Meeran Revision Endo

Question 1

Graves disease exam and ix and mx (very common Paces)

Answer 1

v common in PACES
Exophtalmos,
smooth painless enlarged goitre (nodular-think benign adenoma)
Tachycardia, Tremor, LID LAG->active disease
temperature
Pretibial myxedema
thats active disease

in paces- usually not active-so pulse down etc
so see exophtalmos, goitre, pretibial myxedema

remember- exophtalmos, pretibial-> only in graves

Ix- Thyroid function test, TSHR ab
Mx-
Carbimazole
Propylucil
Radioiodine
surgery

But–eyes need sepcific-steroids and surgery
conservative/support-bblock
Medical thyroid removal-carbimazole, carbi + replace, Propyl-uracil, radioiodine
surgery

Question 2

Acromegaly exam, ix and mx

Answer 2

v common in PACES
Look at face, feet, hand-enlarged
prognasthic jaw, enlarged head bump
doughy enlargement
look for carpal tunnel
Look at vision-visual field defects
ask if ring size has changed, feet size changes
Do you have old photographs?

Activity- BP
complications-diabetes
Ix- GH and Glucose tolerance test, IGF1 for follow up

mx-
as if
surgery -1st line
radiotherapy and
Drugs-octreotide

in most endo paces you want to check if the disease is active or not, and make sure theyre ok

Question 3

Cushings disease exam ix and mx

Answer 3

Less common in paces-as usually treated

examine skin-pinch
see the striae, obesity

BP, Glycosuria
Peripheral muscle weakness, centripedal obesity, oesteoporsosis, immunosupress
(and SE of prednisolone)

Ix-disease (adenoma)>85%,
Dex supression test

Mx- surgery

Question 4

Pagets disease exam, ix, mx

Answer 4

Less/least common in Paces
common in old, most asymtomatic
usually hearing aids-
warmths on bone, with pain-usually in tibia
Bones might be flexed
SENSORY NEURAL Deafness-localise to ear-Ossicles get too big
fractures,
v rarely- heart failure

Ix- ALP, Xray of skull/full body MRI
Technitium bone scans-

Mx-Conservative,
BISPHOSPHONATES