PACES - Diabetes/Endo Flashcards
Thyroid acropachy
Thyroid history qs
Sweating/heat or cold intolerance
Appetite/weight change
Anxious/irritable or depressed/tired
Visual problems, eye pain, change in bowel habit
Oligomenorrhoea or menorrhagia
Compression Sx: dysphagia, SoB, neck discomfort, change of voice
Triggers - hyper: childbirth, stress, infection, hypo: radioiodine, drugs, surgery
Other AI disease, previous thyroid surgery
Complications of thyroid surgery
Early
Reactionary haemorrhage
RLNP
Hypocalcaemia
Thyroid storm
Late
Hypothyroidism
Hypoparathyroidism
Recurrence of disease
Keloid scar
Hyperthyroidism management
Medical
Propranolol
Carbimazole, titreated to TFTs or block and replace
Treat for 12-18m
Radioiodine
CI: pregnancy, around children
May worsen eye disease
Most patients become hypothyroid
Thyroidectomy
Eye disease
Stop smoking, artificial tears, dark glasses
Severe: high dose steroids, surgical decompression
Describe the cortisol feedback system
Hypothalamus -> CRH -> Ant. Pituitary -> ACTH -> Adrenal Cortex -> Cortisol
How does cushing’s present?
Headache, visual disturbance
Weight gain
Bruising
DM/AI disease e.g. pigmentation Sxs
Cause → RhA, fibrosis, COPD = LT steroid use
Moon face, easy bruising, large body habitus, stretch marks
What are the main causes of Cushing’s
ACTH independent
Steroids
Adrenal adenoma
Carney complex
ACTH dependent
Cushing’s disease
SCLC
Qs to ask in acromegaly history
Headache/visual disturbance
Voice deepened
Ring size/shoe size/hat size changed
Pain/numbness in hands → CTS
DM and OSA Sxs
Anyone noticed appearance has changed?
Old photographs
How is acromegaly managed
Transsphenoidal resection
Complications: meningitis, diabetes insipidus, panhypopituitarism
Medical therapy
Somatostatin analogue: octreotide
GH antagonist: pegvisomant
Da agonist: cabergoline
Radiotherapy
Yearly FU with bloods, visual fields, ECG +/- MRI head
Qs to ask in an addison’s history
Weight loss, anorexia
Postural hypotension/dizziness/faints
Hyperpigmentation
Lethargy, depression
AI disease Sxs e.g. DM, vitiligo
TB Sxs
How would you investigate addisons
Bloods - U&Es (low Na, high K), low glucose, 21-hydroxylase Ab
SynACTHen test
8am cortisol low
8am ACTH high
Test leads to no increase in cortisol
CXR for TB
AXR for adrenal calcification
How would you investigate acromegaly?
BP, urine dipstick or CBG (GH normally suppressed by glucose)
Formal perimetry
Bloods - IGF-1, GH, baseline pituitary function tests
OGTT - no suppression of GH
CXR - cardiomegaly, can lead to HF = leading cause of death
MRI pituitary fossa
How would you manage addison’s
Acute
0.9% NS IV rehydration
100 mg hydrocortisone IV
Treat cause e.g. infection
Chronic
Replace hydrocortisone and fludrocortisone
Pt education
Don’t stop steroids suddenly
Increase dose during illness/stress
Wear bracelet
Carry steroid card
