Endo 1 Flashcards by Elliot Colman

What is Diabetes Insipidus?

Inadequate secretion or insensitivity to ADH, leading to ‘Hypotonic Polyuria’

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What are the two types of Diabetes Insipidus?

Cranial/Central: Failure of the posterior pituitary to secrete ADH

Nephrogenic: Collecting ducts become insensitive to ADH

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What causes Cranial/Central Diabetes Insipidus?

Pituitary Tumour

Infection (Meningitis)

Sarcoidosis

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What can cause Nephrogenic DIabetes Insipidus

Hypercalcaemia

Hypokalaemia

Lithium

Inherited Genes (AVPV2)

Idiopathic

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How would a patient with Diabetes Insipidus typicall present?

Polyuria (incl. nocturia)

Polydipsia

Symptoms of Hypernatraemia (Lethargy, Irritability, Confusion)

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How would you investigate a potential case of Diabetes Insipidus?

U&Es, Glucose

Water Deprivation Test

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How is a water deprivation test used to diagnose Diabetes Insipidus?

Water restricted for 8 hours, with plasma and urine osmolality measured every hour.

Give Desmopressin after 8 hours and measure urine osmolality.

In cranial DI - Increase of >50% post-desmopressin

In nephrogenic DI - Increase of <45% post-desmopressin

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How do you manage a patient with Diabetes Insipidus?

Treat the underlying cause

Intranasal Desmopressin (Cranial)

Thiazide Diuretics/NSAIDS (Nephrogenic)

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How do T1DM and T2DM differ in terms of presentations?

Both present with Polyuria + Polydipsia

T1 presents with Tiredness, weight loss, DKA,

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How does a patient experiencing a DKA present?

Nausea and Vomiting

Abdominal Pain

Kussmaul Breathing

Sweet Breath

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What are the risk factors for T1 and T2 DM?

T1 - HLA DR3/4, Other autoimmune conditions

T2 - Obesity, FHx, ethnicity, endocrine disease, drug use.

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How is Diabetes Mellitus diagnosed?

Fasting Glucose >7 mmol/L

Random Glucose >11.1 mmol/L

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How is T1DM managed?

Insulin

Education

Fluids for DKA

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How is T2DM managed?

Diet and Lifestyle advice

Metformin +/- sulphonylurea +/- Insulin

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What are the main causes of Hyponatraemia?

Hypovolaemic - Diarrhea, Vomiting, Diuretics

Euvolaemic - Hypothyroidism, Hypoadrenalism, SIADH

Hypervolaemia - HF, Cirrhosis, Nephrotic Syndrome

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How would you investigate a euvolaemic patient with Hyponatraemia?

TFTs

Short synACTHen test

Drug Review

Breast Exam

CXR/Brain MRI (For tumour - SIADH)

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How would you determine the volaemic status of a patient with hyponatraemia?

Hypo - Reduced turgor, postural hypotension, dry mucous membranes

Hyper - Oedematous, High JVP

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How does Hypernatraemia present?

Lethargy, irritability, thirst, dehydration, confusion, coma, fits.

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What may cause Hypernatraemia?

Rare

Vomiting

Diarrhoea

Primary Aldosteronism

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What is SIADH?

Syndrome of Innappropriate ADH secretion.

Not a diagnosis

Need to find an underlying cause.

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What can cause SIADH?

CNS Pathology

Lung Pathology

Drugs: SSRI, TCA, Opiates, PPIs, Carbamazepine

Tumours (don’t forget breast)

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What can cause Hyperprolactinaemia?

Pituitary Prolactinoma

Hypothyoridism

Drugs (Metoclopramide, antipsychotics)

Physiological causes, such as pregnancy

How does hyperprolactinaemia present?

Women - Galactorrhoea, amenorrhoea, infertility

Men - Loss of libido, infertility, galactorrhoea

Tumour Symptoms - Headache, Bitemporal Hemianopia

How would you investigate the cause of Hyperprolactinaemia?

Prolactin levels

TFTs

Pituitary MRI

How would you manage a patient with Hyperprolactinaemia?

1) DA Agonist - Bromocriptine (Amir Sam says Cabergoline - both are used) 2) Surgery

How does Hyperthyroidism present?

Heat Intolerance, Sweating Palpitations irritable Weight Loss (Good appetite) Diarrhoea Menstrual Irregularities/Impotence Tremor

How does Hypothyroidism present?

Cold Intolerance Bradycardia Lethargy Weight Gain Constipation Menstrual Disturbance Dry skin

What are the main causes of Hyperthyroidism?

Grave's Disease De Quervain (Viral) thyroiditis Toxic Multinodular Goitre Adenoma

What is Grave's Disease?

Autoantibodies to TSH receptor Associated with other Autoimmune Diseases Triad = Exopthalmos, Pretibial Myxoedema, Thyroid Acropachy (Nail changes)

How does De Quervain's Thyroiditis typically present?

Post-Viral Presents with Fever, high ESR, Painful Goitre Self-Limiting (NSAID treatment)

How does Toxic Multinodular Goitre typically present?

In the elderly, and in areas where iodine diet deficincies are more likely.

What is a Thyroid Adenoma?

Single nodule producing T3/4

What would you see on Radioisotope Uptake scans for the main common causes of Hyperthyroidism?

Grave's - Diffuse increased uptake De Quervain's Thyroiditis - No Uptake TMG - Multiple areas of increased uptake Adenoma - Single area of increased uptake

What are the main causes of Hypothyroidism?

Autoimmune Hashimoto's Thyroiditis (Common in the West) Iodine Deficiency (Common Worldwide) Iatrogenic - Post-Surgery, radioiodine, amiodarone De Quervain's Thyroiditis - Hypo once supplies are exhausted Congenital

How would you manage a patient with Hypothyroidism?

Levothyroxine

What are the main types of Thyroid Cancer?

Papillary Follicular Medullary Lymphoma Anaplastic

What is Papillary Thyroid Cancer?

Most Common, affecting younger patients Risk factor- Radiation Exposure SBA Buzzwords - 'Psammoma Bodies', 'Orphan Anne Nuclei'

What is Follicular Thyroid Cancer?

Type affecting middle aged women predominantly SBA Buzzwords - Hurthle Cells

What is Medullary Thyroid Cancer associated with?

MEN2, FHx important

What is a Thyroid Lymphoma?

Cancer more common in females, general occurs after ore-existing Hashimoto's thyroiditis

What is Anaplastic Thyroid Cancer?

The most aggressive Thyroid Cancer Affects mainly Elderly Females SBA Buzzwords - Giant Cells, Pleomorphic Hyperchromatic Nuclei

What is Acromegaly?

Hypersecretion of GH in Adults.

What most commonly causes Acromegaly?

GH secreting Adenoma in the Pituitary

How does Acromegaly typically present?

Rings and shoes become tight Sweaty, oily skin Weight Gain Headaches/Vision changes Carpal Tunnel Syndrome HTN Insulin Resistance

How would you investigate a possible case of Acromegaly?

Serum IGF-1 as screening OGTT - Failure to suppress GH after being given glucose orally - this is diagnostic. MRI brain to assess tumour

How do you manage Acromegaly?

1) Transphenoidal Hypophysectomy 2) Somatostatin Analogue (Octeotride)

What is Multiple Endocrine Neoplasia?

Autosomal dominant condition causing the formation of multiple hormone-producing tumours in mutliple organs.

What is MEN1?

The formation of Endocrine tumours in the Parathyroid Gland, Pancreas and Pituitary Gland

What can a MEN1 tumour in the Pituitary cause?

Hyperprolactinaemia Acromegaly Hyperadrenalism Carcinoid Syndrome

Which tumours does MEN2 typically present with?

Thyroid (Medullary) Adrenal (Phaeochromocytoma) Parathyroid Hyperplasia

What is Carcinoid Syndrome?

Syndrome caused by systemic release of humoural factors from Carcinoid Tumours Leads to increased production of secretory products, such as Serotonin, Histamine, Tachykinins and prostaglandins. Commonly occur in the Appendix and Rectum

How does Carcinoid Syndrome typically present?

Paroxysmal Flushing Diarrhoea Crampy Abdo pain Wheeze Sweating Palpitations

How would you investigate a possible case of Carcinoid Syndrome?

24Hr Urinary 5-HIAA Levels Serotonin metabolite, increased in Carcinoid Syndrome CT/MRI to localise tumours