Endocrine Flashcards
(33 cards)
What is acromeagly?
excessive GH secretion in adults, typically due to an anterior pituitary adenoma
What are clinical features on history for acromeagly?
- Symptoms of current symptoms - headache, visual disturbances
- Resp: OSA, Difficult intubation
- Cardiac: HTN, CAD, cardiomyopathy, arrhythmias
- Endocrine: Diabetes
What are clinical features on exam for acromeagly?
General inspection
- Body habitus/BMI
- Large tongue
- Mandibular enlargement
Cardiac:
- Arryhthmias
- CCF signs
What Ix for acromeagly?
Bloods:
- BSL
- GH levels, IGF-1
ECG:
- LVH
TTE:
- Systolic/diastolic dysfunction
What is diabetes?
hyperglycemia due to an absolute or a relative deficiency of insulin
What are clinical features on history for diabetes?
- Duration of diagnosis
- Insulin requirement
- Complications of diabetes
- Ketoacidosis and hospital admissions
What are clinical features on examination for diabetes?
General inspection:
- Obesity, dehydration
- muscle wasting (peripheral neuropathy)
- Ulcers
Cardiac:
- BP lying and standing (autonomic neuropathy)
- Cardiac failure (secondary to IHD)
Eyes:
Visual acuity, fundoscopy
What Ix for diabetes?
Bloods:
- HbA1c, renal function
- BSL
ECG
- Ischaemia
TTE/stress testing if meet criteria
What is the clinical features of hypercalcaemia?
Renal stones
Abdominal pain
Osteopenia
Confusion
Stones, Bones, Abdominal Groans & Psychological Moans
What is the management of severe hypercalcaemia?
- Phosphate
- Rehydration
- Pamidronate (1st line)
- Forced diuresis (2nd line)
What are the clinical features of acute hypocalcaemia?
o Perioral paresthesias, restlessness, seizures
o Refractory heart failure
o Neuromuscular irritability:
-Inspiratory stridor/laryngospasm
- Tetany, hypereflexia
-Chvostek sign – tapping gently on facial nerve under ear causes brisk twitches on same side of face
-Trousseau sign – tourniquet on arm causes contraction of hand
What are the most common causes of hyperthyroidism?
- Grave’s disease
- Multinodular goitre
- Toxic adenoma
What are the clinical features on history of hyperthyroidism?
weight loss, heat intolerance, sweating, palpitations,
diarrhea, tremor, irritability, anxiety, fatigue
What are the clinical features on exam of hyperthyroidism?
o Fine tremor, palmar erythema, moist + warm peripheries,
tachycardia, AF
o Proximal myopathy, brisk reflexes
o Enlarged neck, check for pemberton’s sign, check tracheal position
o Eyes – exophthalmos (protrusion of eyeball from orbit),
lid lag, chemosis
o CVS – high output CCF, systolic flow murmurs,
cardiomegaly
o Legs – pretibial myxedema
What Ix are useful in hyperthyroidism?
- TFTs - High T3, T4, low TSH
- CT neck to assess for compression of structures eg trachea
What is the management for hyperthyroidism?
- Carbimazole or PTU
- propranolol
- Radioactive iodine
- Surgery
What is a thyroid storm?
life-threatening exacerbation of hyperthyroid state with evidence of decompensation in one or more organ systems
What are causes of hypothyroidism?
o Chronic autoimmune (Hashimoto’s) thyroiditis
o Iatrogenic – thyroidectomy, external neck irradiation, radioiodine therapy, lithium, amiodarone
What are the clinical features on history of hypothyroidism?
fatigue, lethargy, weight gain, slow speech, cold intolerance, decreased sweating, constipation
What are the clinical features on exam of hypothyroidism?
o Mental sluggishness, hypothyroid speech (slow, nasal + deep pitch), deafness
o Hands – cyanosis, swelling, dry + cold skin, bradycardia, small volume pulse from decreased CO, carpal tunnel
o Face – yellow skin, alopecia, loss of eyebrows, swelling, periorbital oedema
o Chest – pericardial effusion, pleural effusion
o Peripheries – proximal myopathy, non-pitting oedema, peripheral neuropathy, slow reflexes
o Peripheral neuropathy, slow reflexes
Describe the TFTs for Primary hypothyroidism
Low T3, T4
High TSH
Primary issue with thyroid - TSH trying to get it to make more
Causes include thyroidectomy, autoimmune thyroiditis
Describe the TFTs for subclinical hypothyroidism
Normal T3, T4
Raised TSH
Normal T3/4 = subclinical
Raised TSH suggests feedback trying to increase thryoid output
Describe the TFTs for secondary hypothyroidism
Low T3, T4
Low/normal TSH
Low thyroid function but due to non thyroid cause - not being stimulated
eg Pituitary adenoma, surgery/radiotherapy that decreases TSH/TRH production
Describe the TFTs for Primary hyperthyroidism
Raised T3/4
Low TSH (negative feedback)
- Causes:
○ Grave’s disease (75%)
○ Toxic multinodular goitre - The thyroid itself is producing too much, appropriate TSH suppression
