4.  Vaccine for Pneumococcal, Influenza, and dTPa
44
Diabetes Mellitus Type 2 FIRST INVESTIGATION
RBG≥11.1
45
Diabetes Mellitus Type 2 BEST INVESTIGATION
FBG: -  If ≥7: DM -  If 5.5-6.9->OGTT. If OGTT≥11.1: DM, if 7.8-11 Retest in a year, if <7.8 with FBG 6.1-6.9 retest in a year, OGTT≤7.7 Retest in 3 years - HbA1c: ≥6.5: DM, 6-6.4: retest in 1y, ≤5.9 retest in 3 years
46
Diabetes Mellitus Type 2 TREATMENT (5):
1. Lifestyle modifications for 3-6m 2. Metformin 3. Metformin+Sulfonilurias or acarbose 4. Insulin (If HbA1c>9%) 5. Follow-up with HbA1c e/3m (<7) except in risk of hypoglycaemia (7-8) -  Pioglitazone - bladder Ca -  Rosiglitazone-HF
47
Diabetic Nephropathy TREATMENT (2)
Annual screening for albuminuria Photocoagulation
48
Diabetic Retinopathy FIRST INVESTIGATION
Screening e/2y. -  If nonproliferative dx: e/1y -  If proliferative dx: Urgent referral -  If vitreous hemorrhage: Same day referral
49
Diabetic Retinopathy TREATMENT
Photocoagulation
50
Diabetic Neuropathy FIRST INVESTIGATION
1. Check Vitamin B12 levels (Metformin can decrease them)
51
Diabetic Neuropathy TREATMENT
1.  Amitriptyline 2.  Gabapentin/Pregabalin
52
Diabetic Ketoacidosis CLINICAL FEATURES
MCC: Infections, HypoK, HypoNa, ketones
53
Diabetic Ketoacidosis FIRST INVESTIGATION
MCC: Infections, HypoK, HypoNa, ketones
54
Diabetic Ketoacidosis BEST INVESTIGATION
Ketones in serum or urine
55
Diabetic Ketoacidosis TREATMENT (2)
1.  Rehydration (NS IV 15-20mL/kg) 2.  Short acting insulin IV
56
Hypoglycaemia CLINICAL FEATURES
Early dumping: 30 mins-1hr: Tx diet Late dumping:1-3 hrs after meals
57
Hypoglycaemia TREATMENT
Conscious: -    <1yr: Milk, >1yr something sweet Unconscious: If Glucose<3 -    Children: 10% dextrose -    Adults: 50% Dextrose Next: IM Glucagon
58
Hyperglycaemic hyperosmolar nonketotic Coma CLINICAL FEATURES
Glucose >33 with normal ketones
59
Hyperglycaemic hyperosmolar nonketotic Coma TREATMENT (2)
1.  Rehydration (NS 0.45%) 2.  Insulin with caution
60
Addison's dx CLINICAL FEATURES
Hypotension, weakness, fatigue, HypoNa, HyperK
61
Addison's dx FIRST INVESTIGATION
Cortisol level
62
Addison's dx BEST INVESTIGATION
Short synacthen stimulation test
63
Addison's dx TREATMENT
1. IV line with fluids -  Dx made: Hydrocortisone -  No Dx: Dexamethasone
64
Hyperaldosteronism CLINICAL FEATURES
Hypertension, HyperNa, HypoK. Renin low if primary. Renin high if secondary
65
Hyperaldosteronism FIRST INVESTIGATION
Plasma aldosterone and renin. - Next: Adrenal CT if primary
66
Hyperaldosteronism TREATMENT (2)
1.  Spironolactone/Amiloride 2.  Surgery to remove adenoma
67
Cushing Syndrome CLINICAL FEATURES
Hyperglycaemia, Hypertension, amenorrhoea, weakness, obesity, HyperNa, HypoK
68
Cushing Syndrome FIRST INVESTIGATION (3)
1.               24-hour cortisol 2.               Early morning cortisol levels following a low dose dexamethasone suppression test 3.               ATCH
69
Cushing Syndrome BEST INVESTIGATION
1. High dose dexamethasone suppression test. 2. Cranial CT/MRI
70
Cushing Syndrome TREATMENT
Surgery. Give steroids if ACTH is supressed
71
Pheochromocytoma CLINICAL FEATURES
Headache, palpitations, diaphoresis
72
Pheochromocytoma FIRST INVESTIGATION
1. 24-hour free catecholamines (increased VMA)
73
Pheochromocytoma BEST INVESTIGATION
1. Plasma metanephrines +MRI
74
Pheochromocytoma TREATMENT (3)
1.  Alpha Blockers (Phenoxybenzamine) 2.  BB 3.  Qx
75
Adrenal Tumours TREATMENT
- <4cm and benign: Follow up in 3-6m - ≥4cm and suspicious: Adrenalectomy
76
Pituitary Tumour FIRST INVESTIGATION (2)
1.  TFT 2.  CT
77
Pituitary Tumour BEST INVESTIGATION
1. MRI
78
Pituitary Tumour TREATMENT
-    If <1cm: Review in 1y -    If ≥1cm: with visual field symptoms: Transphenoidal resection
79
Hyperprolactinaemia CLINICAL FEATURES
Reduced libido, amenorrhoea, erectile dysfunction
80
Hyperprolactinaemia FIRST INVESTIGATION
1. Prolactin: -  >5000: Prolactinoma -  <5000: other causes
81
Hyperprolactinaemia BEST INVESTIGATION
1. MRI
82
Hyperprolactinaemia TREATMENT (2)
1. Dopamine agonist (Cabergoline, bromocriptine) 2. Surgery
83
Acromegaly CLINICAL FEATURES
Spade like hands, frontal bossing, greasy skin, thickened palms, increased shoe size, heteronymous hemianopia
84
Acromegaly FIRST INVESTIGATION
1.               IGF-1. 2.               Measurement of GH following OGTT. If GH is no supressed by glucose, acromegaly
85
Acromegaly BEST INVESTIGATION
Pituitary MRI
86
Diabetes Insipidus CLINICAL FEATURES
Low ADH, HyperNa, HypoK
87
Diabetes Insipidus FIRST INVESTIGATION
1. Plasma Na and osmolality
88
Diabetes Insipidus BEST INVESTIGATION
Water deprivation test: - In primary polydipsia osmolarity will go back to normal. Desmopressin administration to see if its central (Osm increases) or nephrogenic
89
Diabetes Insipidus TREATMENT
1. Central: Desmopressin 2. Nephrogenic: Solute restriction and thiazides
90
SIADH CLINICAL FEATURES
High ADH, HypoNa, concentrated urine. Caused by SSRI, morphine, surgery, etc
91
SIADH FIRST INVESTIGATION
1. Plasma Na and osmolality
92
SIADH TREATMENT (3)
1. Water restriction 2. Hypertonic saline if pt is severely symptomatic. 3. Demeclocycline

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