MLA Endocrinology Flashcards
What is Addison’s disease?
AKA primary adrenal insufficiency
- Impaired synthesis/release of glucocorticoids and mineralocorticoids
Causes: 75-90% autoimmune, or infections like TB and CMV or steroid use
Who is most likely to get Addison’s disease?
Women (90%)
Those with other autoimmune disease
What are some symptoms of Addison’s disease?
Fatigue
Muscle weakness
Anorexia
Loss of libido (hypoandrogenism)
Goitre
What is an Addisonian crisis?
An acute state of severe cortisol and aldosterone deficiency
Symptoms: severe weakness, severe abdo pain, nausea, vomiting, profound hypotension, reduced consciousness
Management: IV hydrocortisone, fluid resuscitation, and electrolyte monitoring
What is the function of glucocorticosteroids in the body?
AKA corticosteroids
Function: supress immune response, balance stress response, glucose and protein homeostasis, inti-inflammatory
Eg. cortisol
What is the function of mineralocorticoids in the body?
Regulate salt and water balance
Eg. aldosterone
What is Cushing’s syndrome?
Too much cortisol
- Causes obesity and stunted grow in children
- Excess hair in women
- Irregular periods
- Erectile dysfunction
What is the pathophysiology of gestational diabetes?
The placental hormones cause insulin resistance and the pancreas can’t produce enough hormones to overcome these effects
What is the management of gestational diabetes?
1st line: exercise and dietary changes
2nd line: meds like metformin insulin
What is the pathophysiology of diabetes insipidus?
Issues with ADH
Nephrogenic: kidneys don’t respond to ADH
- Mostly hereditary. Also caused by chronic kidney disease, pregnancy, electrolyte imbalances
Central: pituitary gland doesn’t produce enough ADH
- Mostly caused by trauma to the pituitary gland or tumours
What are the symptoms of diabetes insipidus?
Polyuria
Extreme thirst
How is diabetes insipidus diagnosed?
Fluid deprivation test
Neurogenic DI: low [urine] normalises with desmopressin.
Nephrogenic DI: low [urine] regardless of desmopressin.
Primary polydipsia: high [urine]
What is the pathophysiology of diabetic ketoacidosis?
When there is not enough glucose because of not enough insulin so the body breaks down fat for energy. If prolonged, the ketones build up and cause acidosis
Affects type 1 diabetics
What is the function of albumin?
Produced in the liver
Function: prevents fluids from leaking out of vessels and it carries hormones and enzymes
How is albumin linked to diabetic nephropathy?
Damaged vessels of the kidneys will leak proteins like albumin into the urine which can be detected to diagnose diabetic nephropathy
What are the causes of secondary hypertension?
- Aldosteronism
- Cushing’s syndrome
- Sleep apnoea
- Hyperparathyroidism
- Endocrine disease
- Phaeochromocytoma
How can hyperlipidaemia occur?
Mainly diet, lifestyle, and genetics
Also diabetes, hypothyroidism, cushing’s syndrome, anorexia nervosa
What is a hypermolar hyperglycaemia state?
AKA HHS
- Very high sugar levels in T2DM without presence of ketones causing dehydration and confusion
What are some causes of hyperparathyroidism?
Primary causes
- Parathyroid hyperplasia
- carcinoma
- Ectopic secretion
Secondary causes
- Vitamin D or calcium deficiency
- Kidney failure
What are the symptoms of hyperparathyroidism?
Usually asymptomatic
Can cause increased thirst, depression, nausea and vomiting, constipation, confusion, high BP, palpitations, hair loss
What are the complications of hyperthermia?
Eg. heat stroke or heat exhaustion
- Precipitated by dehydration
Kidney and liver damage
Rhabdomyolysis
Confusion
Headache
What are some complications of hypothermia?
Kidney failure
Pancreatitis
Arrhythmias
Frostbite
Pulmonary oedema
What is osteomalacia?
‘Bone softening’ caused by prolonged vitamin D deficiency
Treatment: correct the cause, offer surgery for deformities
What are the different thyroid disease?
Hashimoto’s: autoimmune hypothyroidism
- Causes fatigue, constipation, dry skin, hair loss, goitre, menstrual changes
Graves: autoimmune hyperthyroidism
- Causes bulging eyes, weight loss, anxiety, fatigue, fast metabolism
What are the causes of SIADH?
- Pituitary abnormality
- Malignancy (small cell lung cancer)
- Meds like antidepressants
- Hypothyroidism
What are the clinical findings of a pituitary tumour?
- Sudden headache
- Visual changes (loss of peripheral vision)
- Menstrual irregularities and erectile dysfunction
What’s a short synacthen test?
It measures persons ability to produce cortisol
Synacthen is injected and that stimulates the adrenal glands, followed by two blood tests to measure cortisol levels
What’s Conns disease?
Primary hyperaldosteronism
Symptoms: High blood pressure, poor vision, headaches, muscular weakness, muscle spasms
What is the difference between thyrotoxicosis and thyroid storm?
Thyroid storm: when there is end organ damage
Both are a complications of hyperthyroidism but thyrotoxicosis is first
Often caused by Graves disease
What’s the most common cause of asymptomatic hypercalacaemia?
Almost always primary hyperparathyroidism
Sometimes malignancy but that has symptoms
What is Trousseaus test?
Tie a cuff around the arm and increase the pressure for 3 mins
Positive test is flexion of the hand if there is hypocalcaemia
How can ketones be decreased in the blood?
Give dextrose and insulin at the same time to stop neoproduction of ketones
How does HSS kill?
It causes the blood to ‘thicken’ because of the excess glucose so the patient is at high risk of clots and occlusions
What is a Charcot’s foot?
Characterised by 5 D’s:
Density change,
Destruction, Debris, Distension, Dislocation
- Progressive destruction of the joints
Often caused by gout and diabetes mellitus
What are the characteristics oh Horner’s syndrome?
- Partial ptosis (drooping or falling of the upper eyelid)
- Miosis (constricted pupil)
- Facial anhidrosis
- Enopthalmos (sunken eyes appearance)
- Hoarse voice
What is acromegaly?
Abnormal growth of hands, face, and feet caused by an overproduction of growth hormone by the pituitary gland
Screened using insulin-like growth factor 1 (IGF-1)
What’s Adie syndrome?
A rare neurological disorder that affects the pupil of the eye and the autonomic nervous system
