Week 11 - Endocrinology Flashcards
endocrine system - mediated by?
hormones
3 basic problems in endocrine disease?
- excess hormone
- reduced hormone
- physical gland enlargement
thyroid disease - manifestations?
- thyroxine excess: hyperthyroidism/thyrotoxicosis
- thyroxine lack: hypothyroidism
- thyroid mass: goitre
hyperthyroidism: pathophysiology?
- autoimmune: grave’s disease
- goitre/toxic adenoma
- pituitary driven
hyperthyroidism: symptoms?
- sweating, heat intolerance
- irritability, poor sleep, anxiety, palpitations
- excess appetite, weight loss, diarrhoea
- breathlessness
hyperthyroidism: signs?
- warm, moist skin
- tachycardia, irregular heart rate
- increased BP, heart failure
- fine tremor
- goitre
- grave’s disease
- pre-tibial myxoedema
describe grave’s disease?
eye disease
- exopthalmos
- ophthalmoplegia
- lid lag/retraction
- loss of visual acuity
hyperthyroidism - diagnosis?
- clinical signs
- blood tests: thyroid function tests & auto-antibodies
- radiology (sometimes)
diagnosing hyperthyroidism with blood test - what would the thyroid function test results be?
low TSH
high T3, T4
hyperthyroidism - management?
- drugs:
- anti-thyroid drugs e.g. carbomazole, propylthiouracil
- b-blockers: controls symptoms - surgery: control disease first, occasionally eye surgery
- radioactive iodone: caution in young patients, do not use in pregnancy or breast-feeding
hypothyroidism: pathophysiology?
- auto-immune: thyroid destruction
- iatrogenic: from surgery or radioiodone
- iodine deficiency: rare
- rarely pituitary disease
hypothyroidism - symptoms?
reduced metabolism
- cold intolerance
- weight gain, constipation
- hoarse voice, puffed face, extremities
- mental slowness, poor memory
- hair loss
hypothyroidism - signs
- slow pulse
- large tongue, deep voice
- thin/dry hair, loss of eyebrows
- goitre
- coarsening of features
- acute (rare): coma, hypothermia
hypothyroidism - diagnosis
- clinical signs
- blood tests: thyroid function tests & auto-antibodies
- radiology (sometimes)
diagnosing hypothyroidism with blood test - what would the thyroid function test results be?
- high TSH
- low T3, T4
hypothyroidism - management?
replacement
- thyroxine (T4)
- levothyroxine
goitre - thyroid mass: what are the 3 types?
- those not associated with intrinsic thyroid disease: simple cysts/adenomas, iodine deficiency
- associated with intrinsic thyroid disease: auto-immune, toxic multi-nodular goitre/adenoma
- malignant: rare
goitre - what type of compression effect is possible despite being rare?
retro-sternal extension: results in dysphagia and breathing difficulties as it compresses the mediastinum
goitre - investigation methods?
treatment?
- radiology: ultrasound/radioisotope scan
- fine needle aspiration
- blood tests
tx:
- treat underlying cause, may need surgery
thyroid disease - dental aspects:
- anti-thyroid drugs?
- goitres?
- antithyroid drugs e.g. carbimazole -> cause neutropenia and taste disturbance
- goitres:
evidence of lymphadenopathy or compression -> related to thyroid effects?
adrenal disease: two types and their mechanisms?
- excess corticosteroid production: cushing’s syndrome
- deficient corticosteroid production: addison’s disease
cushing’s syndrome: pathophysiology?
excess ACTH:
- pituitary adenoma
- ectopic production by cancers
excess corticosteroids:
- adrenal adenomas, carcinomas
- iatrogenic
cushing’s syndrome: characteristics?
- high BP
- diabetes
- prone to infections
- thinning hair
- high visceral fat
- thin extremities
- buffalo hump
- moon face
cushing’s syndrome - management?
address underlying cause
- iatrogenic: try to reduce/stop
- non-iatrogenic: surgery (ideal)
addison’s disease - pathophysiology?
- iatrogenic: occurs after withdrawal of steroids after long term use
- hypopituitarism: due to cancer, infection, vascular, trauma
- adrenal destruction: due to autoimmune disease
addison’s disease - symptoms?
- chronic: general malaise
- acute: usually in response to stress from infection, trauma, surgery
symptoms may be life-threatening: shock, hypoglycaemia, vomiting, abdominal pain
addison’s disease - signs?
- hyperpigmentation of: buccal mucosa scars pressure points skin creases
addison’s disease - management?
management of addisonian crisis?
replacement therapy: baseline
- hydrocortisone (glucocorticoid)
- fludrocortisone (mineralocorticoid)
increase at times of stress
- infection, trauma, surgery
acute addisonian crisis is a medical emergency
- fluid replacement, glucose, hydrocortisone injections
- need hospitalization
adrenal disease - dental aspects
- cushing’s: poor woulf healing, oral infections
- addison’s: increased steroid dose
growth hormone excess: acromegaly
- due to?
- excess growth hormone, usually due to a pituitary adenoma
- rare
acromegaly: characteristic features?
- large tongue
- excess hair
- large hands/feet
- myopathy/arthritis
- prominent supraorbital ridge
- broad nose
- prognathism
- interdental separation
- thick, greasy skin
- high BP
- heart failure
- diabetes
acromegaly - management?
- medical management (somatstatin analogues to slow down production of growth hormone)
- surgery
- may also need radiotherapy
diabetes mellitus - two forms and their pathophysiology?
10% type 1
- insulin dependent
- auto-immune disease
- commonly seen in young people
90% type 2
- non-insulin dependent
- insulin resistance and deficiency
- more likely if obese
diabetes - diganosis?
- elevated blood sugar
- classical symptoms: high plasma glucose
- no symptoms: from routine medical screening
diabetes - complications?
- infections - increased risk: boils, abscesses, cellulitis in boils and mouth
- eye disease (diabetic retinopathy)
- kidney disease (diabetic nephropathy)
- nerve disease (diabetic neuropathy): loss of nerve function, i.e. lose sensation, bowel and bladder function, muscle weakness and pain
- atherosclerosis
diabetes management: main goal? methods for type 1 and 2?
- normalize blood sugar
- type 1: insulin
- type 2: initially dietary & lifestyle changes. if not,
oral medication given: - sulphonylureas
- biguanides
- glitazones
diabetes - management?
- minimize other risk factors: weight control, exercise, cholesterol, smoking, high BP
- monitor for complications: regular clinic, eyes photographed, feet examined, monitor blood sugar control (HbA1c), monitor cholesterol, kidney fn, BP
2 types of diabetic emergencies? list each
high blood sugar:
- diabetic ketoacidosis - type 1
- hyperosmolar non-ketoic (HONK) coma - type 2
low blood sugar:
- hypoglycaemia
diabetic ketoacidosis - causes?
- insulin not taken due to no food intake
- inadequate insulin in acute physiological stress: infection & surgery
- often a combination of both
DKA - symptoms & signs? diagnosis? management
- impaired consciousness, dehydration, ketones on breath
- elevated blood sugar, ketones in urine
- hospitalization: insulin replacement, fluids, treat underlying cause
hypoglycaemia:
- causes?
- clinical features?
- diagnosis based on?
- taking insulin without any glucose
- occasionally due to tablets
- irritability, personality change, sweating, tremor, hunger. progresses to impaired consciousness -> fits, coma
- clinical features and blood glucose reading
hypoglycaemia:
treatment? for awake & those with impaired consciousness
awake:
oral glucose: soft drinks, biscuits, milk
impaired consciousness:
- hypostop: glucogel, squirt into buccal mucosa
- IM glucagon
- IV glucose
- oral glucose as soon as able
