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1
Q

Describe hyperthyroidism

A

Overproduction of thyroid hormones T3 and T4
Thyrotoxicosis effects of abnormal or excessive amounts of thyroid hormone

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2
Q

What are the symptoms of hyperthyroidism?

A

Weight loss, heat intolerance, fatigue, insomnia, sexual disfunction, goitre, and brisk reflexes

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3
Q

What is the treatment for hyperthyroidism?

A

Carbimazole (teratogenic esp. in first trimester)and Propylthiouracil - first line anti-thyroid drug
May need levothyroxine if it blocks all function
RAI

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4
Q

Describe Graves disease

A

Autoimmune drive condition where thyroid peroxidase and TSH receptor antibodies are seen
The anti-TSH receptor antibodies stimulate activity

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5
Q

What are the features of Graves disease?

A

Weight loss, heat intolerance, sexual dysfunction, tachycardia, goitre, and brisk reflexes.
Graves eye disease - exophthalmos and pretibial myxoedema
Also, thyroid acropachy - clubbing and hand swelling

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6
Q

What is the treatment for Graves disease?

A

Anti-thyroid drug - carbimazole
BB to relive symptoms

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7
Q

Describe toxic multinodular goitre

A

Condition where nodule develop on thyroid gland which are upregulated by thyroid axis and produce excess TH
Common cause of thyrotoxicosis in elderly

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8
Q

What are the features of toxic multinodular goitre?

A

Characteristic goitre and absence of Graves disease
General hyperthyroidism symptoms - weight loss, heat intolerance, tachycardia, brisk reflexes and fatigue

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9
Q

Describe Subacute (de Quervain’s) thyroiditis

A

Condition where there is temporary swelling of thyroid gland with 3 phases - thyrotoxicosis, hypothyroidism, and returns to normal

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10
Q

What is the cause of De Quervain’s thyroiditis?

A

Viral trigger - enteroviruses and coxsackie

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11
Q

What are the symptoms and signs of De Quervains thyroiditis?

A

During thyrotoxicosis - thyroid swelling and tenderness, flu like illness and myalgia
Raised ESR and CRP

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12
Q

What is the treatment for De Quervain’s thyroiditis?

A

May need short term steroids and NSAIDs

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13
Q

Describe subclinical hyperthyroidism

A

Thyroid hormone level is normal but TSH levels are low
Concern for bone density decrease

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14
Q

When are ATD used for subclinical hyperthyroidism?

A

If persistent esp. in elderly and if have cardiac risk

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15
Q

Describe primary hypothyroidism

A

Insufficient production of T3 and T4 thyroid hormones
Increased TSH from negative feedback but has no effect on TH

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16
Q

What are the symptoms of primary hypothyroidism?

A

Weight gain, fatigue, dry skin, course hair, heavy irregular periods, and constipation.
Cold intolerance, non-specific weakness, and bradycardia

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17
Q

What is the treatment for primary hypothyroidism?

A

Oral levothyroxine - synthetic version of T4
Dose titrated by TSH levels

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18
Q

Describe secondary hypothyroidism

A

Pituitary abnormally produces inadequate TSH which results in inadequate stimulation of the thyroid gland
T3, T4 and TSH will be low

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19
Q

What is the treatment for secondary hypothyroidism?

A

Oral levothyroxine

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20
Q

Describe Hashimoto’s thyroiditis

A

Autoimmune condition resulting in an underactive thyroid gland
Autoimmune destruction of thyroid epithelial
Autoantibodies for thyroglobulin and thyroid peroxidase

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21
Q

What are the symptoms of Hashimoto’s thyroiditis?

A

Diffuse enlargement of goitre and general hypothyroidism symptoms - weight gain, cold tolerance, bradycardia, dry skin, course hair and weakness in muscles

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22
Q

Describe Addison’s disease

A

Primary adrenal insufficiency
Most common cause is autoimmune damage
Causes decreased cortisol and aldosterone secretion

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23
Q

What are the symptoms of Addison’s disease?

A

Weakness, anorexia, weight loss, skin pigmentation or vitiligo, hypotension, salt craving, postural symptoms and unexplained vomiting

24
Q

What is the investigations for Addison’s disease?

A

Synacthen test - if abnormal then plasma ACTH which is elevated - Addison’s
Check for adrenal autoantibodies

25
What is the treatment for Addison's disease?
Hydrocortisone (glucocorticoid) is used to replace cortisol Fludrocortisone (mineralocorticoid) to replace aldosterone
26
Describe secondary adrenal insufficiency
Inadequate ACTH which results in lack of stimulation of adrenal glands
27
What are the symptoms of secondary adrenal insufficiency?
Fatigue, muscle, weakness, muscle cramps, dizziness, thirst, craving salt, abdo pain, depression, hypotension and bronze hyperpigmentation
28
Describe Cushing's syndrome
Prolonged high levels of corticosteroids in the body - glucocorticoids (cortisol) and mineralocorticoids (aldosterone) Can be ACTH dependant or independent
29
What are the symptoms of Cushing's syndrome?
Weakness of skin, muscles + bones, hypertension, HF, and may cause DM. Signs - central obesity, hirsutism, purple striae, proximal weakness, moon face, buffalo lump, and oedema
30
What is the investigations for Cushing's syndrome?
24hr urinary free cortisol 1mg overnight dexamethasone suppression test taken at midnight - lack of cortisol response shows Cushing's
31
What is the treatment for Cushing's syndrome?
Trans-sphenoidal surgery if pituitary adenoma Medical - adrenal hormone synthesis inhibitors (ketoconazole, metyrapone, amino glutethimide and etomidate) Also, Milotane to destroy adrenocortical cells RT and bilateral adrenalectomy
32
What is Cushing's disease?
Pituitary adenoma secreting excessive ACTH which stimulates excessive cortisol release from adrenal glands
33
What is Conn's syndrome?
Adrenal adenoma producing too much aldosterone which controls blood pressure and sodium/ potassium levels Primary hyper-aldosteronism
34
What are the symptoms of Conn's syndrome?
Uncontrolled increasing BP, excessive thirst, increased urinary frequency, nocturia, weakness/ tingling, dizziness, blurred vision, and headaches.
35
What is the treatment for Conn's syndrome?
Fludrocortisone (mineralocorticoid) is used to replace aldosterone
36
What is the investigation for Conn's syndrome?
Bloods for aldosterone, renin, sodium, and potassium levels. CT scan Suppression tests, such as saline or a captopril suppression test.
37
Describe primary hyperaldosteronism
Adrenal glands are responsible for overproduction of aldosterone Hypertension is a key feature
38
What is the investigations for primary and secondary hyperaldosteronism?
Primary - high aldosterone and low renin Secondary - high aldosterone and high renin Raised BP, hypokalaemia and alkalosis
39
What is secondary hyperaldosteronism?
Excessive renin stimulating the release of excessive aldosterone Released due to disproportionally lower BP
40
Describe a pheochromocytoma
Tumour of the adrenal glands that excretes excessive and unregulated amounts of catecholamines (adrenaline) In medulla of adrenal gland 10% tumour
41
What is the symptoms of pheochronocytoma?
Hypertension, paroxysmal attacks - headaches, sweating, palpitations, tachycardia, tremor, pallor and anxiety/ fear
42
What is the investigations for pheochromocytoma?
24hr urine measure total metaphrines - if increased then MRI or CT scan If mass seen then consider 123-IMIBG scan
43
What is the treatment for pheochromocytoma?
Pre-operative alpha blockage then surgical resection
44
Describe type I diabetes
Pancreases is unable to produce adequate amounts of insulin which means cell can not absorb glucose Hypercalcaemia and early age of onset
45
What is the symptoms of type I diabetes?
Short duration of thirst, tiredness, weight loss, blurred vision and abnormal pain from high ketones Ketones on breath, increased RR, tachycardia, hypotension and low grade infections
46
Describe type II diabetes
Condition where there is insulin resistance and reduced insulin production leading to hyperglycaemia Usually older age and overweight
47
What are the symptoms of type II diabetes?
Thirst, tiredness, polyuria, weight loss, blurred vision, and signs of complications (CVD) No ketones, usually overweight and low grade infections Acanthosis nigricans (thickening and darkening of skin)
48
What is acromegaly?
Result of excessive growth hormone due to pituitary tumour After epiphyseal plates have closed so growth happens in outward direction
49
What is the symptoms of acromegaly?
Normal height, enlarged hands, feet with prominent facial features and bitemporal hemianopia Headaches, course, sweaty skin, large tongue, and spacing of teeth Also, hypertension
50
What is the treatment for acromegaly?
Surgery to remove tumour or somatostatin analogues to treat
51
What are the investigations for acromegaly?
IGF-1 measured in blood test - raised GH suppression test - 75g sugary drink with GH tested after 2 hrs If not suppressed then shows acromegaly MRI
52
Describe gigantism
Excessive growth hormone production before the epiphyseal plates of long bones close
53
Describe hyperparathyroidism
Raised parathyroid hormone PTH acts to raise Ca levels and converts vitamin D to active form Primary - uncontrolled PTH release Secondary - decrease in Ca resorption so low Ca - increases PTH
54
What are the symptoms of hyperparathyroidism?
Stones, bones, groans, and moans. Kidney stones, painful bones, abdominal groans from constipation + N/V, and psychiatric moans - fatigue, depression and psychosis
55
What is adrenal crisis?
Acute presentation of adrenal insufficiency where absence of steroid hormones leads to medical emergency
56
What is the symptoms for adrenal crisis?
Can present with reduced consciousness levels, hypotension, hypoglycaemia, hyperkalaemia, and hyponatraemia
57
What is the treatment for adrenal crisis?
IM or IV hydrocortisone and IV fluids Correct hypoglycaemia and careful monitoring of electrolytes

Endocrine System (23 decks)

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