Endocrinology Flashcards
Tired and tanned
What specific questions should be asked if Addison’s disease suspected?
Skin pigmentation
Fatigue
Weightloss
Postural hypotension
Abdo pain, N+V, diarrhoea
Myalgia, arthralgia - widespread
Amenorrhoea
Hx of autoimmune disease
Travel history and TB contacts
Previous abdominal surgery (adrenalectomy)
What clinical signs would you look for in suspected Addisons?
Pigmentation: palmar creases and buccal mucosa
Lack of body hair
Other autoimmune diseases - thyroid and vitiligo
Abdominal scars
Bitemporal hemianopia
LS BP
How would you investigate Addisons?
Short Synacthen Test
ACTH
Adrenal auto-antibodies
Hypo Na and Hyper K
Hypoglycaemia
CXR for TB
CT/MRI adrenals
How would you manage Addisons?
Glucocorticoids
Mineralocorticoids
Androgen replacement
How do you tell the difference between primary and secondary hypoadrenalism?
Primary: raised ACTH and hyperpigmentation
Secondary: may have bitemporal hemianopia
What are the features of glucagonoma?
Diarrhoea
Weight loss
Hyperglycaemia
Necrotic skin rash
What are the signs of thyroid eye disease?
Lid retraction
Lid lag
Subsequent red eyes
Proptosis
Oedema
Extra-ocular muscle involvement causes Painful eye movements/Diplopia
Sight loss from optic nerve compression
What are the management options of thyroid eye disease?
Smoking cessation
Ensure euthyroid state
Lubricant eye drops/tape at night
IV pulsed methyl pred
Mycophenolate
Surgical orbital decompression
Orbital radiotherapy
Azathioprine/Monoclonal antibodies - if can’t have steroids
How do you treat a prolactinoma?
Bromocrptine to shrink
Followed by surgery
Management of SIADH in small cell lung cancer
Fluid restriction
Tolvaptan
