Important endocrine presentations Flashcards
Hypothyroidism: causes
Dietary iodine insufficiency.
Autoimmune thyroiditis (Hashimoto’s thyroiditis).
Lymphocytic thyroiditis (10% of post-partum women).
Drugs (amiodarone, interferon alpha, thalidomide, dopamine, lithium).
Radioactive iodine treatment.
Surgical thyroid injury.
External irradiation (e.g. for head and neck or breast cancer).
Pituitary adenoma.
Hypothyroidism: symptoms
Tiredness Weight gain Anorexia Cold intolerance Poor memory Depression Reduced libido Goitre Puffy eyes Brittle hair Dry skin Arthralgia Myalgia Muscle weakness Constipation Menorrhagia
Hypothyroidism: signs
General: croaking voice, mental and physical sluggishness, pseudodementia, ‘myxoedema madness’.
Inspection: coarse, cool dry skin (look for yellowish tint of carotenaemia ‘peaches and cream’ complexion), palmar crease pallor, peripheral cyanosis, puffy lower eyelids, loss of outer 1/3 of eyebrows, thinning of scalp hair, tongue swelling, xanthelasma.
Cardiovascular and chest: mild HTN, pericarditis, pleural effusion, low cardiac output, cardiac failure, bradycardia, small volume pulse.
Neurological: carpal tunnel syndrome, peripheral neuropathy, cerebellar syndrome, proximal muscle weakness, myotonia, muscular hypertrophy, delayed ankle jerks, bilateral neural deafness.
Hyperthyroidism: causes
Graves’ disease
Chronic thyroiditis (Hashimoto thyroiditis)
Subacute thyroiditis (de Quervain thyroiditis)
Postpartum thyroiditis
Drugs (iodine induced, amiodarone)
Bacterial thyroiditis
Postviral thyroiditis
Idiopathic
Toxic multinodular goitre
Malignancy (toxic adenoma, TSH-producing pituitary tumours)
Hyperthyroidism: symptoms
Weight loss Increased appetite Irritability Restlessness Muscle weakness Tremor Breathlessness Palpitations Sweating Heat intolerance Itching Thirst Vomiting Diarrhoea Eye complaints (Graves' ophthalmopathy) Oligomenorrhoea Loss of libido Gynaecomastia
Hyperthyroidism: signs
General: irritability, weight loss.
Inspection: onycholysis, palmar erythema, tremor, sweaty palms, thyroid acropachy, hyperkinesis, gyanecomastia, pretibial myxoedema, Graves’ ophthalmopathy.
Cardiovascular and chest: resting tachycardia, high cardiac output, systolic flow murmurs.
Neurological: proximal myopathy, muscle wasting, hyperreflexia in legs.
Glucocorticoid excess (Cushing’s syndrome): causes
High ACTH production from a pituitary adenoma and ectopic ACTH (e.g. small cell lung cancer).
Primary hypercortisolaemia caused by adrenal hyperplasia, adrenal tumour (adenoma or carcinoma), exogenous steroids.
Ectopic CRF production (v rare).
Depression.
Alcohol-induced.
Glucocorticoid excess (Cushing’s syndrome): symptoms
Weight gain (central/upper body). Change in appearance. Menstrual disturbance. Thin skin with easy bruising. Acne. Excessive hair growth. Muscle weakness. Decreased libido. Depression. Insomnia.
Glucocorticoid excess (Cushing’s syndrome): signs
Supraclavicular fat pads. Moon face. Thoracocervical fat pads (buffalo hump). Centripetal obesity. Hirsutism. Thinning of the skin. Easy bruising. Purple striae. Poor wound healing. Skin infections. Proximal muscle weakness (shoulders and hips). Ankle oedema. Hypertension. Fractures due to osteoporosis. Hyperpigmentation (if raised ACTH). Glycosuria.
Hypoadrenalism (Addison’s disease): causes
Autoimmune adrenalitis (>80% in UK). TB. Metastatic malignancy. Amyloidosis. Haemorrhage. Infarction. Bilateral adrenalectomy. HIV.
Hypoadrenalism (Addison’s disease): symptoms
Anorexia. Weight loss. Tiredness. Nausea. Vomiting. Diarrhoea. Constipation. Abdominal pain. Confusion. Erectile dysfunction. Amenorrhoea. Dizziness. Syncope. Myalgia. Arthralgia.
Hypoadrenalism (Addison’s disease): signs
Skin pigmentation (especially on sun-exposed areas, mucosal surfaces, axillae, palmar creases, and in recent scars. Cachexia. Loss of body hair. Postural hypotension. Low-grade fever. Dehydration.
Growth hormone excess (acromegaly): causes
Pituitary tumour (>95%).
Hyperplasia due to GHRH excess (v rare).
Tumours in hypothalamus, adrenal, or pancreas.
Growth hormone excess (acromegaly): symptoms
Headache. Diplopia. Change in appearance. Enlarged extremities. Deepening of voice. Sweating. Tiredness. Weight gain. Erectile dysfunction. Dysmenorrhoea. Galactorrhoea. Snoring. Arthralgia. Weakness. Numbness. Paraesthesia. Polyuria. Polydipsia.
Growth hormone excess (acromegaly): signs
Prominent supraorbital ridges. Large nose and lips. Prognathism (protrusion of lower jaw). Interdental separation. Macroglossia. Spade-like hands. Doughy soft tissues. Thick oily skin. Carpal tunnel syndrome. Hirsutism. Bitemporal hemianopia- if pituitary tumour impinging on optic chiasm. Cranial nerve palsies (III, IV, and VI). Hypertension.
Prolactinoma
A pituitary tumour.
The most common hormone-secreting tumour.
Prolactinoma: symptoms
Depend on age, sex, and degree of prolactinaemia.
In females: oligomenorrhoea, vaginal dryness, dyspareunia, galactorrhoea.
In males: loss of libido, erectile dysfunction, infertility, galactorrhoea; if before puberty may have female body habitus and small testicles.
Prolactinoma: signs
Visual field defects (bitemporal hemianopia).
Cranial nerve palsies (III, IV and VI).
Galactorrhoea.
In males: small testicles and female pattern of hair growth.
Hypercalcaemia: causes
Common: hyperparathyroidism, malignancy (PTHrP production or metastases in bone).
Less common: vitamin D intoxication, granulomatous disease, familial hypocalciuric hypercalcaemia.
Rare: drugs e.g. bendrofluazide, hyperthyroidism, Addison’s disease.
Hypercalcaemia: symptoms
Depend largely on the underlying cause.
Mild hypercalcaemia is asymptomatic.
Higher levels may cause nausea, vomiting, drowsiness, confusion, abdominal pain, constipation, depression, muscle weakness, myalgia, polyuria, headache, and coma.
Hypercalcaemia: signs
Often there are signs of the underlying cause.
There are no specific signs of hypercalcaemia.
Hypocalcaemia: causes
Hypoalbuminaemia. Hypomagnesaemia. Hyperphosphataemia. Surgery to the thyroid or parathyroid glands. PTH deficiency or resistance. Vitamin D deficiency.
Hypocalcaemia: symptoms
Depression.
Paraesthesia around the mouth.
Muscle spasms.
Hypocalcaemia: signs
Trousseau’s sign.
Chvostek’s sign.
