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Core Conditions AJL (minus renal and respiratory) > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

How common is type 1 diabetes?

A

1 in 20 people in the UK have diabetes

10% of those being type 1

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2
Q

Who does type 1 diabetes affect?

A

Usually diagnosed before 30 years old
Usually lean individuals
Finland & Sardinia have highest incidence

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3
Q

What causes type 1 diabetes?

A

Autoimmune destruction of pancreatic beta-cells

Idiopathic in origin but thought to be found in genetically susceptible individuals and is probably triggered by one or more environmental antigens

Auto-antibodies found against insulin, and islet cell antigens predate the onset of clinical disease by several years

There is an association with other organ specific autoimmune disease

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4
Q

What are the risk factors for type 1 diabetes?

A

Family history
Genetics
Geography (further from equator)

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5
Q

What are the symptoms of type 1 diabetes?

A 
Polydipsia (osmotic diuresis secondary to hyperglycaemia
Nocturia
Excessive fatigue
Weight loss
Loss of muscle bulk

Itchiness in genital area (recurrent thrush)
Blurred vision
Slow healing cuts

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6
Q

What are the signs of type 1 diabetes on examination?

A

Physical examination usually normal

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7
Q

What are the possible differential diagnoses for type 1 diabetes?

A

UTI
Prostatic hypertrophy
Incontinence
Cancer of the urinary tract

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8
Q

What investigations are necessary to diagnose type 1 diabetes?

A

Random plasma glucose concentration of >11mmol/L
Fasting plasma glucose concentration of >7.0mmol/L or higher
Urinalysis: microalbuminuria
FBC, serum U&Es, fasting bloods for cholesterol and triglyceride levels
Liver biochemistry
HbA1c levels (using FBC or finger prick) >48mmol/L

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9
Q

What are the treatments for type 1 diabetes?

A

4 preparations insulins:
Rapid acting - administered shortly before or just after eating. Injected/insulin pump

Short acting - regular/neutral insulin is given before a meal. Injected via syringe/insulin pen

Intermediate acting - isophane insulin

Long acting - no peak of activity allowing constant delivery throughout day (lantus given once a day)

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10
Q

What is type 2 diabetes?

A

Type 2 diabetes develops when the insulin producing cells in the body are unable to produce enough insulin or when insulin produced does not work properly

Known as insulin resistance

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11
Q

How common is type 2 diabetes?

A

1 in 20 people have diabetes

Of these, 90% have type 2 diabetes

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12
Q

Who does type 2 diabetes affect?

A

Usually diagnosed over 30 years
Often overweight
More common in African/Asian decent

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13
Q

What causes type 2 diabetes?

A 
Polygenic disorder
Rare forms caused by mutations in insulin receptors
Environmental factors:
- central obesity
- trigger genetically susceptible
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14
Q

What are the risk factors for type 2 diabetes?

A 
>40 years old
Family history
Overweight/obesity
South Asian/Chinese/Afro-Caribbean/Black African ethnicities
Previous cardiovascular disease
Female with polycystic ovaries
Impaired glucose tolerance
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15
Q

What are the symptoms of type 2 diabetes?

A 
Polydipsia
Nocturia
Excessive fatigue
Weightloss
Itchiness in genital area
Blurred vision
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16
Q

What are the signs of type 2 diabetes on examination?

A 
Physical examination usually normal in early stages
Pts usually overweight
Chronic uncontrolled:
- hypertension
- retinal haemorrhages
- absent pedal pulses
- loss of deep tendon reflexes in ankle
-
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17
Q

What are the possible differential diagnoses of type 2 diabetes?

A 
Metabolic syndrome
UTI
Prostatic hypertrophy
Incontinence
Cancer of urinary tract
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18
Q

What investigations are required to diagnose type 2 diabetes?

A

HbA1c levels measured using FBC or using finger-prick method
- >48mmol/L = type 2 diabetes

Random non fasting plasma glucose concentration >11.1mmol/L

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19
Q

What are the treatment for type 2 diabetes?

A

Lifestyle changes: diet, weight, level of physical activity

Medication:

  • Metformin = first line in type 2 diabetes, reduced CV risk
  • sulphonylureas (gliclazide) = promote insulin secretion, prescribed if pt can’t take Metformin
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20
Q

How common is hypothyroidism?

A

15 in every 1000 women in UK

1 in every 1000 men in UK

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21
Q

Who does hypothyroidism affect?

A

More common in women

Usually 40-50 (menopausal years)

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22
Q

What are the causes of hypothyroidism?

A

Autoimmune disease: most common Hashimotos

  • cytotoxic T-cells and autoantibodies directed against thyroglobulin and thyroid peroxidase
  • first stimulate the thyroid causing enlargement, and then destroy the thyroid follicles causing atrophy of thyroid

Pituitary or hypothalamic failure causing secondary hypothyroidism

Genetic dysfunction: thyroid may be dysfunctional at birth or is predisposed later in life

Chronic iodine deficiency (iodine required to make thyroid hormones)

Treatment for hyperthyroidism

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23
Q

What are the risk factors for hypothyroidism?

A 
Gender (female)
Age >60yrs
Environmental (iodine deficiency)
Autoimmune disease
Family History
Treatment with radioactive iodine
Radiation to neck/upper chest
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24
Q

What are the symptoms of hypothyroidism?

A

Depends on severity

Fatigue
Increased sensitivity to cold
Constipation
Dry/scaly skin
Unexplained weight gain
Muscle weakness
Elevated blood cholesterol level
Pain, stiffness, swelling of joints
Heavier or irregular menstrual periods
Hair thinning
Depression
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25
What are the signs of hypothyroidism on examination?
``` Slow speech, dull facial expression Psychosis Low BP, bradycardia Dry skin, coarse brittle, straw-like hair, loss of hair Overweight Jaundice, pallor Goitre Pericardial effusion, oedema (non pitting) Hyporeflexia ```
26
What are the possible differential diagnoses of hypothyroidism?
``` Anaemia Autoimmune thyroid disease and pregnancy Thyroid lymphoma Chronic fatigue syndrome Depression Menopause ```
27
What investigations are necessary to diagnose hypothyroidism?
Thyroid function tests: looking at TSH and thyroxine (T4) levels - ⬆️ TSH and ⬇️ T4 = primary hypothyroidism - primary hypothyroidism only disease where sustained raised TSH Assays for anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies helpful in determining aetiology
28
What are the treatments of hypothyroidism?
Thyroxine replacement therapy Levothyroxine (T4) - main treatment Liothyronine (T3) - is active hormone and acts quicker than T4 but shorter duration so BD
29
How common is hyperthyroidism?
8 in 100 women develop | 1 in 100 men develop
30
Who does hyperthyroidism affect?
More common in women More commonly begins 20-40 years More common in white people
31
What are the causes of hyperthyroidism?
Graves' disease: - autoimmune disease - most common cause of an overactive thyroid (80%) - most common in females - anti-thyroid stimulating hormone receptor antibodies (IgG) stimulate thyrocytes to secrete thyroid hormones Toxic multi nodular goitre Toxic adenoma - responsible for 5% of hyperthyroidism cases Thyroiditis Over medication of thyroxine Pituitary problems
32
What are the risk factors for hyperthyroidism?
``` Gender (female) Family history Smoking High iodine intake Thyroid trauma Child birth Stress Genetics ```
33
What are the symptoms of hyperthyroidism?
``` Weight loss despite increased appetite Restlessness, irritability Breathlessness, palpitations Heat intolerance, increased thirst, sweating Itching, thinning hair Malaise, vomiting, diarrhoea Infrequent, light menstruation - oligomenorrhoea Eye complaints Stiffness, muscle weakness, tremor Oncholysis ```
34
What are the signs of hyperthyroidism on examination?
``` Tremor Hyperkinesis Psychosis Proximal myopathy, muscle wasting, pretibial myxoedema Oncholysis, thyroid acropatchy Palmar erthema Tachycardia, AF Warm, vasodilated peripheries Systolic hypertension Exophthalmos, lid lag, stare Goitre, bruit ```
35
What are the possible differential diagnoses of hyperthyroidism?
Graves' disease Goitre Thyrotoxicosis
36
What investigations are necessary to diagnose hyperthyroidism?
Thyroid function test: looking at levels of thyroid stimulating hormone (TSH) and thyroxine (T4) - serum TSH suppressed - serum free T3 and T4 elevated Thyroglobulin antibodies Thyroid ultrasound
37
What are the treatments of hyperthyroidism?
Anti thyroid drugs - Carbimazole - blocks thyroid hormone synthesis and have immunosuppressive effects which affects Graves' disease process - beta blockers - as most symptoms Re mediated via sympathetic nervous system Radioactive iodine treatment - accumulates in thyroid gland and causes local irradiation damage Surgery - thyroidectomy
38
How common is goitre?
Affects 12% people worldwide
39
Who does goitre affect?
More common in women | More common in >40s
40
What are the causes of goitre?
Diffuse: entire thyroid gland enlarged and smooth to touch - Physiological; puberty, pregnancy - Autoimmune; graves, Hashimotos - Acute viral thyroiditis - Iodine deficiency Nodular: solid or fluid filled nodules present, lumpy to touch, multiple or single nodules - multi nodular - solitary nodule - fibrotic - cysts Tumours: - adenoma - carcinoma - lymphoma
41
What are the risk factors for goitre?
``` Gender (female) Age (⬆️ with age) Family history Iodine deficient diet Pregnancy and menopause Medication Exposure to radiation ```
42
What are the symptoms of goitre?
``` Usually noticed as cosmetic defect Discomfort/pain in neck Difficulty breathing/swallowing (tracheal compression Hoarseness/change in voice Symptoms for hypo&hyperthyroidism ```
43
What are the signs of goitre on examination?
Bruit | Lymphadenopathy
44
What are the possible differential diagnoses of goitre?
Oesophageal cancer | Tracheal/bronchial cancer
45
What investigations are necessary to diagnose goitre?
Blood tests: - thyroid function and thyroid antibodies Imaging - high resolution thyroid ultrasound FNA - cytology necessary to assess for malignancy Thyroid scan
46
What are the treatments for goitre and thyroid nodule?
Watch and wait Anti thyroid medication/radioactive iodine Levothyroxine Surgical intervention
47
What is the goitre grading system?
``` 0 = not palpable or visible even when neck extended 1 = palpable 1A = detected on palpation 1B = palpable and visible when neck extended 2 = visible when neck in normal position 3 = large goitre visible from distance ``` ``` Simple = non toxic Toxic = hyperthyroid ```
48
How common is thyroid nodule?
1 in 12-15 young women | 1 in 40 young men
49
Who does thyroid nodule affect?
``` More common in women Increasing incidence with age 50% 50 yr olds 60% 60 yr olds 70% 70 yr olds ```
50
What are the causes of thyroid nodules?
``` Iodine deficiency Hypertrophy of thyroid tissue Thyroid cyst Thyroiditis Multi- nodular goitre thyroid cancer ```
51
What are e risk factors for thyroid nodules?
``` Gende (female) ⬆️ age Radiation to neck/upper chest Pre-existing thyroid condition Family history ```
52
What are the symptoms of thyroid nodules?
``` Usually Asymptomatic Usually noticed as cosmetic defect Discomfort/pain in neck Difficulty breathing/swallowing Hoarseness/voice changes Symptoms of hypo/hyper thyroid ```
53
What are the signs of thyroid nodules on examination?
Moveable (less likely to be malignant) Fixed nodule - malignancy Lymphadenopathy
54
What is the differential diagnosis for thyroid nodule?
Goitre
55
What investigations are necessary to diagnose thyroid nodules?
Blood tests- serum TSH and free T4 Immunoassays: antibodies titres to thyroperoxidase or thyroglobulin FNA Thyroid ultrasound - detects poorly palpable nodules - determine size/number of nodules, solid/cystic - assist in FNA Radionuclide scanning
56
How common is Cushing's syndrome?
Very rare | 1 in 50,000
57
Who does Cushing's syndrome affect?
Adults 20-50 years | Women 3x more likely
58
What are the causes of Cushing's syndrome?
Adrenocorticotrophic hormone (ACTH) dependent causes: - pituitary dependent (Cushing's disease): primary hyper- secretion of ACTH - ectopic ACTH- producing tumours Non- ACTH dependent causes - adrenal adenomas - adrenal carcinomas - glucocorticoid administration Other - alcohol induced pseudo-Cushing's syndrome
59
What are the risk factors for Cushing's syndrome?
Obesity Type 2 diabetes Poorly controlled blood glucose Hypertension
60
What are the symptoms of Cushing's syndrome?
``` Weight gain Change of appearance Depression Insomnia Amenorrhoea/oligomenorrhoea Thin skin/easy bruising Muscular weakness Back pain ```
61
What are e symptoms of Cushing's syndrome on examination?
``` Moon face Plethora Depression/psychosis Thin skin/bruising, skin infections Hypertension Osteoporosis, kyphosis, pathological fractures, rib fractures Buffalo hump Central obesity, striae, Proximal myopathy, proximal muscle wasting ```
62
What are the possible differential diagnoses of Cushing's syndrome?
Cushing's disease Hypothyroidism Hypertension
63
What investigations are necessary to diagnose Cushing's syndrome?
Confirm raised cortisol Establishing cause of Cushing's syndrome: - adrenal CT/MRI will detect adrenal adenomas and carcinomas - pituitary MRI and CT will detect some but not all pituitary adenomas Corticotrophin- releasing hormone test
64
What is the difference between Cushing's disease and Cushing's syndrome?
Cushing's disease is when the ACTH comes from the pituitary gland Cushing's syndrome is where there is an adrenal tumour producing too much cortisol, or too much ACTH is made which causes the adrenal glands to make cortisol
65
What are the treatments for Cushing's syndrome?
Surgical removal for most pituitary tumour indicated Drugs inhibiting cortisol synthesis External beam irradiation to pituitary Iatrogenic Cushing's syndrome
66
What is parathyroid adenoma?
Benign tumour of parathyroid gland and last common cause of hyperparathyroidism Leads to hypercalcaemia
67
What other aetiology of parathyroid adenoma?
Genetic Idiopathic Secondary to excess PTSH
68
What are the risk factors for parathyroid adenoma?
Age (>60yrs) | Irradiation
69
What are the symptoms of parathyroid adenoma?
``` Often Asymptomatic Confusion Constipation Lethargy Muscle pain Nausea ```
70
What is the aetiology of primary hyperparathyroidism?
Single parathyroid adenoma - most common cause - benign - increased parathyroid hormone Hyperplasia of multiple parathyroid glands - benign enlargement - increased parathyroid hormone Parathyroid carcinoma - very rare cause
71
What is the aetiology of secondary hyperparathyroidism?
Kidney disease - hypocalcaemia leading to over stimulation Vitamin D deficiency - hypocalcaemia Intestinal malabsorption - hypocalcaemia
72
What are the symptoms of hyperparathyroidism?
``` Tiredness Muscle weakness Nausea/vomiting Constipation Abdo pain Polydipsia Polyuria Depression ```
73
What are the complications of hyperparathyroidism?
``` Kidney stones Corneal calcification Pancreatitis Peptic ulceration Renal damage ```
74
What is Addison's disease?
Primary adrenal insufficiency (hypoadrenalism) Rare condition in which there is destruction of entire adrenal cortex therefore not enough cortisol or aldosterone is produced
75
What is the aetiology of Addison's disease?
90+% of cases are auto antibody destruction Others: surgical removal, TB, haemorrhage
76
What are the symptoms of Addison's disease?
``` Lethargy Depression Anorexia Weight loss Postural hypotension - salt and water loss Hyper pigmentation ```
77
What is addisonian crisis?
``` Vomiting Abdo pains Profound weakness Hypoglycaemia Hypovolaemic shock ```
78
What investigations are necessary to diagnose Addison's disease?
``` Single cortisol measurements Short ACTH stimulation test Plasma ACTH level Long ACTH stimulation test Adrenal antibodies testing ```
79
What is Type 1 diabetes?
It is an autoimmune disease that causes the insulin producing beta cells in the pancreas to be destroyed, preventing the body from being able to produce enough insulin to adequately regulate blood glucose levels

Core Conditions AJL (minus renal and respiratory) (10 decks)

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