Flashcards in Endocrinology Deck (52):
1
3 basic problems with endocrine system?
- excess hormones - widespread effect
- reduced hormones - widespread effect
- physical gland enlargement - mass pressure/effect
2
pituitary gland produces what hormone that encourages the thyroid to produce T4/T3?
TSH
3
Thyroxine excess is a disease of the thyroid causing?
hyperthyroidism
thyrotoxicosis
4
Thyroxine lack is a disease of the thyroid causing?
hypothyroidism
5
Thyroid mass changes is a disease of the thyroid causing?
Goitre
6
incidence of hyperthyroidism?
2-3% of women
0.2% men
age common = 20-40 years
7
most common causes of hyperthyroidism?
autoimmune e.g graves disease = most common
goitre or toxic adenoma
pituitary driven
8
symptoms of hyperthyroidism?
sweating, heat intolerance
irrtable, poor sleep, anxiety, palpitations
excess appetite, weight loss, diorrhea
breathlessness
9
signs of hyperthyroidism?
warm moist skin
tachycardia - irregular heart rate
increased blood pressure, heart failure
fine tremor
goitre
10
what is graves disease?
eye disease
exopthalmus
opthalmaplegia
lid lag/retraction
loss of visual activity
11
signs of graves disease?
pretibial myxoedema
12
diagnose graves disease?
clinical
blood tests - thyroid function - low TSH, high T3/4, autoantibodies
radiology sometimes
13
management of graves disease?
anti thyroid drugs - carbimazole, propylthiouracid
beta blockers - control symptoms while other tx
surgery - control disease first, poss eye surgery
radioactive iodine - caution if youner/pregnant/breastfeeding
14
incidence of hypothyroidism?
2% women
0.2% men
mean age of diagnosis = 60 yrs
15
causes of hypothyroidism?
autoimmune most common = destructive
iatrogenic - surgery, radioiodine
iodine deficiency - rare - iodised salt/fish, poor mountainous areas
rarely pituitary disease
16
symptoms of hypothyroidism?
cold intolerance
weight gain
constipation
hoarse voice
puffed face/extremities
mental slowness/poor memory
hair loss
17
signs of hypothyroidism?
slow pulse
large tongue
deep voice
thin/dry hair
loss of eyebrows
goitre
coarsening of features
acute - rare - coma - hypothermia
18
diagnosis of hypothyroidism?
clinical
blood tests - thyroid function tests - high TSH, low T4/T3
auto antibodies
radiology
19
management of hypothyroidism?
replacement
thyroxine
levothyroxine
20
what is goitre?
thyroid masses
21
types of goitre?
- no association with intrinsic thyroid disease - simple cysts/adenomas - iodine deficiency
- associated with intrinsic thyroid disease - autoimmune, toxic multi nodular goitre/adenoma
- Malignant = rare
22
Goitres can cause?
retro sternal extension = dysphagia/breathing difficulties
23
what is an ominous sign of goitre?
look for lymph node enlargement
24
goitre investigations?
radiology - ultrasound/radioisotope scans
fine needle aspiration
blood tests
25
treatment of goitre?
remove underlying cause
may need surgery
26
anti thyroid drug carbimazole can cause what orally?
neutropenia
taste distrubances
27
types of adrenal disease?
- excess corticosteroid - Cushings
- deficient corticosteroid production - Addisons
28
what is Cushings syndrome?
excess ACTH caused by pituitary adenoma
or ectopic production by lungs = cancer
29
excess corticosteroids caused by?
adrenal adenomas
carcinomas
iatrogenic
30
Cushings syndrome has what systemic risk factors?
can cause high bp
diabetes
pt prone to infection
31
what is Addison's disease?
- caused iatrogenically by withdrawl of steroids after long term use
- hypopituitarism - b/c cancer, infection, vascular, trauma
- adrenal destruction - b/c autoimmune disease
32
what is chronic addisons?
general malaise
33
what is acute addisons?
response to stress
infection/trauma/surgery
life threatening
=> shock, hypoglycaemia, vomiting, abdominal pain
34
signs of addisons?
hyperpigmentation
buccal mucosa scars, pressure points, skin creases
35
treatment of addisons?
replacement therapy = baseline tx
hydrocortisone - glucocorticoid 20mg am 20mg pm
flufrocortisone - mineralcorticoid
36
what is an acute addisonian crisis?
medical emergency
need fluid replacement
glucose
hydrocortisone injection
treat if infection is present
hospital
37
dentally look out for what with addisons pt? cushings?
addisons - hyperpigmentation
cushings - oral infections/poor wound healing
38
what is an excess of growth hormone?
acromegaly
caused by pituitary adenoma - rare = 2-3/million
39
signs of acromegaly?
large tongue
excess hair
spade like hands/feet - myopathy/arthritis
pronounced supraorbital ridge
broad nose
prognathism
inderdental seperation
thick greasy skin
diabetes
high bp
heart failure
40
treatment of acromegaly?
medically - somatostatin analouges
surgery - compressing nearby structures, also radiotherapy
41
types of diabetes?
type 1 - IDDM 10% autoimmune young pts
type 2 - NIDDM 90% - insulin resistance/deficiency - more likely if obese >40 yrs. 10% are over 70
42
what does diabetes cause an increased risk of?
increased risk of all infections
43
what is seen on skin/mouth with diabetes?
boils, abscesses, cellulitis, candidosis
44
what kind of diseases are seen commonly with diabetic pt's?
diabetic retinopathy
diabetic nephropathy
diabetic neuropathy - loss of sensation, loss of bowel/bladder/sexual function, muscle weakeness/pain
45
what type of heat condition is common with diabetic pts?
atherosclerosis
46
foot problems with diabetes?
atherosclerosis
neuropathy
infections
47
treat type 1 with?
insulin
48
type 2 treat with?
sometimes insulin
initially dietary
sulphonylureas
biguanides
glitazones
49
emergencies with diabetes - high blood sugar?
DKA
HONK - hyperosmolar non ketotic coma
50
low blood sugar?
hypoglycaemia
51
what is DKA?
insulin not taken in because no food intake
inadequate insulin in acute physiological stress = infection/surgery
52