Endocrine Conditions

Question 1

What is the pathology of type 1 diabetes?

Answer 1

Autoimmune destruction of the B cells in the islets of langerhans leading to insulin deficiency

Question 2

At what age does type 1 DM usually present?

Answer 2

12

Question 3

What are the symptoms of type 1 DM?

Answer 3

Polyuria
Polydipsia
Weight loss

Question 4

How is type 1 DM diagnosed?

Answer 4

Symptoms plus one of:
Random venous plasma glucose concentration >11.1 mol/l
Fasting plasma glucose concentration >7
2hr plasma glucose concentration >11.1mmol/l 2hrs after a 75 anhydrous glucose in OGTT

Question 5

How is type 1 DM treated?

Answer 5

Patient education is crucial
Insulin - different regimes
Eg - rapid acting mixed with intermediate acting before breakfast and evening meal

Question 6

What are the complications of diabetes mellitus?

Answer 6

Microvascular - retinopathy, nephropathy, neuropathy

Macrovascular - coronary vascular disease, cerebrovascular disease, peripheral vascular disease

Question 7

Hypoglycaemia

Answer 7

BG <4 mol/l

Tremor, sweating, irritability, dizziness, pallor

Question 8

What is the pathology of diabetic ketoacidosis?

Answer 8

Hyperglycaemia
Dehydration
Ketosis
Metabolic acidosis
Potassium imbalance

Question 9

What are the symptoms of diabetic ketoacidosis?

Answer 9

Polyuria
Polydipsia
Nausea/vomiting
Abdominal pain
Acetone smell to breath
Altered consciousness

Question 10

What investigations would be done if diabetic ketoacidosis was suspected?

Answer 10

Blood glucose
Venous blood gas
Blood - ketones, bicarbonate
Urinalysis for ketones too

Question 11

How is diabetic ketoacidosis treated?

Answer 11

Weight-based fixed IV insulin infusion
Aggressive fluid replacement
Monitor K and replace if needed
Treat underlying cause

Question 12

What are the complications of diabetic ketoacidosis?

Answer 12

Cerebral oedema
Hypoglycaemia
Hypo/hyperkalaemia
Pulmonary oedema

Question 13

What is the pathology of type 2 diabetes?

Answer 13

Combination of insulin resistance and inadequate production (B cell destruction) / impaired secretion of insulin (B cell dysfunction)

Question 14

What are the causes of type 2 diabetes?

Answer 14

Obesity
Cushing’s
Chronic pancreatitis

Question 15

What is the average age of onset for type 2 diabetes?

Answer 15

50

Question 16

How does type 2 diabetes present?

Answer 16

Can present with complications of diabetes (eg vascular problems)
Fatigue
Polyuria
Polydipsia

Question 17

How is type 2 diabetes investigated?

Answer 17

FBC
Glucose
OGTT
HbA1c

Question 18

How is type 2 diabetes treated?

Answer 18

Patient education
Dietary modification
Metformin - biguanide, increases insulin sensitivity, SE lactic acidosis
Then add:
Sulphonylurea - eg glimepiride, stimulates insulin release from pancreas, SE hypoglycaemia
Thiazolidinedione - eg pioglitazone, increases insulin sensitivity
DPP-4 inhibitor, SGLT inhibitor

Question 19

What is the pathology of Cushing’s syndrome?

Answer 19

Excess cortisol

Question 20

What are the causes of Cushing’s syndrome?

Answer 20

Exogenous - iatrogenic, steroids, alcohol
ACTH dependent - pituitary overproduction of ACTH, Cushing’s disease (pituitary adenoma)
ACTH independent - adrenal adenoma

Question 21

What are the signs of Cushing’s syndrome?

Answer 21

Moon face
Central obesity
Proximal muscle wasting
Easy bruising
Hirsutism

Question 22

What investigations would be done if Cushing’s syndrome was suspected?

Answer 22

24hr urinary free cortisol
Random blood cortisol
Low-dose dexamethasone suppression test - to see if ACTH can be suppressed
High dose dexamethasone suppression test - to differentiate between pituitary or ectopic secretion

Question 23

How is Cushing’s syndrome treated?

Answer 23

Remove tumour if that’s the cause

Question 24

What is the pathology of Addison’s disease?

Answer 24

Destruction of adrenal cortices - steroid (glucocorticoid) and aldosterone (mineralocorticoid) deficiency
Autoimmune

Question 25

What are the signs of Addison's disease?

Answer 25

``` Bronze hyperpigmentation of skin Postural hypotension Fatigue Nausea Cramps ```

Question 26

What investigations would be done if Addison's disease was suspected?

Answer 26

Short synacthen test | Hyponatraemia

Question 27

How is Addison's disease treated?

Answer 27

Hydrocortisone to replace steroid | Fludrocortisone to replace mineralocorticoid

Question 28

What are the causes of hyperthyroidism?

Answer 28

Grave's disease | Toxic multi nodular goitre

Question 29

What are the features of hyperthyroidism?

Answer 29

``` Anxiety Irritability Sweating Heat intolerance Tachycardia Weight loss Fatigue Frequent loose stools ```

Question 30

What investigation findings would hyperthyroidism give?

Answer 30

TSH - decreased | T3T4 - increased

Question 31

Grave's disease

Answer 31

Cause of hyperthyroidism TSH receptor antibodies Exopthalmos, pre-orbital myxoedema

Question 32

How is hyperthyroidism treated?

Answer 32

Carbimazole

Question 33

What are the causes of hypothyroidism?

Answer 33

``` Hashimoto's thyroiditis Iodine deficiency Congenital Radio-iodine Lithium ```

Question 34

What are the signs of hypothyroidism?

Answer 34

``` Weight gain Fatigue Dry skin Fluid retention Amenorrhoea Constipation ```

Question 35

What investigation findings would primary hypothyroidism give?

Answer 35

TSH - increased | T3T4 - decreased

Question 36

What investigation findings would secondary hypothyroidism give?

Answer 36

TSH - decreased | T3T4 - decreased

Question 37

Hashimoto's thyroiditis

Answer 37

Cause of hypothyroidism Anti-thyroid peroxidase antibodies (anti-TPO) Anti-thyroglobulin antibodies

Question 38

How is hypothyroidism treated?

Answer 38

Levothyroxine

Question 39

Acromegaly

Answer 39

Increased growth hormone Most common cause - pituitary adenoma Presentation - bilateral hemianopia, coarse features Treatment - trans-sphenoidal removal of pituitary adenoma, somatostatin

Question 40

Hypercalcaemia

Answer 40

Bones, stones, moans and groans Cause - bone metastases (breast, lung, prostate) Treatment - fluid rehydration, loop diuretics

Question 41

What is the cause of hyperparathyroidism?

Answer 41

Solitary parathyroid adenoma | Associated with MEN I and II

Question 42

What is the presentation of hyperparathyroidism?

Answer 42

50% asymptomatic | 50% - bones, stones, moans and groans

Question 43

What would primary hyperparathyroidism show investigation wise?

Answer 43

(Cause - tumour) PTH - high Ca - high

Question 44

What would secondary hyperparathyroidism show investigation wise?

Answer 44

(Cause - low vit D, CKD) PTH - high Ca - low/normal

Question 45

How is hyperparathyroidism treated?

Answer 45

High fluid | Resect if significant symptoms

Question 46

Phaochromocytoma

Answer 46

Tumour of adrenal medulla Secretes noradrenaline and adrenaline Signs - flushing, palpitations, sweating, headache Investigation - 24hr urine catecholamines x 3 Treatment - alpha blocker (phenoxybenzamine)

Question 47

What are the different types of thyroid cancer?

Answer 47

Papillary - 70% Follicular - 20% Medullary - 5% Anaplastic - <5%

Question 48

Diabetes insipidus

Answer 48

Kidney's can't conserve water - frequent urination, pronounced thirst Investigation - water deprivation test Treatment - desmopressin

Question 49

Syndrome of inappropriate ADH secretion (SIADH)

Answer 49

ADH (vasopressin) causes water retention by increasing the permeability of the nephron Causes - meningitis, encephalitis, tumour, SAH, TB, asthma, COPD, malignancy, drugs (antidepressants, carbamazepine, diuretics) Treatment - fluid restriction, correct Na

Question 50

Congenital adrenal hyperplasia

Answer 50

21-hydroxylase