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Flashcards in Endocrine Deck (78)
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1
Q

What is T1DM?

A

Autoimmune destruction of pancreatic β-cells leading to loss of insulin production.

2
Q

What genetics are T1DM linked to?

A

Maybe HLA linked

3
Q

What Ab are T1DM linked to?

A

GAD65 and ZnT8 auto-antibodies important.

4
Q

What are some risk factors for T1DM?

A

Obesity can decrease the level of cell loss needed for presentation.

5
Q

What are some signs of T1DM?

A

Acute onset of: thirst, weight loss (normally lean), polyuria and fatigue. Can have candida or blurred vision. Can present with diabetic ketoacidosis (vomiting, dehydration, tachycardia, breath smells sweet).

6
Q

What are some complications of T1DM?

A

Diabetic ketoacidosis and HHS. Ischemic heart disease, stroke, neuropathy, nephropathy, retinopathy, erectile dysfunction.

7
Q

How do you diagnose T1DM?

A

Fasting glucose (<6mmol = normal, 6.1-6.9 = prediabetes, >7 = diabetes), OGTT (<7.7mmol/l = normal, 7.8-11mmol/l = prediabetes, >11mmol/l = diabetes), random glucose (>11.1 = diabetes). HbA1c (not used in Britain. <41mmol = normal, 42-47mmol = prediabetes, >48mmol = diabetes). C-peptide for measurement of insulin production.

8
Q

How do you treat T1DM?

A

Insulin

9
Q

What is T1DM associated with?

A

Coeliac, thyroid disease, Addison’s disease, pernicious anaemia and IgA deficiency.

10
Q

What is T2DM?

A

Insensitivity to insulin caused by unclear aetiology but involving: genetics, obesity, environment etc. Leads to hyperinsulinemia and eventually β-cell failure.

11
Q

What are some risk factors for T2DM?

A

Obesity (test everyone with BMI>25 with further risk factors), affected 1st degree relative, CVD, African, Asian, Latin, hypertension, HDL<35, polycystic ovary disease, inactivity.

12
Q

What are some signs of T2DM?

A

Insidious onset of: tiredness, weight loss, blurred vision, microvascular disease and recurrent infections.

13
Q

What are some complications of T2DM?

A

Diabetic ketoacidosis and HHS. Ischemic heart disease, stroke, neuropathy, nephropathy, retinopathy, erectile dysfunction.

14
Q

How do you diagnose T2DM?

A

Fasting glucose (<6mmol = normal, 6.1-6.9 = prediabetes, >7 = diabetes), OGTT (<7.7mmol/l = normal, 7.8-11mmol/l = prediabetes, >11mmol/l = diabetes), random glucose (>11.1 = diabetes). HbA1c (not used in Britain. <41mmol = normal, 42-47mmol = prediabetes, >48mmol = diabetes).

15
Q

How do you treat T2DM?

A

Weight loss, BP control (ACEI first). Drugs to increase insulin secretion (sulfonylureas: tolbutamide, glibenclamide, gliclazide), Insulin sensitisers (Biguanides: Metformin; Glitazones (TZD): Pioglitazone). Insulin when β-cells fail.

16
Q

What is Diabetic Ketoacidosis?

A

Lack of insulin leads to no glucose in cells therefore more glucose released from liver. Excess glucose lost in urine causing dehydration etc. Perceived low glucose also leads to lipid breakdown which generated ketones leading to metabolic acidosis.

17
Q

What are some risk factors for Diabetic Ketoacidosis?

A

T1DM, infection, alcohol, drug abuse, hospital.

18
Q

What are some signs of Diabetic Ketoacidosis?

A

Thirst and polyuria. Flushing, vomiting, abdo pain, breathlessness, ketone smell on breath.

19
Q

What are some complications for Diabetic Ketoacidosis?

A

Cardiac arrest, adult resp distress syndrome, cerebral oedema, gastric dilation/aspiration.

20
Q

How do you diagnose Diabetic Ketoacidosis?

A

> 3mmol ketones in blood or >2mmol in urine, blood glucose >11mmol or known DM, bicarb < 15mmol or venous pH <7.3.

21
Q

How do you treat Diabetic Ketoacidosis?

A

Insulin and fluid replacement.

22
Q

What is Hyperglycaemic Hyperosmolar Syndrome?

A

Due to increased glucose get high blood sugar, but no ketoacidosis, leading to dehydration etc.

23
Q

What are some risk factors for Hyperglycaemic Hyperosmolar Syndrome?

A

T2DM, elderly, black, refined carbs, CVD, sepsis, medication.

24
Q

What are some signs of Hyperglycaemic Hyperosmolar Syndrome?

A

Dehydration (polyurea and increased thirst), hypovolemia, hyperglycaemia (>30mmol/l), no ketones, normal bicarb/pH, osmolality > 320, hypernatremia, altered consciousness, blurred vision, headaches, muscle weakness, clot formation.

25
Q

How do you diagnose Hyperglycaemic Hyperosmolar Syndrome?

A

Hyperglycaemia (>30mmol/l), osmolality > 320, normal bicarb/pH, profound dehydration.

26
Q

How do you treat Hyperglycaemic Hyperosmolar Syndrome?

A

Fluid replacement, insulin, K.

27
Q

What is Diabetes Insipidus?

A

Inadequate production or insensitivity to ADH leads to fluid loss.

28
Q

What are the two forms of Diabetes Insipidus?

A

Central (no ADH from post pit) and nephrogenic (insensitivity to ADH in collecting ducts).

29
Q

What are some signs of Diabetes Insipidus?

A

Excessive polyuria and extreme thirst.

30
Q

How do you diagnose Diabetes Insipidus?

A

Water deprivation test (deprive of fluid for 8h and see if Ur/Serum osmol ratio is >2). If test is positive give desmopressin to determine central or nephrogenic.

31
Q

How do you treat Diabetes Insipidus?

A

Central: Desmopressin. Nephrogenic: Thiazide diuretic.

32
Q

What is Hashimoto’s disease/Chronic thyroiditis?

A

Form of primary (failure of thyroid gland) goitre hypothyroidism (Low free T3/4 and high TSH) caused by autoimmune destruction of thyroid gland.

33
Q

Whan Ab is associated with Hashimoto’s disease/Chronic thyroiditis?

A

Anti-thyroid peroxidase (TPO) Ab and T-cell infiltration.

34
Q

What risk factors are associated with Hashimoto’s disease/Chronic thyroiditis?

A

Autoimmune diseases such as T1DM coeliac, vitiligo, alopecia. High I intake, selenium deficiencies. Down’s and Turner syndrome.

35
Q

What are some signs of Hashimoto’s disease/Chronic thyroiditis?

A

Painless goitre, fatigue, weight gain, puffy face, cold intolerance, constipation, dry thin hair, menstrual abnormalities, depression, slow HR,

36
Q

What is a complication of Hashimoto’s disease/Chronic thyroiditis?

A

Myxoedema.

37
Q

How do you diagnose Hashimoto’s disease/Chronic thyroiditis?

A

Anti-thyroid peroxidase (TPO) Ab.

38
Q

How do you treat Hashimoto’s disease/Chronic thyroiditis?

A

Thyroid hormone replacement (levothyroxine).

39
Q

What is Myxoedema?

A

Life threatening complication of severe hypothyroidism (or hyperthyroidism) caused by polysaccharide deposition in skin leading to swelling.

40
Q

What are some risk factors of Myxoedema?

A

Elderly women with longstanding untreated hypothyroidism

41
Q

What are some signs of Myxoedema?

A

Non-pitting swelling in lower limb (pretibial myxoedema) and behind eyes (exophthalmus). Cold intolerance, weakness, cognitive sluggishness, dry skin, hoarse voice. Bradycardia, heart block, T-wave inversion, prolonged QT intervals.

42
Q

How do you diagnose Myxoedema?

A

Clinically.

43
Q

How do you treat Myxoedema?

A

Give thyroxine slowly. ABCDE and rewarm.

44
Q

What is Grave’s disease?

A

Autoimmune over stimulation of thyroid by Thyroid Stimulation Immunoglobulin (TSI) that acts like TSH but is unchecked by T3/4.

45
Q

What are some risk factors for Grave’s disease?

A

Smoking makes harder to treat and eye disease worse.

46
Q

What are some signs of Grave’s disease?

A

Hyperthyroidism: raised BMR (weight loss and heat intolerance), fast pulse (palpations), nervousness and emotional instability, insomnia, diarrhoea. Thyroid acropachy (severe clubbing), thyroid bruits.

47
Q

What are some complications of Grave’s disease?

A

Myxoedema (thyroid eye disease and pretibial myxoedema).

48
Q

How do you diagnose Grave’s disease?

A

Clinically. Low TSH, high fT3/4, TRAb (TSH receptor antibody). Imaging.

49
Q

How do you treat Grave’s disease?

A

Dose titration: 12-18m of antithyroid drugs (carbimazole). Block and replace: 6m of intensive antithyroid treatment to give hypo then replace with levothyroxine. Treat relapse with surgery or radioiodine.

50
Q

What are Thyroid nodules?

A

Lumps of granular tissue found in the thyroid that secrete excessive hormone and can invade other structures. Usually asymmetrical.

51
Q

What are the forms of Thyroid nodules?

A

Solitary and multinodular.

52
Q

What are some signs of Thyroid nodules?

A

Lump on thyroid (can be solid or cyst). Bad if hoarse voice, rapid increase in size, compression of other structures or lymphadenopathy.

53
Q

What are some complications of Thyroid nodules?

A

Can develop to malignancy.

54
Q

How do you diagnose Thyroid nodules?

A

Clinical and US imaging. Low TSH and high fT3/4. TRAb negative and high iodine uptake on imaging. Fine needle biopsy for histology.

55
Q

What is Addison’s disease?

A

Type of primary adrenal insufficiency caused by damage to the adrenal cortex (autoimmune, TB, tumours, haemorrhage) leading to lack of cortisol and aldosterone production.

56
Q

What can cause Addison’s disease?

A

damage to the adrenal cortex (autoimmune, TB, tumours, haemorrhage)

57
Q

What are some risk factors for developing Addison’s disease?

A

Linked with T1DM, coeliac and autoimmune thyroiditis.

58
Q

What are some signs of Addison’s disease?

A

Weight loss, fatigue, fever, dizziness, low BP, abdo pain, vomiting, diarrhoea, skin pigmentation (due to raised ACTH. Palm creases major site). Salt craving due to lack of aldosterone.

59
Q

What are some complications of Addison’s disease?

A

Adrenal crisis (severe adrenal insufficiency): sudden pain in lower legs or back, vomiting and diarrhoea, low BP, syncope, hypoglycaemia, hyponatremia, hyperkalaemia, hypercalcemia, convulsions. Treat with IV steroids and saline with dextrose.

60
Q

How do you diagnose Addison’s disease?

A

Synacthen test (Give ACTH and check cortisol levels at: 0, 30, 60 and 90 mins. Baseline should be >250nmol/l. Should rise to >550nmol/l if normal)

61
Q

How do you do a synacthen test?

A

Give ACTH and check cortisol levels at: 0, 30, 60 and 90 mins. Baseline should be >250nmol/l. Should rise to >550nmol/l if normal

62
Q

How do you treat Addison’s disease?

A

Fludrocortisone- if suspect Addison’s treat as such until proven otherwise. Hydrocortisone.

63
Q

What is Cushing’s syndrome and disease?

A

Cushing’s disease (excess production of ACTH) is a form of Cushing’s syndrome (excess cortisol).

64
Q

What is a risk factor for Cushing’s syndrome?

A

Cushing’s syndrome: Glucocorticoid use, adrenal tumour

65
Q

What are some signs of Cushing’s syndrome and disease?

A

Rapid weight gain in trunk (central obesity), fat pad on back of neck, moon face, thin skin, sweating, purple stretchmarks, hirsutism, baldness/dry brittle hair, insomnia, impotence, amenorrhea and infertility, insulin resistance, hypertension, depression, hypercalcemia (osteoporosis and kidney stones). Hyperpigmentation due to ACTH excess.

66
Q

How do you diagnose Cushing’s syndrome and disease?

A

Diagnose Cushing’s syndrome first: Overnight dexamethasone suppression test (1mg dexa at midnight and cortisol test at 8am, <50 is normal and >100 is abnormal), Low dose dexamethasone suppression test (0.5mg dexa every 6 hours, <40 is normal. Gold standard). Urine free cortisol test (<250 normal). Distinguish between primary (adrenal cause) and secondary (disease) with ACTH levels: <1 in primary and ~300 in secondary.

67
Q

How do you treat Cushing’s syndrome and disease?

A

Syndrome: Taper steroids, remove adenoma, Metyrapone or Ketoconazole to inhibit cortisol synthesis. Disease: Remove adenoma with surgery or radiation or remove adrenals and replace hormones.

68
Q

What is Conn’s Syndrome?

A

Form of primary hyperaldosteronism caused by hyperplasia or adenoma resulting in excess production of aldosterone.

69
Q

What are some signs of Conn’s Syndrome?

A

Hypertension, hyperkalaemia, raised BP and alkalosis. Tingling sensation and headaches.

70
Q

What are some of the complications of Conn’s Syndrome?

A

Stroke, heart disease and kidney failure related to high BP.

71
Q

How do you diagnose Conn’s Syndrome?

A

Suspect if high BP with low K. Ratio of plasma aldosterone and renin. If ratio raised diagnose subtype with imaging or adrenal vein sampling (use cortisol as a control).

72
Q

What is a differential for Conn’s Syndrome?

A

Licorice ingestion.

73
Q

How do you treat Conn’s Syndrome?

A

Treat underlying cause. Spironolactone.

74
Q

What is a Phaeochromocytoma?

A

A neuroendocrine tumour of the medulla of the adrenal glands that produces excess noradrenaline and adrenaline.

75
Q

What gene is associated with Phaeochromocytoma?

A

VHL

76
Q

What are some signs of a Phaeochromocytoma?

A

Raised HR and BP (BP can be paroxysmal or fall n standing), palpations, anxiety headaches, pallor, hypokalaemia, hyperglycaemia and weight loss.

77
Q

How do you diagnose a Phaeochromocytoma?

A

24h urine catecholamines or plasma catecholamines at time of symptoms.

78
Q

How do you treat a Phaeochromocytoma?

A

Treat underlying cause and give α (first) and β-blockers