whore moans Flashcards
what is hypocalcaemia
low serum calcium
2.2-2.6mmol/L
what can cause hypocalcaemia
hypoparathyroidism vitamin D deficiency diarrhoea liver and kidney disease PPI blood transfusions
how does hypocalcaemia present
muscle twitches seizures fractures poor blood clotting ventricular tachycardia tetany
what are clinical tests for hypocalcaemia
chovstek’s - tap skin 1cm below zygomatic process, will cause facial twitch/spasm
trousseaus - use blood pressure band to compress arm, flexors will be activated and hand will twitch
what investigations should you do for hypocalcaemia
ECG
serum Ca, albumin and phosphate
PTH
how can you manage hypocalcaemia
oral Ca tablets
oral VD tablets if deficient
if serum Ca is below 1.9 this is an emergency
treat with IV calcium gluconate
what is hypoparathyroidism
when the parathyroid gland does not produce enough PTH resulting in low serum Ca
what causes hypoparathyroidism
thyroid/parathyroidectomy
autoimmune destruction of gland
how does hypoparathyroidism present
symptoms of hypocalcaemia
what is hypercalcaemia
increased serum calcium
3-3.5mmol/l above 3.5 is an emergency
what can cause hypercalcaemia
hyperparathyroidism renal failure acromegaly MEN syndromes TB sarcoidosis
how does hypercalcaemia present
polyuria nausea vomiting constipation bone pain fatigue pancreatitis coma osteoporosis
what investigations could you do for hypercalcaemia
serum Ca, albumin, phosphate
U&Es
DEXA for osteoporosis
how do you treat hypercalcaemia
rehydrate with 4-6l of 0.9% saline over 4-6hrs IV bisphosphonates glucocorticoids calcitonin cinacalcet
what is primary hyperparathyroidism
gland makes PTH uncontrollably
high serum PTH and high Ca
what causes primary hyperparathyroidism
adenoma
hyperplasia of gland
carcinoma
how does primary hyperparathyroidism present
stones, thrones, bones, moans, psychiatric overtones Ca kidney stones polyuria constipation sore bones muscle weakness depression confusion
how can you manage hyperparathyroidism
remove tumour
what is secondary hyperparathyroidism
when renal failure or VD deficiency causes low absorption of Ca resulting in hypocalcaemia
the parathyroid gland reacts to this by releasing more PTH and undergoes hyperplasia
serum calcium is normal but PTH is high
what can cause secondary hyperparathyroidism
vitamin D deficiency
chronic kidney failure
how does secondary hyperparathyroidism present
symptoms of chronic renal failure
calcification of vessels
how can you manage secondary parathyroidism
correct VD deficiency
manage renal failure
what is tertiary hyperparathyroidism
when secondary hyperparathyroidism becomes primary over a long period of time
treat by surgical removal of part of the gland
what is primary adrenal insufficiency
hyposecretion of adrenal hormones
most commonly aldosterone and cortisol, can be sex steroids too
what can cause primary adrenal insufficiency
waterhouse-friederschein disease
sudden increase in BP causing rupture of vessels causing ischaemia
how does primary adrenal insufficiency present
hypotension
nausea
vomiting
confusion coma
what is Addison’s disease
chronic primary renal insufficiency due to destruction of adrenal cortex
how does addison’s disease present
lethargy sore muscles, abdomen, joints depression diarrhoea vomiting
what can cause addison’s
autoimmune destruction
TB
metastatic carcinoma
what investigations would you do in addison’s
synacthen test
what are clinical signs of addison’s
hyperpigmentation (CRH is a precursor of melalin) - of buccal membrane, palmar creases
acanthesis nigricans
postural hypotension
weight loss
how can you manage addisons
hydrocortisone
fludrocortisone
increase dose when patient has infection or minor surgery
patient given emergency ID tag
what is addisonian crisis
sudden increased need for hormones causes acute symptoms
what can cause addionian crisis
sudden stopping of steroids/hormone therapy
bilateral adrenal haemorrhage
how does addisionian crisis present
hypotension nausea, vomiting pain in back abdomen and legs dehydration weakness psychosis coma
what investigations could you do in addisonian crisis
bloods for cortisol and ACTH
how could you manage addisonian crisis
Hydrocortisone Sodium succinate 100mg IV
IV saline
monitor BG
find underlying cause
what is graves disease
autoimmune disease where antibodies are formed that mimic TSH and bind to receptors causing an increase in T3 and T4
TRH and TSH levels are low
the increased demand for TH causes hyperplasia (increased number of follicular cells) and hypertrophy of the gland
the antibodies also stimulate fibroblasts in eyes and skin causing them to make more glycosaminoglycans
causes hyperthyroidism
what is toxic multinodular goitre
nodules develop on the gland that act independently of the TRH and TSH negative feedback and produce lots of TH (some TSH receptors are turned on constantly - like megan)
causes hyperthyroidism
usually caused by iodide deficiency - hypothalamus increases TRH and therefor TRH causing hypertrophy and hyperplasia of the gland - goitre develops
what is the effect of a thyroid adenoma
the adenoma produces TH regardless of TH level in the blood
what can happen when the thyroid gland is inflamed or damaged?
the hormones can all spill out causing hyperthyroidism
how does hyperthyroidism present
increased basal metabolic rate heat intolerance sweating fever anxiety muscle weakness osteoporosis if chronic loose stools hyperreflexia palpitations
what is thyroid storm/ thyrotoxic crisis
severe hypermetabolism
life threatening
what can cause thyrotoxic crisis
sudden stopping of therapy
infection
surgery
how does thyrotoxic crisis present
pyrexia
tachycardia
delirium
arrhythmia
what are specific clinical signs of graves disease
enlarged thyroid - goitre
exophthalmos (bulging of eye)
pretibial myxoedema
oedema
what are specific clinical signs of toxic multinodular goitre
enlarged thyroid hoarse voice airway obstruction dysphagia SVC syndrome - facial and arm swelling
how can you treat hyperthyroidism
Carbimazole - 1st line
propylthiouracil
radioactive iodine ablation (+ levothyroxine if needed)
beta blockers
surgical removal
for thyroid storm - beta blockers, thionamides, glucocorticoids
what investigations can you do in hyperthyroidism
TFTs
ECG
what is primary hypothyroidism
thyroid gland doesn’t make enough hormones
what can cause primary hypothyroidism
hashimoto’s thyroiditis - autoimmune destruction of thyroid gland
iatrogenic - thyroidectomy or iodine ablation
chronic iodine deficiency
congenital
what is secondary hypothyroidism and what can cause it
there is not enough TSH to release TH
tumour of pituitary or hypothalamus
how does hypothyroidism present
weight gain loss of appetite cold intolerance lethargy constipation myxoedema - swelling of tongue and skin
what is myxoedema coma and how does it present
extreme hypothyroidism due to surgery, infection
hypothermia
loss of consciousness
confusion
what investigations could you do in hypothyroidism
blood hormone levels - TH will always be low, TSH only raised in primary disease (and low in secondary disease).
thyroid peroxidase antibodies for autoimmune disease
how do you treat hypothyroidism
levothyroxine long term - start with a high dose and gradually reduce
TFTs every month
what is acromegaly
extra GH after growth plates have closed
what is gigantism
excess GH in kids before growth plates have closed
what can cause acromegaly
pituitary adenoma secreting GH
MEN 1 syndrome
how does acromegaly present
large hands and feet large jaw gaps between teeth large forehead soft tissue swelling large tongue carpal tunnel syndrome diabetes (GH increases insulin resistance)
what investigations could you do in acromegaly
blood GH levels
MRI for pituitary adenoma
GH suppression test
oral glucose tolerance test
how do you treat acromegaly
somatostatin analogues GH receptor antagonists dopamine agonists pituitary tumour removal removal of any other causative tumour
what is hyperprolactinemia
high levels of prolactin in the blood
what can cause hyperprolactinemia
prolactinoma pregnancy polycystic ovary disease tumour in hypothalamus secreting prolactin releasing hormone or in pituitary secreting prolactin lactation stress dopamine depleting drugs
how can hyperprolactinaemia present in women
menstrual irregularity
lactating when not pregnant
infertility
how can hyperprolactinaemia present in men
gynecomastia impotence visual disturbances headache decreased facial hair
what investigations could you do in hyperprolactinaemia
blood prolactin level > 550mu/l
pregnancy and polycystic ovary test
how can you treat hyperprolactinaemia
dopamine agonists
increase calcium and vitamin D uptake because risk of osteoporosis
What is the first presentation of thyroid cancer?
A solitary hard painless lump on the thyroid gland. it can cause hoarseness and trouble swallowing if it gets too big.
what does non functional thyroid cancer mean?
They don’t produce signs of hyperthyroidism or hypothyroidism.
What is the diagnosis of thyroid cancer made with?
Thyroid ultrasound. Radioiodine scan - where radio iodine is injected and taken up by cells which make thyroid hormone, usually thyroid tumours don’t make thyroid hormone so they are ‘cold nodues’
what is the definitive diagnostic test for thyroid cancer?
Fine needle aspiration.
what is the treatment for thyroid cancer?
partial or total thyroidectomy followed by thyroid hormone replacement.
what is primmery hyperaldosteronism?
aldosterone s a mineralocirtocoid. it increases sodium reabsorption, and increases hydrogen secretion and potassium secretion.
Conns syndrome - when the adrenal gland produces too much aldosterone, the renin is low because of the high blood pressure entering the kidneys.
Where does stage 2 of the RAAS system occur? (mediated by ACE hormones)
In the lungs.
which hormone stimulates the release of aldosterone?
Angiotensin II
what is the cause of Conns syndrome?
adrenal adenoma - most common cause.
bilateral adrenal hyperplasia
familial hyperaldosteronism.
adrenal carcinoma
What is secondary hyperaldosteronism?
where renin is causing the increase in aldosterone - renin will be high.
what is the main cause of secondary hyperaldosteronism?
when theres reduced blood flow to the kidneys, tricking them into thinking the blood pressure is too low:
renal artery stenosis, heart failure, atherosclerosis.
what is the investigation for hyperaldosteronism?
to check the renin:aldosterone ratio
- high aldosterone : low renin (primary hyperaldosteronism)
- High aldosterone : high renin (secondary hyperaldosteronism).
Blood pressure, hypokalaemia, alkalosis.
treatment of aldosteronism?
aldosterone antagonists - spironolactone, eplenerone.
surgery - remove adenoma.
percutaneous angioplasty - to stent the renal artery.
what does hyperaldosteronism cause?
it is the leading cause of secondary hypertension.
when is radioactive iodine for hyperthyroidism contraindicated?
pregnant women (can't get pregnant within 6 months) can be around pregnant women or children for 3 weeks must have limited contact with anyone for days after receiving the dose.
which mood stabilising drug can cause hypothyroidism?
Lithium - inhibits production of thyroid hormone.
