Endocrinology Conditions A Flashcards
Diabetes Mellitus Type 1 - Description
decreased insulin secretion
Diabetes Mellitus Type 1 - Causes (1)
1) autoimmunity (90% of HLA-DR3/HLA-DR4)
Diabetes Mellitus Type 1 - Pathophysiology (2)
1) autoimmune destruction of β cells in pancreas islet of Langerhans
2) decreased insulin secretion
Diabetes Mellitus Type 1 - Symptoms (6)
1) polyuria*
2) polydipsia*
3) weight loss
4) hunger
5) fatigue
6) blurred vision
Diabetes Mellitus Type 1 - Signs (4)
1) acute onset (<1 month)
2) ketosis (pear drop breath)
3) Caucasian
4) child/adolescent (esp. 5-15)
Diabetes Mellitus Type 1 - Complications (9)
1) vascular disease
2) nephropathy
3) neuropathy (30% painful)
4) retinopathy
5) cataracts
6) diabetic ketoacidosis (uncontrolled)
7) hypoglycaemia (iatrogenic)
8) infection (e.g. thrush, UTI)
9) autoimmune associations (e.g. Hashimoto’s thyroiditis, Addison’s disease, Coeliac disease)
Diabetes Mellitus Type 1 - Investigations (2/2)
initial 1) random plasma glucose* (>11mM) 2) Hb1Ac (>48mmol/mol, >6.5%) consider 1) fasting plasma glucose (>7mM) (follow-up) 2) glucose tolerance test (rarely used)
Diabetes Mellitus Type 1 - Management (6/4/0)
conservative 1) dietary advice 2) smoking cessation 3) alcohol control 4) regular exercise 5) monitor glucose 6) monitor Hb1Ac medical 1) basal-bolus insulin (1st line) 2) pre-meal insulin (adjunct) 3) pre-meal amylin (adjunct) 4) fixed-dose insulin (2nd line)
Diabetes Mellitus Type 2 - Description
decreased insulin secretion and efficacy
Diabetes Mellitus Type 2 - Risk Factors (10)
1) family history
2) Afro-Caribbean
3) Hispanic
4) Asian
5) old age
6) obesity
7) physical inactivity
8) pre-diabetes
9) gestational diabetes
10) hypertension
Diabetes Mellitus Type 2 - Pathophysiology (4)
1) dysfunction of β cells in pancreas islet of Langerhans
2) decreased insulin secretion
3) peripheral resistance to insulin
4) decreased insulin efficacy
Diabetes Mellitus Type 2 - Symptoms (3)
1) asymptomatic*
2) fatigue
3) blurred vision
Diabetes Mellitus Type 2 - Complications (7)
1) vascular disease
2) nephropathy
3) neuropathy (30% painful)
4) retinopathy
5) cataracts
6) hypoglycaemia (iatrogenic)
7) infection (e.g. thrush, UTI)
Diabetes Mellitus Type 2 - Investigations (2/2)
initial 1) random plasma glucose* (>11mM) 2) Hb1Ac (>48mmol/mol, >6.5%) consider 1) fasting plasma glucose (>7mM) (follow-up) 2) glucose tolerance test (rarely used)
Diabetes Mellitus Type 2 - Management (6/3/0)
conservative 1) dietary advice 2) smoking cessation 3) alcohol control 4) regular exercise 5) monitor plasma glucose 6) monitor Hb1Ac medical 1) metformin* 2) statin 3) antihypertensive (e.g. thiazide diuretic)
Diabetes Mellitus Type 2 - Management (Failed Hb1Ac Targets) (6)
1) pioglitazone
2) sulfonylurea
1) GLP-1 receptor agonist
4) SGLT-2 inhibitor
5) DPP-4 inhibitor
6) insulin (last resort)
Diabetic Ketoacidosis - Description
increased plasma ketone bodies
Diabetic Ketoacidosis - Risk Factors (3)
1) uncontrolled diabetes mellitus (esp. type 1)
2) infection
3) myocardial infarction
Diabetic Ketoacidosis - Pathophysiology (5)
1) decreased insulin secretion
2) increased lipolysis
3) increased hepatic fatty acid metabolism
4) increased plasma ketone bodies
5) decreased plasma pH
Diabetic Ketoacidosis - Symptoms (8)
1) polyuria
2) polydipsia
3) abdominal pain
4) nausea
5) vomiting
6) anorexia
7) weight loss
8) weakness
Diabetic Ketoacidosis - Signs (5)
1) acute onset (<1 week)
2) Kussmaul’s breathing (deep, laboured breathing)
3) tachycardia
4) hypotension
5) dehydrated
Diabetic Ketoacidosis - Complications (6)
1) acute respiratory distress syndrome
2) aspiration pneumonia
3) thromboembolism
4) hypoglycaemia (insulin)
5) hypokalaemia (insulin)
6) cerebral oedema (rehydration)
Diabetic Ketoacidosis - Investigations (5/0)
initial
1) plasma ketones* (>3mM)
2) random plasma glucose (>13.9mM)
3) ABG (pH<7.3, HCO3-<15mM)
4) UnE
5) serum osmolality
Diabetic Ketoacidosis - Management (1/5/0)
conservative 1) ICU admission medical 1) IV fluids (3L in 1st 3 hours) 2) potassium phosphate (replace electrolytes) 3) sodium bicarbonate (metabolic acidosis) 4) insulin 5) vassopressor (DA/NA)
Hyperosmolar Hyperglycaemic State - Description
highly increased plasma glucose and osmolality without ketosis
Hyperosmolar Hyperglycaemic State - Risk Factors (3)
1) uncontrolled diabetes mellitus (esp. type 2)
2) infection
3) myocardial infarction
Hyperosmolar Hyperglycaemic State - Symptoms (9)
1) altered mental status
2) polyuria
3) polydipsia
4) abdominal pain
5) nausea
6) vomiting
7) anorexia
8) weight loss
9) weakness
Hyperosmolar Hyperglycaemic State - Signs (5)
1) acute onset (<1 week)
2) Kussmaul’s breathing (deep, laboured breathing)
3) tachycardia
4) hypotension
5) dehydration
Hyperosmolar Hyperglycaemic State - Complications (6)
1) acute respiratory distress syndrome
2) aspiration pneumonia
3) thromboembolism
4) hypoglycaemia (insulin)
5) hypokalaemia (insulin)
6) cerebral oedema (rehydration)
Hyperosmolar Hyperglycaemic State - Investigations (5/0)
initial
1) plasma ketones (normal)
2) random plasma glucose (>33.3mM)
3) ABG (pH>7.3, HCO3->15mM)
4) UnE
5) serum osmolality (>320mmol/kg)
Hyperosmolar Hyperglycaemic State - Management (1/4/0)
conservative 1) ICU admission medical 1) IV fluids (1-2L in 1st 3 hours) 2) potassium phosphate (replace electrolytes) 3) insulin 4) vassopressor (DA/NA)
Hypoglycaemia - Description
decreased plasma glucose
Hypoglycaemia - Causes (4)
1) insulin
2) sulphonylurea
3) kidney disease
4) liver disease
Hypoglycaemia - Symptoms (Autonomic) (3)
random plasma glucose <3.8mM
1) sweating
2) palpitations
3) tremor
Hypoglycaemia - Symptoms (Neuroglycopenic) (5)
random plasma glucose <2.8mM
1) confusion
2) drowsiness
3) altered behaviour
4) dysphasia
5) incoordination
Hypoglycaemia - Symptoms (Severe Neuroglycopenic) (2)
random plasma glucose <1.5mM
1) convulsions
2) coma
Hypoglycaemia - Investigations (3/0)
initial
1) random plasma glucose (<3.8mM)
2) RFT
3) LFT
Hypoglycaemia - Management (4/2/0)
conservative
1) adjust medications
2) patient education (recognition, treatment)
3) fast acting carbohydrate (15g) (3x 15 minute intervals)
4) long acting carbohydrate (glucose>4mM)
medical
1) IV glucose (unconscious or refractory)
2) IM glucagon (unconscious or refractory)
Hyperthyroidism - Description
increased T3/T4 secretion
Hyperthyroidism - Causes (6)
1) Graves’ disease (2/3)
2) toxic adenoma
3) toxic multinodular goitre
4) drug induced (iodine, amiodarone)
5) post-partum thyroiditis
6) De Quervain’s (subacute) thyroiditis (post-infection)
Hyperthyroidism - Pathophysiology (Graves’ Disease) (3)
1) autoimmune thyroid stimulating IgGs (TRAb) bind to TSH receptors
2) increased thyroid activation
3) increased T3/T4 secretion
Hyperthyroidism - Symptoms (7)
1) weight loss
2) increased appetite
3) diarrhoea
4) heat intolerance
5) sweating
6) tremor
7) palpitations
Hyperthyroidism - Signs (7)
1) goitre (diffuse-Graves’, solitary-adenoma, multinodular-MNG)
2) tachycardia
3) lid lag
4) lid retraction
5) onycholysis
6) palmar erythema
7) warm moist skin
Hyperthyroidism - Complications (7)
1) angina
2) atrial fibrillation
3) heart failure
4) osteopenia—>osteoporosis
5) hypothyroidism (iatrogenic)
6) recurrent laryngeal nerve damage (thyroidectomy)
7) hypoparathyroidism (thyroidectomy)
Hyperthyroidism - Complications (Thyroid Storm) (5)
severe hyperthyroidism
1) hyperthermia
2) vomiting
3) diarrhoea
4) confusion
5) coma
Hyperthyroidism - Complications (Graves’ Disease) (3)
1) ophthalmology (inc. exophthalmos)
2) tibial myxoedema
3) acropachy
Primary Hypothyroidism - Description
decreased T3/T4 secretion (99% of hypothyroidism)
Primary Hypothyroidism - Causes (6)
1) Hashimoto’s thyroiditis
2) post-partum thyroiditis
3) iodine deficiency
4) drug induced (iodine, amiodarone)
5) iodine 131 therapy
6) thyroidectomy
Primary Hypothyroidism - Pathophysiology (Hashimoto’s Thyroiditis) (3)
1) cytotoxic T cell mediated destruction of thyroid cell
2) autoantibodies to thyroid peroxidase and thyroglobulin
3) decreased T3/T4 secretion
Primary Hypothyroidism - Symptoms (7)
1) weight gain
2) constipation
3) weakness
4) lethargy
5) bad mood
6) cold intolerance
7) amenorrhoea
Primary Hypothyroidism - Signs (4)
1) bradycardia
2) hyporeflexia
3) hair loss
4) cool dry coarse skin
Primary Hypothyroidism - Complications (1)
1) pregnancy problems
Primary Hypothyroidism - Complications (Myxoedema Coma) (6)
severe hypothyroidism
1) hypothermia
2) hypoventilation
3) hypoglycaemia
4) hyponatraemia
5) seizures
6) coma
Primary Hypothyroidism - Investigations (1/1)
initial
1) TFT* (high TSH, low T3/T4)
consider
1) serum TPOAb (Hashimoto’s, positive)
Primary Hypothyroidism - Management (0/1/0)
medical
1) synthetic L-thyroxine
Secondary Hypothyroidism - Description
decreased T3/T4 secretion (1% of hypothyroidism)
Secondary Hypothyroidism - Causes (2)
1) pituitary adenoma
2) Sheehan’s syndrome
Secondary Hypothyroidism - Pathophysiology (2)
1) low thyroid stimulation
2) low T3/T4 secretion
Secondary Hypothyroidism - Symptoms (7)
1) weight gain
2) constipation
3) weakness
4) lethargy
5) bad mood
6) cold intolerance
7) amenorrhoea
Secondary Hypothyroidism - Signs (4)
1) bradycardia
2) hyporeflexia
3) hair loss
4) cool dry coarse skin
Secondary Hypothyroidism - Complications (1)
1) pregnancy problems
Secondary Hypothyroidism - Complications (Myxoedema Coma) (6)
severe hypothyroidism
1) hypothermia
2) hypoventilation
3) hypoglycaemia
4) hyponatraemia
5) seizures
6) coma
Secondary Hypothyroidism - Investigations (1/1)
initial
1) TFT* (low TSH, low T3/T4)
consider
1) pituitary MRI
Secondary Hypothyroidism - Management (0/1/0)
medical
1) synthetic L-thyroxine
Thyroid Carcinoma - Description
malignant proliferation of thyroid cells
Thyroid Carcinoma - Types (4)
1) papillary (70%)
2) follicular (20%)
3) medullary (5%)
4) anaplastic (5%)
Thyroid Carcinoma - Risk Factors (2)
1) head/neck irradiation
2) female
Thyroid Carcinoma - Prognosis (4)
1) papillary - good
2) follicular - good
3) medullary - good
4) anaplastic - poor
Thyroid Carcinoma - Symptoms (3)
late presentation
1) dysphonia
2) dysphagia
3) dyspnoea
Thyroid Carcinoma - Signs (2)
1) thyroid nodules
2) cervical lymphadenopathy
Thyroid Carcinoma - Investigations (3/0)
initial
1) TFT
2) fine needle biopsy cytology
3) neck ultrasound
Thyroid Carcinoma - Management (0/2/1)
medical 1) radioactive iodine ablation (papillary, medullary) 2) levothyroxine (TSH suppression) surgery 1) thyroidectomy
Hyperthyroidism - Investigations (1/1)
initial
1) TFT* (low TSH, high T3/T4)
consider
1) serum TRAb (Graves’, positive)
Hyperthyroidism - Management (1/4/1)
conservative
1) smoking cessation
medical
1) carbimazole (block+replace* or titrate)
2) propyluracil (block+replace* or titrate)
3) iodine 131 (refractory) (not in pregnancy or feeding)
4) βB (thyroid storm)
surgery
1) thyroidectomy
Acromegaly - Description
increased GH secretion
Acromegaly - Causes (1)
1) pituitary adenoma
Acromegaly - Pathophysiology (3)
1) pituitary adenoma
2) increased GH secretion
3) increased IGF-1 secretion
Acromegaly - Symptoms (6)
1) arthralgia
2) sweating (excessive)
3) headaches (late, 50%)
gonadal dysfunction
4) low libido
5) amenorrhoea
6) erectile dysfunction
Acromegaly - Signs (8)
1) acral enlargement
2) big nose
3) big tongue
4) big jaw
5) big supraorbital ridges
6) dark skin
7) skin tags
8) deep voice
Acromegaly - Complications (9)
1) gigantism
2) arthritis
3) carpal tunnel syndrome
4) diabetes mellitus
5) hypertension
6) heart conditions (e.g. cardiomyopathy)
7) stroke
8) sleep apnoea
9) bitemporal hemianopia
Acromegaly - Investigations (3/1)
initial 1) serum GH (high) 2) serum IGF-1 (high) 3) glucose tolerance test* (nadir GH>1μg/L) consider 1) pituitary MRI
Acromegaly - Management (0/4/1)
medical 1) DA agonist (e.g. cabergoline) 2) SST analogue (e.g. octreotide) 3) GH receptor antagonist 4) radiotherapy (refractory) surgery 1) transsphenoidal surgery*
Cushing’s Syndrome - Description
chronic excess cortisol exposure
Cushing’s Syndrome - Causes (5)
1) Cushing’s disease
2) adrenal adenoma
3) adrenal hyperplasia
4) ectopic ACTH secretion
5) steroids (iatrogenic)
Cushing’s Syndrome - Pathophysiology (Cushing’s Disease) (3)
1) pituitary adenoma
2) increased ACTH secretion
3) increased cortisol secretion
Cushing’s Syndrome - Symptoms (8)
1) weight gain mood 2) depression 3) lethargy 4) irritability 5) psychosis gonadal dysfunction 6) hirsutism 7) oligomenorrhoea 8) erectile dysfunction
Cushing’s Syndrome - Signs (8)
1) central obesity
2) moon face
3) plethoric
4) acne
5) bruising
6) skin atrophy
7) muscle atrophy
8) violaceous striae
Cushing’s Syndrome - Complications (6)
1) diabetes mellitus
2) hypertension
3) hypokalaemia
4) osteoporosis
5) nephrolithiasis
6) hypopituitarism (iatrogenic)
Cushing’s Syndrome - Investigations (2/1)
initial 1) overnight low dose dexamethasone suppression + 9:00am cortisol 2) 24 hour urinary free cortisol* consider 1) pituitary MRI (70%)
Cushing’s Syndrome - Management (2/1/4)
conservative
1) alcohol control
2) review steroids
medical
1) metyrapone or mitotane (pre-op)
surgery*
1) transsphenoidal surgery (Cushing’s disease)
2) unilateral adrenalectomy (adrenal adenoma)
3) bilateral adrenalectomy (adrenal hyperplasia)
4) local tumour resection (ectopic ACTH secretion)
Hyperaldosteronism - Description
increased aldosterone secretion (independent of RAAS)
Hyperaldosteronism - Causes (2)
1) Conn’s syndrome
2) adrenal hyperplasia
Hyperaldosteronism - Pathophysiology (Conn’s Syndrome) (1)
1) aldosterone producing adrenal adenoma (aldosteronoma)
Hyperaldosteronism - Symptoms (4)
1) asymptomatic (often)
2) polyuria
3) nocturia
4) lethargy
Hyperaldosteronism - Complications (3)
1) hypertension
2) hypernatraemia
3) hypokalaemia*
Hyperaldosteronism - Investigations (3/1)
initial 1) UnE (low K+, high Na+) 2) serum renin (low) 3) serum aldosterone (high) consider 1) adrenal vein sampling* (unilateral - Conn’s syndrome, bilateral - adrenal hyperplasia)
Hyperaldosteronism - (0/1/1)
medical
1) spironolactone (aldosterone anatgonist)
surgery
1) laparoscopic adrenalectomy (Conn’s syndrome)
