Week 128 - Summary of Endocrine Diseases Flashcards
Hyperthyroidism - Symptoms, Investigations, Treatment
Symptoms: hyperactivity, palpitations, sensitivity to heat, weight loss, sweating
Investigations: ↑T4,T3, ↓TSH
Treatment: Carbimazole, Radioactive iodine or thyroid surgery
What is Phaeochromocytoma - Symptoms, Investigations, Treatment
Tumour producing catecholamines
Symptoms: Hypertension, sweating, tachycardia, headaches
Investigations: Urinary catecholamines and metabolites (>2 fold). MRI/CT/MIBG to localise the tumour
Treatment: α-blockers (phenoxybenzamine), β-blockers (propranolol), high-salt diet + surgery
What is Cushing’s Syndrome - Symptoms, Investigations, Treatment
↑Cortisol, ↑ACTH (ectopic ACTH production)
Symptoms: lemon on a stick, red round face, high blood sugar, poor wound healing, high BP, thin skin, hirsutism, depression, fatigue
Investigations: Dexamethasone suppression test
Treatment: Metyrappone (cortisol synthesis inhibitor), surgery
What is Cushing’s Disease- Symptoms, Investigations, Treatment
↑ Cortisol, ↑ACTH (pituitary is responsible)
Symptoms: lemon on a stick, red round face, high blood sugar, poor wound healing, high BP, thin skin, hirsutism, depression, fatigue
Investigations: Dexamethasone suppression test
Treatment: Metyrappone (cortisol synthesis inhibitor), surgery
What is Non-ACTH-dependent Cushing’s - Symptoms, Investigations, Treatment
↑ Cortisol, ↓ACTH (excess endogenous cortisol secretion)
Symptoms: lemon on a stick, red round face, high blood sugar, poor wound healing, high BP, thin skin, hirsutism, depression, fatigue
Investigations: Dexamethasone suppression test
Treatment: Metyrappone (cortisol synthesis inhibitor), surgery
What is Conn’s syndrome? Symptoms, Investigations, Treatment
Excess aldosterone secretion - tumour
Symptoms: Hypertension, Hypokalaemia, metabolic acidosis
Investigations: ↓plasma renin, ↑aldosterone
Treatment: Adrenalectomy, low sodium diet and spironolactone
What is Addison’s Disease? Symptoms, Investigations, Treatment
Primary adrenal insufficiency caused by autoimmune disease or TB
Symptoms: Pigmentation, general malaise, nausea, vomiting, hypoglycaemia, postural hypotension, weight loss
Investigations: Hyperkalaemia, hyponatraemia, hypoglycaemia, elevated ACTH, inadequate synacthen response
Treatment: Hydrocortisone and Fludrocortisone
What is Congenital Adrenal Hyperplasia? Symptoms, Investigations, Treatment
Excess androgen production (reduced aldosterone)
Commonly 21 hydroxylase deficiency
Symptoms: salt-wasting, short-stature, impaired fertility
Investigations: elevated 17-α hydroxyprogesterone before and after synacthen stimulation
Treatment: Dexamethasone, oestrogen, cyproterone (adults)
Fludrocortisone and hydrocortisone
Primary Hyperparathyroidism - Symptoms, Investigations, Treatment
↑PTH, ↑Ca (adenoma/hyperplasia)
Symptoms: Generally asymptomatic; tiredness, muscle weakness, dehydration, anorexia, nausea, vomiting, polyuria, mental confusion, cardiac arrhythmias, kidney stones (Stones, moans, groans)
Investigations: ↑PTH, ↑Ca, ↑ urinary Ca, ↓PO4
Treatment: surgery
Secondary Hyperparathyroidism - Symptoms, Investigations, Treatment
↑PTH, ↓Ca
Symptoms: Generally asymptomatic; tiredness, muscle weakness, dehydration, anorexia, nausea, vomiting, polyuria, mental confusion, cardiac arrhythmias, kidney stones (Stones, moans, groans)
Investigations: ↑PTH, ↑PO4
Treatment: surgery
Tertiary Hyperparathyroidism - Symptoms, Investigations, Treatment
↑PTH, ↓Ca
Symptoms: Generally asymptomatic; tiredness, muscle weakness, dehydration, anorexia, nausea, vomiting, polyuria, mental confusion, cardiac arrhythmias, kidney stones (Stones, moans, groans)
Investigations: ↑PTH, ↓PO4
Treatment: surgery
What is Malignant Hypercalcaemia?
Malignancy results in ↑osteoclast bone resorption
Symptoms: Generally asymptomatic; tiredness, muscle weakness, dehydration, anorexia, nausea, vomiting, polyuria, mental confusion, cardiac arrhythmias, kidney stones (Stones, moans, groans)
Investigations:↑Ca, ↓PO4
Treatment: Treat malignancy
Hypomagnesaemia - Symptoms, Investigations, Treatment
↓Mg -> ↓PTH -> ↓Ca, ↓K
Symptoms: ↑neuromuscular excitability, tingling, tetany, prolonged QT, cataracts
Investigations: ↓Mg, ↓Ca, ↓K
Treatment: Oral/IV Mg
Pseudohypoparathyroidism - Symptoms, Investigations, Treatment
Resistance to PTH ( Gα deficiency)
Symptoms: Albright’s Hereditary Dystrophy (short, round face and neck, short metacarpals)
Investigations: ↑PTH, ↓Ca, ↑PO4, deficient in cAMP response to PTH
Treatment: Vitamin D
Osteomalacia - Symptoms, Investigations, Treatment
Caused by vitamin D deficiency
Symptoms: bone fractures, myopathy
Investigations: ↑PTH, ↓Ca, ↓PO4, ↓vitD
Treatment: Vitamin D
Hypoparathyroidism - Symptoms, Investigations, Treatment
↓Ca
Symptoms: ↑neuromuscular excitability, tingling, tetany, prolonged QT, cataracts
Investigations: ↓PTH, ↓Ca, ↑PO4
Treatment: vitD, oral calcium
Primary Hypogonadism in men - Symptoms, Investigations, Treatment
Androgen deficiency and/or impaired sperm production
Symptoms: Small testes, gynacomastia, infertility, reduced libido, reduced hair, osteoporosis, eunochoid body proportions
Investigations: ↓testosterone, ↑LH and FSH
Treatment: testosterone replacement, infertility treatment, phosphodiesterase type V inhibitors
Foetal Androgen Deficiency - Symptoms, Investigations, Treatment
Testosterone deficiency/resistance
Symptoms: phenotypically female, primary amenorrhoea
Investigations: male testosterone levels, XY chromosomes
Treatment: Orchidectomy (testes removed), oestogen replacement
PCOS - Symptoms, Investigations, Treatment
Androgen excess from ovary
Symptoms: ovarian dysfunction from puberty, hirsutism, acne
Investigations: ↑LH:FSH ratio, U/S polycystic ovaries, elevated testosterone levels
Treatment: Metformin, oral oestrogen/progesterone, infertility treatment
Precocious puberty - Symptoms, Investigations, Treatment
Rare in boys. Oestrogen secretion before 7-8 yrs in girls
Symptoms: Early onset of puberty
Investigations: LH, FSH, Bone age
Treatment: LHRH down regulates LH and FSH secretion
Premature Ovarian Failure - Symptoms, Investigations, Treatment
Hypergonadotropic Amenorrhoea (<40 yrs)
Symptoms: Amenorrhoea for 6 months, night sweats
Investigations: ↑FSH (x2)
Treatment: Oestrogen replacement
Name the types of autoimmune hypothyroidism
Hashimoto’s thyroiditis - formation of goitre, TPO antibodies present
Postpartum thyroiditis - usually a transient phenomenon observed following pregnancy. It may cause hypo/hyperthyroidism or the two sequentially
What is the most common cause of Hyperthyroidism?
Grave’s disease - autoimmune (IgG to TSH receptors in the thyroid) -> stimulating thyroid hormone production
Many show relapse + remission -> may become hypothyroid eventually
What is the treatment for hyperthyroidism?
Carbimazole (inhibit thyroid hormone production), propranolol for symptomatic control, Radioactive iodine, surgery
