Endocrine Flashcards
(86 cards)
1
Q
What are the symptoms of hypothyroidism?
A
- Constipation
- Menorrhagia
- Weight gain + loss of appetite
- Lethargy + weakness
- Cold intolerance
- Infertility
- Loss of libido
- Poor memory/ cognition
- Low mood
2
Q
What are the signs of hypothyroidism?
A
- Bradycardia
- Delayed tendon reflex relaxation
- Jaundice
- Pitting oedema + ascites
- Cold hands
- Peripheral neuropathy
- Myxoedema- puffy hands/ feet/ face
- Pleural effusion
- Overweight
- Carpal tunnel
- Goitre
- Cerebellar ataxia
3
Q
Causes of hypothyroidism
A
- Primary (Low T3/4, High TSH)
- Primary atrophic hypothyroidism (no goitre)
- Hashimoto’s (goitre)
- Iodine deficiency
- Post-thyroidectomy/ radioactive iodine
- Drug induced- antithyroid, amiodarone, lithium, iodine
- Secondary (Low T3/4 and TSH) = hypothalamus/ pituitary dysfunction.
4
Q
Ix and Tx of hypothyroidism
A
- Ix- TFTs, autoantibodies, cholesterol/ triglycerides
- Tx= levothyroxine. Start low (50 micrograms OD) and titrate up monthly. Once stable –> yearly bloods.
- Elderly/ cardiac disease start 25 micrograms.
5
Q
Presentation of myxoedema coma
A
- Usually >65y
- Hypothermia
- Cyanosis
- Hyporeflexia
- Hypoglycaemia
- Bradycardia
- Coma/ seizures
- Preceding psychosis (myxoedema madness)
- Signs/ Sx of hypothyroid eg goitre. Prev radiodine/ thyroidectomy
6
Q
Ix and Tx of myxoedema coma
A
- Ix- ECG, TFTs, FBC, U+Es, cultures, cortisol, glucose, ABG. ??Cause
- Tx: In ITU
- ABCDE +/- O2 + cautious IVT
- Warming blanket
- Correct hypoglycaemia
- T3 (liothyronine) IV 2-3d –> Levothyroxine PO
- Hydrocortisone if ?pituitary
- ABx if ?infection
7
Q
Symptoms of hyperthyroid
A
- Weight loss + increased appetite
- Diarrhoea/ fatty stools
- Sweats
- Heat intolerance
- Loss of libido
- Oligomenorrhoea
- Irritability
- Tremor
- Palpitations
8
Q
Signs of hyperthyroid
A
- Proximal myopathy
- Osteoporosis
- Fine tremor
- Palmar erythema
- Goitre
- Thin
- Exophthalmos/ ophthalmoplegia/ lid lag / lid retraction
- Moist skin
- Tachycardia
9
Q
Causes of hyperthyroidism
A
- Graves’ disease= AI. Thyroid enlargement and increased thyroid hormone production
- Toxic multinodular goitre- Nodules secreting more thyroid hormone
- Toxic adenoma- Solitary nodule secreting T3/T4. Hot on isotope uptake
- Ectopic thyroid tissue eg metastatic thyroid cancer
- Exogenous- iodine excess, levothyroxine, amiodarone, lithium
- Thyroiditis- Destruction –> release hormones
- de Quervain’s- self-limiting post-viral goitre. High temp/ESR. Decreased isotope uptake.
- Post-partum
- TB
- Secondary- pituitary/ hypothalamus. RARE.
10
Q
Hyperthyroid investigations
A
- Bedside- ECG
- Bloods- TFTs, FBC, ESR, calcium, LFTs, thyroid autoantibodies
- Imaging- USS, isotope uptake scan
- ? Eye testing
11
Q
Treatment of hyperthyroid
A
- Medical:
- Beta blockers (rapid)
- Titration- carbimazole titrated to TFTs
- Block and replace- carbimazole + thyroxine
- Graves’ Tx for 12-18 months –> stop. 1/2 relapse.
- Radioiodine
- Thyroidectomy (risk: recurrent laryngeal n.)
12
Q
Presentation of thyroid storm
A
- Signs/ Sx of hyperthyroid
- Hyperthermia
- Agitation
- Confusion
- Coma
- Tachycardia
- AF
- D+V
- Goitre
- Thyroid bruit
- HF
- Acute abdo
13
Q
Ix and Tx of thyroid storm
A
- Ix- TFTs, culture, isotope uptake. Don’t delay Tx
- Tx:
- ABCDE + IVT
- ?Sedate- chlorpromazine
- Propranolol (diltiazem if asthma/HF)
- ?Digoxin to slow heart
- Antithyroid drugs- carbimazole (reduce after 5d) –> Lugol’s solution (iodine) for 7-10d.
- Hydrocotisone/ dexamethaone
- ?ABx
- Cool fluid, paracetamol
14
Q
Features and treatment of mild/ subclinical hypothyroid
A
- Raised TSH, normal T3/T4, no obvious Sx
- Recheck TFTs 2-4 months later to check persistence.
- Tx if TSH >10/ autoantibodies/ past Tx Graves’/ other AI
- TSH 4-10 –> trial Tx 6 months and stop if Sx don’t improve
- No Tx –> monitor yearly TFTs
15
Q
Features and Tx of mild/ subclinical hyperthyroid
A
- Low TSH, normal T3/T4
- Recheck TFTs 2-4months. Check for non-thyroid cause eg pregnancy, illness
- TSH <0.1 Tx if Sx of hyperthyroid/ AF/ unexplained weight loss/ osteoporosis/ goitre
- Tx- carbimazole, propylthiouracil
- No Sx –> recheck 6 monthly
16
Q
Signs of Graves’ Disease
A
- Eyes- ophthalmoplegia, exophthalmos
- Pre-tibial myxoedema
- Thyroid acropachy (clubbing)
17
Q
Goitre differentials
A
- Diffuse
- Iodine deficiency
- Physiological- puberty, pregnancy
- Congenital
- AI- Graves’, Hashimoto’s
- Nodular
- Multinodular goitre
- Cyst
- Adenoma (hot)
- Malignancy (cold)
18
Q
Types of thyroid cancer + Tx
A
- Papillary (60%). Younger. Tx- total thyroidectomy+ node excision + radioactive iodine + thyroxine
- Follicular (25%). Older. Tx as above.
- Medullary- MEN. Calcitonin. Thyroidectomy
- Lymphoma- stridor/ dysphagia. chemo/ radio
- Anaplastic- elderly. Poor response to Tx.
19
Q
Hyperglycaemic symptoms
A
- Polydipsia
- Polyuria
- Ketotic breath (pear drops)
- Sweet smelling urine
- Fatigue
- Weight loss
- Susceptible to infection eg thrush
20
Q
What makes the Dx more likely to be T1DM and not T2DM?
A
- T1DM= absolute insulin deficiency –> insulin
- Young
- Thin
- Usually no FHx
- Complications not usually present at Dx
21
Q
What makes the Dx more likely to be T2DM and not T1DM?
A
- Relative insulin deficiency
- Gradual onset. Usually adults.
- Obese.
- Usually 1st degree relative.
- Complications often present at Dx
22
Q
Features of MODY
A
- Genetic –> strong FHx
- Present young but don’t always need insulin
23
Q
Features of LADA
A
- T1DM in adulthood.
- Slower onset.
- Rapid progression to insulin
- May present with DKA
24
Q
Secondary causes of DM
A
- Pregnancy (GDM)
- Cushing’s
- Acromegaly
- Pancreatitis
- Hyperthyroid
- Haemachromatosis
- Steroids
25
What is metabolic syndrome?
* Cluster of conditions:
* Central obesity
* BP \>130/85
* Fasting BM \>5.6 mmol/L
* High triglycerides and HDL
* Increased risk of: DM, heart diease, stroke, gallstones, cancer.
* Tx= usually diet and exercise.
26
WHO diagnostic criteria for DM
* Sx of hyperglycaemia and 1x elevated venous blood glucose:
* Fasting \>7mmol/L
* Random \>11.1mmol/L
* 2x elevated venous blood glucose (or OGTT 2h \>11.1 mmol/L)
* HbA1c \>48 mmol/L (only T2DM)
27
Complications of DM
* Macrovascular:
* Heart- MI, angina, CHF, HTN
* Brain- CVA, TIA, cognitive impairment
* PDV- Ulcers, gangrene, claudication, amputation
* Microvascular:
* Kidney- nephropathy (frothy urine)
* Eye- retinopathy, maculopathy, cataracts, glaucoma
* Neuropathy
* Erectile dysfunction
* Ischaemic foot
* Emergencies- Hypo, DKA, HHS
28
Causes of hypoglycaemia
EXPLAIN
* EXogenous- insulin, gliclazide, alcohol, aspirin, ACEi, beta blockers
* Pituitary insuffiency
* Liver failure
* AKI/ Addison's
* Islet cell tumours (insulinoma) + Immune Hypo
* Neoplasm (non-pancreatic)
29
Presentation of hypoglycaemia
* 'Drunk'
* ANS- sweating, palpitations, hunger, dizziness
* Neuroglycopoenic- Coma, confusion, drowsiness, difficulty speaking, seizure, incoordination, visual disturbance
30
Emergency treatment of hypoglycaemia
* ABCDE
* Correct glucose
* Can swallow- 10-20g glucose PO eg juice, biscuits, glucogel
* Cannot swallow- 1mg glucagon IM/SC OR 100ml 10% glucose/ 50ml 20% glucose over 20mins
* Repeat until glucose over 4mmol/L
* Long acting carbs eg toast
31
Presentation of DKA
* Drowsy/coma
* Dehydration/ shock
* Kussamul breathing (deep and laboured)
* Ketotic breath
* Abdo pain
* Vomiting
* Weakness
* Hyperglycaemic Sx
32
Diagnosis of DKA
* BM, urine, ABG
* Glucose \>15mmol/L
* Raised urine/ blood ketones
* pH \<7.3
33
Management of DKA
* ABCDE
* IVT- 6L in 1st 24h. IL stat --\> 1hour --\> 2h --\> 4h --\> 8h
* Sliding scale insulin actrapid- 0.1 units/kg/hour. Stop reg. short acting.
* Hunt for trigger
* K+ replacement after 1st bag (40mmol/L)
* Monitor: BM, K+, VBG (pH, bicarb, glucose, K+)
* BM \<14 --\> Add 10% glucose 125ml/h
* Stop insulin when ketones \<0.3, pH \>7.3, bicarb \>18mmol/L. Rapid acting --\> stop 30mins later
* LMWH
34
Presentation of HHS
* Subacute- around 1w
* Nausea
* Dry skin
* Profound dehydration
* Reduced consciousness + confusion
* Polyuria
* Polydipsia
* Lethargy
35
HHS Dx
* Glucose \>35mmol/L
* Osmolality \>340mosmol/kg
* No acidosis
36
HHS management
* Slow IVT over 28h
* Replace K+ when passed urine
* Aim glucose to fall 5mmol/L/h --\> if not, add 0.05units/kg/h insulin
* LMWH
37
Key features of diabetic retinopathy
* Background- Microaneurysms, hard exudates, blot haemorrhages
* Pre-proliferative- Blot haemorrhages, venous bleeding, cotton wool spots
* Proliferative- new vessel formation. Risk of haemorrhage!
38
Presentation of diabetic nephropathy
* Most Asx
* Proteinuria
* Measure annually- urine dip, serum creatinine, eGFR
39
Annual r/v of DM
* HbA1c
* Injection sites
* Albumin:creatinine ratio
* Fundoscopy
* Check feet
* LIpid profile
* U+Es, urine dip
* BP
* BMI
* Education
40
Management of T1DM
* Lifestyle- good diet, carb counting, courses
* CVS risk control- statin, aspirin, ACEi
* Insulin
* Rapid acting eg novorapid
* Short acting eg actrapid
* Intermediate eg isophane
* Long acting eg glargine
* Mixed eg novomix
* Regimes eg basal-bolus
* Changes in insuline dose- increase by 10%, decrease by 20%
41
Management of T2DM
* Lifestyle
* Manage glucose:
* Metformin (gliclazide if thin/ poor renal function)
* Metformin + gliclazide (or gliptin/ pioglitazone)
* Metformin + gliclazide + gliptin/pioglitazone
* Insulin
* Manage BP- ACEi
* Manage lipids + CVS risk- Statins, aspirin
* ID + manage complications
42
What is Cushing's syndrome and how might it present?
* ++ Cortisol. Loss of -ve feedback.
* Presentation:
* Buffalo hump
* Moon face
* Central obesity
* Proximal muscle wasting
* Plethora, bruising, striae
* Osteoporosis
* Skin/ muscle atrophy
* Gynaecomastia
* Mood change
43
Causes of Cushing's Syndrome
* ACTH Dependent (raised):
* Cushing's disease- piuitary adenoma.
* Ectopic ACTH eg SCLC. Sx- hyperpigmentation, weight loss, hyperglycaemia, hypokalaemia, metabolic alkalosis
* Ectopic CRF production (thyroid/ prostate Ca)
* ACTH Independent (Low):
* Adrenal adenoma
* Adrenal nodular hyperplasia
* Iatrogenic \*\*steroids\*\*
44
Ix of Cushing's syndrome
* Confirm cushing's- raised serum cortisol
* Low dose dexamethasone- Cushing's = no suppression of cortisol.
* 48h cortisol suppression test:
* Cushing's disease suppresses with 8mg --\> pituitary MRI
* Ectopic ACTH/ adrenal adenoma not suppressed.
* Plasma ACTH
* Undetected= adrenal tumour --\> CT
* Detectable = cushing's disease/ ectopic ACTH. Do 48h suppression.
45
What is Addison's Disease and what might cause it?
* Addison's= destruction of adrenal cortex --\> reduced cortisol and aldosterone
* Primary= Addison's disease. Destruction of adrenals --\> no production of mineralo/glucocorticoids
* Secondary= Common. Iatrogenic due to long term steroids. Present in crisis after removal of steroids
* Causes: AI, TB, adrenal mets, opportunistic infection, adrenal haemorrhage, late onset congenital
46
Presentation of Addison's Disease
* Mood change
* Tired + tearful
* Weight loss/ anorexia
* Tanned
* Myalgia/ arthralgia/ weakness
* Hypogonadal
* Changed distribution of body hair
* GI disturbance- abdo pain, vomiting
47
Addison's Disease Ix
* Bedside- BM (low)
* Bloods- anaemia, hyponatraemia, hyperkalaemia, hypercalcaemia, uraemia, eosinophilia, autoantibodies, plasma renin-aldosterone
* Imaging- AXR/CXR ?TB ?acute abdo
* Special- short synacthen test:
* Plasma cortisol before and 30mins after 250 micrograms tetracosactide
* Addison's exclused if 30 min cortisol \>550 nmol/L
48
Management of Addison's Disease
* Replace steroids!
* 15-25mg hydrocortisone (+5-10 before exercise)
* 50-200 micrograms fludrocortisone
* Double steroids in febrile illness/ injury/ stress
* Don't stop abruptly!
* Give steroid card
* Follow up annually. BP, U+Es, look for AI disease
49
Causes and presentation of Addisonian Crisis
* Causes- infection/ trauma/ dehydration/ shock in someone with Addison's. Missed steroid in someone on long term.
* Presentation:
* Intense fatigue/ weekness
* Nausea ++
* Confusion, headache, dizziness
* Low GCS/ coma
* Hypotension
* Hypoglycaemia
* ?Hyperkalaemia + hyponatraemia
50
Ix and Tx of Addisonian Crisis
* Don't delay Tx if suspect!
* Ix: Bloods- cortisol, ACTH, U+Es, glucose, cultures
* Tx:
* ABCDE + IVT resus
* HYDROCORTISONE 100MG IV STAT --\> PO after 72h
* ?Fludrocortisone if adrenal disease
* ?Glucose
* Tx the cause
51
What is hyperaldosteronism, what causes it and how might it present?
* = excess aldosterone production --\> Na+ and water retention
* Causes: Adrenal adenoma (conn's), adrenal hyperplasia.
* Presentation:
* Thirst ++
* Polyuria
* Weakness
* Muscle spasms
* Headaches
* Hypertenison (in young, refractory)
52
Ix and Tx of primary hyperaldosteronism
* Ix-
* U+Es (hypokalaemia, hypernatraemia)
* ABG (metabolic alkalosis)
* Plasma renin:aldosterone (high ald, low renin)
* Tx:
* Spironolactone 200-300mg/24h PO
* ?Surgical resection of adenoma
53
What causes secondary hyperaldosteronism?
* Renal hypoperfusion
* Eg diuretics, HF, liver failure, renal artery stenosis
* Presents similarly, renin:aldosterone not high
* Tx- spironolcatone, ACEi
54
What is a phaeochromocytoma and what causes it?
* = Excess catecholamine (noradrenaline) release from the adrenal medulla.
* Caues= usually adrenal tumour. Rarely paraganglioma.
55
Presentation of phaeochromocytoma
* Triad: Epidodic headache, tachycardia, sweating.
* Other Sx:
* Episodic hypertension
* Anxiety
* Facial flushing
* Chest tightness
* SOB
* Tremor
* Palpitations
* Abdo pain + vomiting
56
Ix and Tx of Phaeochromocytoma
* Ix
* Bedside- 24h urine collection for creatinine, catecholamines, metanephrines.
* Bloods- serum metanephrines
* Imaging- CT abdo
* Special- Genetic testing
* Lifelong malignancy screening.
* Tx:
* Alpha blockers (phenoxybenzamine) --\> beta blockers (propranalol)
* Surgical resection of tumour
57
What is acromegaly and how might it present?
* = Excess growth hormone secretion from pituitary tumour/ hyperplasia
* Large hands/ feet
* Coarse facial features
* Jaw protrusion
* Headaches +/- bitemporal hemianopia
* Macroglossia
* Hyperglycaemia
* Hypertenison
* Sweating
58
Ix and Tx of acromegaly
* Ix
* Bedside- ECG, BM, visual fields, BMI
* Bloods- IGF-1, glucose, calcium, phosphate
* Imaging- MRI pituitary
* Special- OGTT
* Tx
1. Pituitary tumour resection
2. Octreotide
3. Pegvisomant
59
Complications of acromegaly
* DM
* Vascular- HTN, LVH, cardiomyopathy, arrhythmias, CVA, IHD
* Neoplasia- colon
60
What hormones are produced by the pituitary?
* Ant. Pituitary
* TSH
* ACTH
* GH
* Prolactin
* LH
* FSH
* Post. Pituitary
* ADH
* Oxytocin
61
Causes of Hypopituitarism
* Hypothalamus- Kallman's, tumour, inflammation, infection, ischaemia
* Pituitary stalk- Trauma, surgery, mass lesion, meningioma, carotid arty aneurysm
* Pituitary- Tumour, irradiation, inflammation, AI, infiltration (mets, haemachromatosis), ischaemia (apoplexy, Sheehan's, DIC)
62
What is Pituitary apoplexy, how might it present and how should it be treated?
* = Rapid pituitary bleed and enlargement.
* Sx- acut headache, meningism, low GCS, ophthalmoplegia, visual field defect
* Tx= urgent hydrocortisone 100mg IV
63
What is Kallman's syndrome?
* Loss of GRH
* Colour blindness
* Anosmia
* Hypopituitarism
64
Presentation, Ix and Tx of Hypopituitarism
* Presentation depends on hormone- GH, FSH/LH, hypothyroidism, adrenal insufficiency, prolactin
* Ix:
* Bloods- LH, FSH, LSH, testosterone, oestradiol, cortisol, IGF-1, U+Es
* Short synacthen
* Imaging- MRI
* Tx- **Hydrocortisone**, replace other hormones
65
What is Diabetes Insipidus, what causes it, and how might it present?
* = Failure to concentrate urine due to lack of ADH (neurogenic) or lack of renal respone (nephrogenic).
* Causes:
* Neurogenic- Idiopathic, traum, tumour/ mets, infection, haemorrhage
* Nephrogenic- Lithium, CRF, post-obstructive uropathy
* Presentation- Polydipsia ++, polyuria, diluted urine, dehydration
66
Ix and Tx of Diabetes Insipidus
* Ix:
* Bedside- urine osmolality
* Bloods- U+Es, calcium, glucose, serum osmolality
* Water deprivation test- don't drink water, monitor weight, fluid balance, urine+plasma osmolality over 8 hours
* --\> DI = failure to concentrate urine (\<600mOsmol/Kg).
* --\> Give desmopressin --\> concentrated in neurogenic not nephrogenic
* Tx: Tx cause!
* Neurogenic- desmopressin
* Nephrogenic- bendroflumethiazide, NSAID
67
Causes and presentation of hypokalaemia
* Hypokalaemia= \<3.5mmol/L
* Intake- diet, IVT (need 1mmol/kg/hr)
* Excretion- D+V, sweating, diuretics, Cushing's Conn's, renal (eg gittleman's)
* Intracellular shift- Alkalosis, insulin, salbutamol
* Presentation- weakness, cramps, nausea, palpitations
68
Ix and Tx of hypokalaemia
* Ix:
* ECG- flatted T waves, arrhythmias
* U+Es (inc Mg)
* ABG- ?alkalosis
* Tx: (emergency = \<2.5mmol/L)
1. ABCDE
2. Continuous ECG
3. Access and bloods
4. Replace 40mmol/L KCl in 1L 0.9 NaCl
5. ABG
6. Senior r/v
* Non-emergency- Sando K, Mg replacement, 20-40mmol/L KCl
69
Causes and presentation of hyperkalaemia
* Hyperkalaemia= K+ \>5.3 mmol/L
* Intake- IVT
* Excreation- Renal failure, Addison's, spironolactone, amiloride, ACEi
* Extracellular shift- Metabolic acidosis, non-selective Beta blockers, low insulin, tissue necrosis
* Presentation- Palpitations, chest pain, dizziness
70
Ix and Tx of Hyperkalaemia
* Ix:
* ECG- tall tented t waves --\> broad QRS --\> VF
* U+Es
* ABG- acidosis
* Tx: Emergency= \>7mmol/L
1. ABCDE + ECG
2. Access and bloods- U+Es
3. 10mL 10% calcium gluconate over 2 mins
4. 10 units actrapid in 50mL 50% glucose over 10 mins
5. 5mg salbutamol NEBS
6. ABG
7. Senior r/v
* Non-emergency- furosemide, ?dialysis. Stop nephrotoxic drugs
71
Presentation of hyponatraemia
* Anorexia
* Nausea
* Malaise
* Headache
* Irritability
* Confusion
* Weakness
* Low GCS (cerebral oedema)
* Seisures
* ?HF/ Oedema
72
Causes of hyponatraemia
* Hypovolaemic:
* Urine Na+ \>20mmol/L = renal loss. Addison's, diuretics, salt losing nephropathy
* Urine Na+ \<20mmol/L= non-renal loss. D+V, burns, SBO, heat
* Hypervolaemia- nephrotic syndrome, HF\< liver cirrhosis, renal failure
* Euvolaemia:
* Urine osmolality \>100mmol/kg= Water overload, hypothyroid
* \<100mmol/kg = SIADH
73
What is SIADH and how is it diagnosed?
* Syndrome of Inappropriate ADH secretion from hypothalamus --\> hyponatraemia
* Diagnosis
* Urine concentrated (osmolality \>500mOsmol/kg), dilute plasma (\<275mOsmol/kg)
* No recent diuretics
* Euvolaemic
* Urine sodium \>20mmol/L
* Normal adrenal and thyroid function.
74
Causes of SIADH
* Malignancy- lung, pancreas, lymphoma
* Lung/ CNS infection
* Vascular events
* Drugs- SSRIs, TCAs, carbamazepine, antipsychotics
* Idiopathic
75
Treatment of hyponatraemia
* Correct fluid and Na+ at same rate lost (ie usually slowly)
* Na+ rise no more than 10mmol/l/24h (risk of osmotic demyelination)
* Acute- seizures/ coma or Na+ \<120mmol/l --\> rapid replacement with hypertonic saline 5mmol/L
* Chronic Asx- fluid restriction +/- domecloclyline
* Stop diuretics + NSAIDs
* Hypovolaemia- replace lost fluid with 0.9% NaCl
76
Causes and presentation of hypernatraemia
* Causes:
* Fluid loss- D+V, burns, DI, DM, Conn's
* ++ Na+- IVT, Conn's
* Presentation:
* Thirst
* Weakness/ lethargy
* Irritability
* Confusion
* Seizures/ Coma
* Signs of dehydration
77
Ix and Tx of Hypernatraemia
* Ix:
* Urine osmolality (\>400mOmol/kg = fluid loss)
* Plasma osmolality
* ?CT/ MRI if ?central cause
* Tx:
* Slow correction
* Hypovolaemia- 0.9% NaCl 1L/6h
* Normovolaemic- PO fluids/ 5% glucose 1L/6h
78
Presentation of hypercalcaemia
* Stones - renal stones
* Bones - pain, osteoporosis, osteopoenia, arthritis
* Groans - abdo pain, D+V, constipation, weight loss
* Psychiatric Moans - depression, confusion
* Thrones - polyuria + polydipsia
* Signs- dehydration, arrhythmias, cachexia, HTN
79
Causes of hypercalcaemia
* Hyperparathyroidism- Primary (adenoma), tertiary (prolonged secondary and hyperplasia)
* Malignancy- Boney mets, myeloma, AML, ALL, ectopic PTH-related peptide (SCLC, endometrial, breast, ovarian, renal)
80
Ix and Tx of hypercalcaemia
* Bedside- ECG, urine electrophoresis
* Bloods- FBC, U+Es, Mg2+, Ca2+, PO43-, ALP, PTH, ESR, serum electrophoresis
* Hyperparathyroidism- High calcium + PTH
* Multiple myeloma- High calcium, high serum albumin
* ALL- High calcium and phosphate
* AML- variable calcium levels
* Ectop PTH-r peptide- High calcium, low phosphate, variable albumin
* Imaging- CXR, bone scan
* Tx- IVT, bisphosphonates eg Zolendronic acid
81
Presentation of Hypocalcaemia
SPASMODIC
* Spasms
* Perioral tingling
* Anxious/ depressed
* Seizures
* Muscle tone (tetany + hyperreflexia)
* Orientation impaired (confusion)
* Dermatitis
* Impetigo herpetiformis
* Chvostek's + cardiomyopathy
* Others: arrhythmias, bradycardia/hypotension
82
What are Trousseau's and Chvostek's signs and what do they indicate?
* Trousseau's= spasm of hand when inflating BP cuff
* Chvostek's= Unilateral twitching of face from tapping facial nerve
* = Hypocalcaemia
83
What are the causes of hypocalcaemia?
* Vitamin D deficiency:
* Malabsorption- Coeliac, CF, short bowel
* Lack of sunlight
* Renal disease
* Hyperventilation
* Hypomagnesia:
* Drug induced- PPI, loop + thiazide diuretics, alcohol
* Malabsorption- laxative abuse, crohn's, UC, coeliac, short gut
* Hypoparathyroidism- Post-surgical, Di-George
84
Ix and Tx of hypocalcaemia
* Ix:
* Bedside- ECG (arrhythmias)
* Bloods- U+Es, calcium, phosphate, magnesium, albumin, ALP, PTH, Vit D
* Tx:
* Hypoparathyroid- Acute= IV calcium gluconate. Chronic- PO calcium + calcitrol (vit D)
* Hypomagnesia- Acute= IV magnesium sulphate replacement +/- IV calcium gluconate . Chronic- PO magnesium oxide
85
Causes, Sx and Tx of Hypophosphataemia + Hyperphosphataemia
Hypo
* Causes- Vit D def, alcohol withdrawal, refeeding syndrome, starvation, hyperparathyroidism, DKA
* Sx: Muscle weakness, rhabdomyolysis, cardiac arrest, arrhythmias
* Tx: PO/IV phosphase supplement
Hyper causes- CKD Tx with phosphate binders, tumour lysis
86
Caues, Sx and Tx of hypomagnesaemia/ hypermagnesaemia
Hypo
* Causes- diuretics, diarrhoea, ketoacidosis, alcohol, parenteral nutrition
* Sx- Paraesthesia, seizures, tetany, arrhythmias
* Tx= magnesium salts
Hyper
* Renal failure, excessive antacids.
* Sx- low bp/ hr, hyporeflexia, CNS/resp depression, coma
* Tx only severe \>7.5
