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C > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the endocrine system mediated by?

A

Hormones

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2
Q

What are 3 basic problems that occur with the endocrine system?

A

Excess hormone
Reduced hormone
Physical gland enlargement

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3
Q

What effects can physical gland enlargement have? (2)

A

Mass

Pressure

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4
Q

Thyroxine excess

A

Hyperthyroidism

Thyrotoxicosis

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5
Q

Thyroxine lack

A

Hypothyroidism

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6
Q

Thyroid mass

A

Goitre

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7
Q

What can cause hyperthyroidism? (3)

A

Graves disease
Goitre / toxic adenoma
Pituitary driven

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8
Q

Symptoms of hyperthyroidism

A

Sweating, heat intolerance
Irritability, poor sleep, anxiety, palpitations
Excess appetite, weight loss, diarrhoea
Breathlessness

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9
Q

Signs of hyperthyroidism

A 
Warm moist skin
Tachycardia, irregular heart rate
Increased blood pressure, heart failure 
Fine tremor
Goitre
Pre-tibial myxoedema
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10
Q

Signs of Graves Disease

A 
Eye disease
Exophthalmos
Ophthalmoplegia
Lid lag/ retraction 
Loss of visual clarity
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11
Q

Diagnosis of hyperthyroidism

A

Clinical
Blood tests - Thyroid function tests - Low TSH, High T3, T4; Auto antibodies
Radiology sometimes

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12
Q

What drugs are used to manage hyperthyroidism?

A

Anti thyroid drugs - carbimazole, prophylthiouracil
Beta blockers control symptoms
Radioactive iodine I(131) - caution in young patients and contraindicated if pregnant/ breastfeeding

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13
Q

What causes hypothyroidism?

A

Auto-immune
Iatrogenic - surgery, radioiodine
Iodine deficiency
Rarely pituitary disease

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14
Q

Symptoms of hypothyroidism

A 
Reduced metabolism
Cold intolerance
Weight gain
Constipation
Hoarse voice
Puffed face and extremities
Mental slowness, poor memory 
Hair loss
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15
Q

Signs of hypothyroidism

A 
Slow pulse
Large tongue
Deep voice 
Thin/ dry hair, loss of eyebrows
Goitre
Coarsening of fetures
Acute (rare) - coma, hypothermia
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16
Q

Diagnosis of hypothyroidism

A

Clinical
Blood tests - thyroid function tests - high TSH, low T4, T3; Auto-antibodies
Radiology sometimes

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17
Q

How is hypothyroidism managed?

A

Replacement - thyroxine (T4), levothyroxine

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18
Q

What kind of Goitres are there? (3)

A
  1. No associated intrinsic thyroid disease
    - simple cysts/ adenomas
    - iondine deficiency
  2. Associated with intrinsic thyroid disease
    - auto-immune
    - toxic multi-nodular goitre/ adenoma
  3. Malignant
    - rare
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19
Q

Side effects of Goitres?

A

Dysphagia

Breathing difficulties

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20
Q

How can Goitres be investigated?

A
  1. Radiology
    - ultrasound scan
    - radioisotope scan
  2. Fine needle aspiration
  3. Blood tests
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21
Q

How are Goitres treated?

A

Underlying cause treated

May need surgery

22
Q

What are 2 side effects of carbimazole

A

Taste disturbance

Neutropenia

23
Q

Two types of adrenal disease

A

Cushing’s Syndrome
- Excess corticosteroid production
Addison’s disease
- Deficient corticosteroid production

24
Q

What is Cushing’s syndrome cause by?

A
  1. Excess ACTH (Adrenocorticotropic hormone)
    - Pituitary adenoma
    - Ectoptic production by cancers (Lung)
  2. Excess corticosteroids
    - Adrenal adenomas, carcinomas
    - Iatrogenic
25
Q

Symptoms of Cushing’s syndrome

A 
HBP
Weight gain - abdominal obesity
Prone to diabetes
Prone to infections 
Thinning skin that bruises easily
Redish - purplish streth marks on thighs, stomach, buttocks, arms, legs or breasts 
Fat deposits on face - round face 
Muscle or bone weakness 
Acne
26
Q

How is Cushing’s syndrome managed?

A

Address underlying cause - if iatrogenic, reduce/ stop medication
Non - iatrogenic, surgery ideally

27
Q

What are the causes of Addison’s disease?

A
  1. Iatrogenic - withdrawal of steroids after long term use
  2. Hypopituitarism - cancer, infection, vascular, trauma
  3. Adrenal destruction - auto-immune disease
28
Q

What are the symptoms of Addison’s disease?

A 
Chronic disease
- General malaise 
Acute (usually in response to stress)
(Infection, trauma, surgery)
- Life threatening: shock, hypoglycaemia, vomiting, abdominal pain
29
Q

What are the signs of Addison’s disease?

A 
Hyperpigmentation on:
Buccal mucosa
Scars
Pressure points
Skin creases
30
Q

What is used to treat Addison’s disease?

A

Hydrocortisone (glucorticoid) 20mg am, 10mg pm

Fludrocortisone (mineralocorticoid)

31
Q

When should dosage be increased?

A

Times of stress:
Infection
Trauma
Surgery

32
Q

How should an Addisonian crisis be treated?

A 
Fluid replacement
Glucose
Hydrocortisone injections 
Treat infection if present
Hospitalisation
33
Q

What is Acromegaly

A

Excess growth hormone

34
Q

What is it usually due to?

A

Pituitary adenoma

35
Q

What characteristic features of Acromegaly?

A 
Large tongue
Excess hair
Large "spade like" hands/ feet
Myophathy / arthritis 
Prominent supraorbital ridge
Broad nose
Prognathism 
Interdental separation 
Thick, greasy skin
Diabetes
HBP
Heart failure
36
Q

Medical treatment of Acromegaly

A

Somatostatin analogues (protein which slows down the function of many hormones)

37
Q

Other treatments of Acromegaly

A

Surgery is compressing nearby structures

May also need radiotherapy

38
Q

How is diabetes diagnosed?

A

Elevated blood sugar
Random plasma glucose >/= 11.1mmol/L
Or fasting plasma glucose >/= 7.0mmol/L

39
Q

What complication arise due to diabetes?

A 
Infections
- especially skin, mouth
- boils, abscesses, cellulitis 
- candidosis 
- tuberculosis 
Eye disease (Diabetic retinopathy)
- leading cause of blindness in developed world
Kidney disease (Diabetic nephropathy)
- leading cause for dialysis in UK
40
Q

What is diabetic neuropathy?

A

Loss of nerve function
Loss of sensation
Loss of bowel and bladder function and sexual function
Muscle weakness and pain

41
Q

Athersclerosis

A

Complication of diabetes
Disease of arteries
Deposition of fatty material on walls
Main reason for premature deaths in diabetes

42
Q

How is type 2 diabetes managed?

A 
Initially dietary 
Medication:
- Sulphonylureas
- Biguanides 
- Glitazones

Blood sugar monitoring

43
Q

Diabetes risk factors

A 
Weight control
Physical activity 
Cholesterol 
Smoking
HBP
44
Q

What else should be monitored in patients with diabetes?

A 
Regular clinics
Eyes photgraphed
Feet
Monitor blood sugar control - HbA1c
Monitor cholesterol
Blood pressure
45
Q

What medical emergency is most likely to occur with Type 1 diabetes?

A

Hypoglycaemia, low blood sugar

46
Q

What are the two different types of high blood sugar in diabetics?

A

Type 1 - Diabetic ketoacidosis (DKA)

Type 2 - Hypersmolar Non-Ketotic Coma (HONK)

47
Q

What causes DKA?

A

Insulin not taken due to no food intake

Inadequate insulin in acute physiological stress e.g. infection, surgery

48
Q

Diabetic ketoacidosis signs and symptoms

A

Impaired consciousness
Dehydration
Ketones on breath

49
Q

Management of DKA

A

Hospitalisation
Insulin replacement
Fluids
Treat underlying cause

50
Q

Signs and symptoms of hypoglycaemia

A 
Irritability 
Personality change
Sweating
Tremor
Hunger
Progresses to impaired consciousness, fits, coma
51
Q

How would you treat hypoglycaemia?

A 
Don't wait for confirmation of low blood sugar
Oral glucose
Unconscious:
- Hypostop (Buccal gel)
- IM glucagon 
- IV glucose
- Oral as soon as able

C (7 decks)

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