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Flashcards in endocrine core conditions Deck (58):
1

what is diabetes? how does it differ in type 1 and type 2?

lack or reduced efficacy of endogenous insulin
in type 1 this is a result of beta cell destruction in the islet of langerhan cells causing reduced insulin production usually autoimmune
type 2 diabetes it is a result of increase insulin resistance / beta cell dysfunction and thus reduces insulin secretion

2

risk factors for type 1 and 2 and who it affects

type 1 - usually In infancy, HLA D3 and D4 association been found and high concordance rates in fraternal and identical twins. 10% increase risk if family member posses it.. can be seen in adults, latent type 1 (1.5)
type 2- usually in adult hood (40 +) but seen increasingly these days in teens, Asians, elderly and men are more at risk
associated with alcohol intake, poor diet, obesity

3

other causes

cushing syndrome
steroids/ anti hiv drugs
pancreatitis

4

symptoms

polyuria
tiredness
polydyupsia - excess thirst
weight loss
hypoglycaemia
increased incidence of vaginal thrush

5

what diagnostic tests can be done

HB1AC
glucose monitoring plasma - over 11 mmol/L or 7mmol/L if fasting
urine dipstick

6

what is the oral glucose tolerance test

patient fasts over night, given 75mg of glucose in 300ml of water In morning.
measure blood glucose before and 2 hr after test
if 11.1mol/L or more after 2 hr, significant

7

management

type 1 - insulin twice daily
type 2 - lifestyle factors changes-diet controlled
or medications needed

metformin (bugiainde) increase insulin sensitivity - NO HYPO possible
gitazine -pioglitazone - increase sensitivity
sulfonylureas -gluclazide - increased insulin sensitivity

others- glucagon like peptide analogues, sulfonylureas receptor binders- increase insulin release

8

other factors to consider

monitoring eye, neuro changes, kidney function, ulcers
cataracts
MI stroke risk

9

what is hyperthyroidism?

hyperthyroidism is the excess of thyroid hormone produced.

10

how common is hyperthyroidism?

0.75% of the population
but increases amongst older women
10x more common in females over males
common in countries with high idione deficency such as Denmark

11

what can cause it?
risk factors

graves disease - most common cause
toxic nodular goitre
solitary thyroid nodule
thyroiditis
drugs- lithium, nsaids, amidorone
autoimmune disease
increased thyroid intake
RF-smoking, femle, FH, smoker, Diabetes type 1

12

presentation

weight loss
heat intolerance
sweating
increased apettite
diarrheea
oligomenorrhoea
infertility
irritability
palpitations/tachycardia
lethargy
difficult concentrating
tremor
eye buldging
pretibal myxodema
lid lag
lid retraction
loss of libido
gynaecomastica
proximal myopathy
brisk reflex

13

what can be seen in thyroid crisis

insomnia
marked fever, tachycardia, palpitations sweating
vomiting
diarrhoea

14

investigations

TFT
idione radioactive scan
USS of thyroid
autoimmune antibodies
CRP ESR raised

15

treatment

treatment is carbimazole 20mg BD
radioidione
thyroidectomy
beta blockers- for tachycardia

16

which other AI seen with it?

type 1 diabetes

17

what would be seen on tft?

primary t3/t4 elevated, tsh low

secondary both TSH and T3/T4 elevated this is rare

18

what is subclinical hyperthyroidism?

normal t3/t4
low TSH
only treat if symptomatic
monitor

19

what is hypothyroidism?
who does it affect

it is a lack of thyroid hormone
affect 2% of population
6x more common in women
usually 40 plus
can be seen in infancy and is the most common paed thyroid problem. if not treated can lead to intellectual impairment

20

presentation?

menorrhagia -heavy periods
cold intolerance
dry brittle hair
weight gain
fatigue
lethargy
increase appetite
constipation
hoarse voice
reduce memory
myalgia
dementia
cramps
LOW MOOD
reduced/slowed relfxes, ataxia, thin dry skin
cold hands
odema
ascites/pitting odema
puffy face
neuropathy

21

diagnosis

TFT
Scan -USS
cholesterol triglyceride- elevated

22

what would TFT test show?

primary -low T3/T4 elevated TSH
secondary both TSH and t3/t4 low (TSH may be normal)

23

causes

reduced intake
hashimoto disease
primary atrophic hypothyroidism -atrophy caused be diffuse lumphoctic infilteration
commonly seen with diabetes, addisons as well
drugs- lithium, amidorone

24

associations

turner syndrome,
downs syndrome
pendred syndrome
CF

25

things to consider in pregnancy

prematurity risk increased, low birth weight, still birth risk increases, anaemia, eclampsia

26

management

levothyroxine 50-100ugram daily

27

what is the prognosis like?

excellent but if left untreated can cause dementia and heart disease

28

what is a goitre?

swelling of the thyroid gland

29

what can occur when it is symptomatic?

coughing
dysphagia
difficulty bbreathing
hoareness
tight feeling in throat

30

diagnosis

examination
USS
TFTs

31

treatment

depending on cause
radioidone
surgery

32

how many can be due to cancer

1 in 20

33

causes

thyroid cancer
hyper and hypothyroidism
thyroiditis
drugs- lithium
inadequate idione
hormone changes in pregnancy
RADIOTHERAPY

34

Whaht are the two types

diffuse- smooth all over
nodular- fluid filled cysts/lumpy like

35

how does this differ from a thyroid nodule

a thyroid nodule is usually a small fluidfilled sac/solidary mass in the neck usually noticed asesthetically
caused by same causes but also overgrowth of thyroid tissue, multiple nodular goitre

test with FNA/USS, Tft

36

DDx

dermatoid cyst
lymphoma
lymphadenopathy
malignant tumour
haemangioma

37

what is addisons disease

it is adrenal insufficiency resulting in a lack of cortisol and aldosterone

38

how many people in uk affected
who does it affect and what age

8,400 people in the UK
ffemmales
30-50 years of age

39

early signs then symptoms -severe

depression

flu like

low mood
weight loss
loss of apetite
muscle weakness
fatigue
fainting
cramps
dizziness

40

the three Ts

tanned tearful and tired

41

cause

80% autotimmune in UK
most common cause worldwide is TB
can be caused by
opportunist infections such as HIV
lymphomas
SLE
waterhouse freiserichsen syndrome
adrenal mets

42

treatment

15-25mg of hydrocortisone
staggered out over morning and afternoon
avoid at night as can cause insomnia

43

severe smyptoms can lead to

adrenal crisis a medical emergency

44

what can be seen on bloods

drop in glucose and sodium
increase in pottasiumn
eseophilia
ca 2 drop and anaema
ccan do ACTH TEST

45

which autoantibodies

21 hydroxylase adrenal antibodies

46

what is cushing syndrome?

the over production of cortisol

47

what can cause it?

tumour of adrenal gland
tumour in pituitary gland
steroid use
alcohol

48

symptoms

fat stored on tummy, back, shoulders with slim arms and legs
purple stretch marks

easy bruising
huriritism
irritability
anxiety
increase urinary
high bp
diabetes
low libido
MOON FACE
plethora
hyperpigmentation
frontal balding

49

diagnosis

blood and urine for cortisol
ct scan
dethamexsone suppression test

50

treatment

surgery
radiotherapy
reduce dose of or stop steroid

51

difference between cushing syndrome and disease

Cushing disease is caused by a pituitary gland tumor (usually benign) that over-secretes the hormone ACTH, thus overstimulating the adrenal glands' cortisol production. Cushing syndrome refers to the signs and symptoms associated with excess cortisol in the body, regardless of the cause

52

what is hyperparathyroidism

increased produced
of HPT hormone

53

who

post menopausal women

54

RF

MEN syndromes multiple endocrine neoplasia (MEN) R

55

causes

85% single PT adenoma
10-15% multigland hyperplasia

56

symptoms

BONES MOANS GROANS STONES
bones-ache pains in larger joints
stones-cal in renal stones
moan- lethargy, depression, low mood
groans-gi symptoms such as constipation nausea abdo pain

57

tests/diagnosis

USS
CT/MRI
hypercalacemia unexplained is suggestive but notdiagnositic
with high PTH then diagnostic
inmets - low PTH

58

treatment

parathyroidectomy