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Title: Endocrinology overview
Description: Layout of all of the main endocrine conditions: Diabetes Thyroid Parathyroid Adrenals Pituitary - Growth hormone, Prolactin, ADH Laid out comparing hyper and hypo state (description, cause, presentation, diagnosis and management) Written by final year medical student, for other medical students, biology students, nurses, health science students, and anyone with an interest! Really easy to understand, and gives you everything you need to know!
Description: Layout of all of the main endocrine conditions: Diabetes Thyroid Parathyroid Adrenals Pituitary - Growth hormone, Prolactin, ADH Laid out comparing hyper and hypo state (description, cause, presentation, diagnosis and management) Written by final year medical student, for other medical students, biology students, nurses, health science students, and anyone with an interest! Really easy to understand, and gives you everything you need to know!
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HYPER-‐
HYPO-‐
Glucose -‐ DIABETES
Description
Metabolic disorder of multiple aetiology
characterized by chronic hyperglycaemia,
disturbances in other macronutrients resulting
from defects in insulin secretion, action or both
TYPE 1
TYPE 2
Aetiology
Autoimmune beta cell Insulin secretionê
destruction by Auto
+/-‐ insulin resistance
é
Abs:
Obesity
-‐Insulin
MODY (AD form of
-‐Islet cell
T2DM)
-‐Glutamic acid
Metabolic syndrome
decarboxylase (GAD)
Association with other
AI conditions
...
Polyuria
complications
2
...
Weight-‐loss
DKA
Low C-‐peptide
Diagnosis
Management
Complications
PITUITARY
Description
Clinical + raised venous
glucose
...
Glucose tolerance test
>11
...
g
...
Insulin pump
DAFNE
Retinopathy
Neuropathy
Nephropathy
Diabetic foot
Infections
Oral glucose
tolerance test
Incidental finding
1st
...
Sulphonylurea,
Glitazone, DPP-‐
IV inhibitor
3rd
...
Injectable
insulin, GLP-‐1
agonists
Retinopathy
Nephropathy
Erectile dysfunction
Macro vascular
disease
Cerebrovascular
disease
Diabetic foot
Infections
Blood glucose <3
...
Plasma hypoglycaemia
2
...
Resolution of symptoms with treatment
Quick acting CHO followed by longer acting CHO
-‐ 10-‐20g of oral glucose
-‐ if unresponsive 75-‐80ml 20% glucose
repeat capillary BM after 10-‐15
Glucagon 1mg IM or SC
Hypoglycaemia unawareness
Coma
Cognitive impairment
Failure of anterior pituitary
...
Loss of axis in the same order:
1
...
LH
3
...
ACTH
5
...
Prolactin and ADH
HYPER-‐
HYPO-‐
Aetiology
Management
Tumours
Radiotherapy
Infarction/haemorrhage (apoplexy)
Trauma
Hormone replacement therapy:
ACTH – hydrocortisone
TSH – thyroxine
FSH/LH – testosterone/oestrogen
GH – Growth hormones
Prolactin
Aetiology
Prolactinoma (macro <1cm)
Physiological – lactation and pregnancy
Drugs that inhibit dopamine
(Metoclopramide/Haloperidol)
Stalk effect (lack of inhibitory dopamine)
Presentation
Galactorrhoea
Headaches
Visual field defect (mass effect)
Amenorrhoea/erectile dysfunction
Diagnosis
Serum prolactin >6000 (N<500)
Other endocrine function (TFTs, Cortisol)
Visual fields and acuity (monitoring of
prolactinoma in pregnancy)
MRI pituitary
Management
Dopamine Agonists (cabergaline)
Surgery
Anti-‐Diuretic Hormone – DIABETES INSIPIDUS
Description
Aetiology
Presentation
Diagnosis
Passage of large volumes
...
Can be:
a) Cranial
b) Nephrogenic
Cranial
Nephrogenic
Idiopathic
Inherited
Congenital
Metabolic – low K+, high
Pituitary Tumour
Ca2+
Trauma
Drugs – lithium
Infiltration -‐ Sarcoid
Chronic renal disease
Vascular -‐ heamorrhage Post obstructive
Infection –
uropathy
meningoencephalitis
Polyuria
Polydipsia
Dehydration
Hypernatremia
8 hour water deprivation test – assess ability to
concentrate urine with ADH
...
N – Urine osmolality >600 after 8 hours
Cranial DI – Urine Osmolality >600 after
desmopressin
Nephrogenic DI – No increase in Urine Osmolality
after desmopressin
MRI pituitary
Anterior pituitary function
HYPER-‐
HYPO-‐
Management
Cranial
Treat underlying cause
ADH analogues
(desmomelt tabs)
Nephrogenic
Treat underlying cause
Bendroflumethiazide
NSAIDs
Growth Hormone -‐ ACROMEGALY
Aetiology
GH secreting pituitary tumour
Presentation
Growth of hands, jaw and feet
Coarsening of face
Change in facial features – macroglossia,
widening of teeth
Obstructive sleep apnoea
Cardiomyopathy
Carpel tunnel (50%)
Headache
Sweating
Complications
Impaired glucose tolerance
Hypertension
LVH, Cardiomyopathy, Arrhythmias
Increased risk of colon cancer
Diagnosis
Glucose tolerance test
Glucose should suppress GH
IGF -‐1
MRI pituitary
Visual fields and acuity
st
Management
1 line surgery
Somatostatin analogues – octeratide
GH receptor agonists – pegvisomant
Radiotherapy
THYROID
Aetiology
Graves disease (AI)
Toxic multi-‐nodular goitre
Toxic adenoma
Ectopic thyroid tissue
Exogenous – iodine excess, levothyroxine
excess
TSH secreting adenoma
Amiodarone induced (inhibits conversion of t3-‐
>t4)
Presentation
Weight loss
Graves disease:
Irritability
Thyroid eye disease –
Diarrhoea
exophthalmos, opthalmoplegia,
Tremor
lid retraction and lid lag
Anxiety
Pretibial myxoedema
Heat
Thyroid Acropachy
intolerance
Enlarged thyroid
Tachycardia Thyroid bruit
– AF
Goitre
Brisk
reflexes
Diagnosis
TFTs:
1° TSHê Free T4 é
2° TSHé Free T4é
TRH stimulation test
Auto Abs:
-‐Anti-‐TPO
-‐Anti-‐thyroglobulin
-‐Anti-‐TSH receptor
Thyroid USS
Iodine uptake scan
Hashimoto’s thyroiditis (AI)
Primary Atrophic Hypothyroidism (AI)
Iodine deficiency
Radioactive iodine treatmenet
Cretinism
Postpartum
Thyroidectomy
Medications – carbimazole, amiodarone, lithium
Lethargy
Decreased mood
Weight gain
Cold intolerance
Constipation
Dementia
Myalgia
Bradycardia
Slow relaxing reflexes
Thin hair
TFTs:
1° TSHé Free T4 ê
2° TSHê Free T4ê
Auto Abs:
-‐Anti-‐TPO
-‐Anti-‐thyroglobulin
-‐Anti-‐TSH receptor
HYPER-‐
HYPO-‐
Management
B-‐Blockers (propranolol) – symptom control
Carbimazole +/-‐ levothyroxine (block and
replace)
Propylthiouracil (in pregnancy)
Radioiodine
Thyroidectomy
Osteoporotic fractures
CV disease – AF, HF
Thyrotoxic storm
-‐fever
-‐tachycardia
-‐seizures
-‐V&D
Lifelong Levothyroxine (t4)
Primary
Parathyroid
adenoma
Multi-‐gland
adenoma or
hyperplasia
Parathyroid
Carcinoma
Iatrogenic – following neck surgery
Congenital:
-‐DiGeorge syndrome
-‐PTH gene defect
-‐AI
Acquired:
-‐Neck surgery
-‐Radiation
-‐Infiltration (iron, copper)
-‐magnesium deficienct
Complications
PARATHYROID
Aetiology
Presentation
Diagnosis
Management
Complications
Secondary
Hyperplasia of parathyroid
gland after chronic
hypocalcaemia
Dialysis dependant CKD
Vit D
deficiency/malabsorption
PTHrP producing
squamous cell lung CA,
breast CA and renal cell CA
Secondary
Renal failure
Skeletal problems
CV complications
Osteomalacia
Primary
Bones – pain,
osteopenia
Stones -‐ renal
Groans – abdo
pain, n&v
Thrones –
constipation,
polyuria,
haematuria
Psychiatric
overtones –
insomnia,
cognitive
dysfunction
Serum Ca2+
Serum Ca2+ (ê), PTH (é)
(é),PTH (é)
PO42-‐, U+E
X-‐ray/CT – bone
damage
Acute
IV fluids
Loop diuretic
Calcitonin
Bisphosphonate (pamidronate)
Corticosteroids (vit D intoxication)
Long term
Surveillance – serum Ca2+ and creatinine
Annual DEXA scan
Surgery
Cinacalcet
Bisphonphonates
HRT
Hypoparathyroidism
Recurrant laryngeal nerve damage
Pregnancy:
-‐Eclampsia
-‐Anaemia
-‐Low birthweight
Symptoms of hypocalcaemia
Muscle pain
Bone pain
Abdo pain
Paraesthesia of face, fingers and toes
Facial twitching
Corpopedal spasm
Stridor
Convulsions
Syncope
Serum Ca2+, PO42-‐, U+E
PTH
Thyroid AutoAbs
IV calcium
Increase dietary calcium
Calcium and D3 supplements
PTH replacement
Laryngospasm
Neuromuscular irritability
QT interval changes
HYPER-‐
HYPO-‐
ADRENALS
Aetiology
Presentation
Diagnosis
Management
Primary adrenal insufficiency
Addisons Disease (AI)
Congenital adrenal hyperplasia
Adrenal TB/malignancy
Secondary adrenal insufficiency
Iatrogenic – long term suppression from exogenous
steroid use
Anorexia
Skin pigmentation (buccal/palmar creases)
Fatigue/lethargy
Emotional
Dizzy
Diarrhoea and vomiting
Postural hypotension
Addisonian crisis -‐ shock
Bloods: NA+ê K+ é low BM, uraemia, Ca2+é
Short SynACTHen test
-‐cortisol should remain <550
ACTH levels ééé
Renin éé aldosterone levels
Adrenal Auto Abs:
-‐21 hydroxylase adrenal auto Abs
Acute
100mg IV hydrocortisone
IV fluids
Monitor BM
Blood, urine, sputum C+S
Long term
5-‐10mg oral hydrocortisone
Education:
-‐sick days
-‐IM hydrocortisone if vomiting
-‐steroid warning card
Cortisol – CUSHINGS SYNDROME
Aetiology
ACTH Dependant
Cushings Disease – ACTH producing pituitary
adenoma
Ectopic ACTH production – SCLC, carcinoid
tumours
Ectopic CRF production – medullary thyroid and
prostate CA
ACTH Independent
Adrenal adenoma
Adrenal nodular hyperplasia
Iatrogenic – exogenous steroids
Presentation
Easy bruising
Facial plethora
Striae
Proximal myopathy
Buffalo hump
Euphoria
Hypertension
Osteoporosis
Poor wound healing
Obesity
Thin skin
HYPER-‐
HYPO-‐
Diagnosis
1
...
Establish source of cortisol excess
Plasma ACTH
CRH suppression test
CT pituitary
Petrosal sinus sampling (gradient >3 = pituitary
driven)
Treat underlying cause
Surgery
Radiotherapy
CV mortality
Osteoporosis
Hypertension
Management
Complications
Aldosterone
Description
Production od aldosterone independent of
RAAS, causing increased Na+ and water
retention
Aetiology
Aldosterone producing adenoma (Conns
syndrome)
Bilateral adrenocortical hyperplasia
Adrenal Carcinoma
Presentation
Hypokalaemia
Weakness
Cramps
Paraesthesia
Polyuria
Polydipsia
Hypertension
Diagnosis
Bloods: U+E
Renin/aldosterone ratio
CT/MRI adrenals
Management
Laproscopic adrenalectomy
-‐4 weeks pre-‐op spironolactone (BP and K+
control)
Spironalactone
Catecholamine -‐ PHAEOCHROMOCYTOMA
Aetiology
Catecholamine producing tumour of chromaffin
cells in adrenal medulla
...
Episodic headache
2
...
Tachycardia
Hypertension
Diagnosis
Bloods: FBC
Plasma catecholamines
24hr free urinary catecholamines
Clonidine suppression test
CT/MRI adrenals
HYPER-‐
HYPO-‐
Management
Surgery
-‐alpha and beta blockade to avoid crisis from
unopposed alpha stimulation
Long term BP control on follow up
Title: Endocrinology overview
Description: Layout of all of the main endocrine conditions: Diabetes Thyroid Parathyroid Adrenals Pituitary - Growth hormone, Prolactin, ADH Laid out comparing hyper and hypo state (description, cause, presentation, diagnosis and management) Written by final year medical student, for other medical students, biology students, nurses, health science students, and anyone with an interest! Really easy to understand, and gives you everything you need to know!
Description: Layout of all of the main endocrine conditions: Diabetes Thyroid Parathyroid Adrenals Pituitary - Growth hormone, Prolactin, ADH Laid out comparing hyper and hypo state (description, cause, presentation, diagnosis and management) Written by final year medical student, for other medical students, biology students, nurses, health science students, and anyone with an interest! Really easy to understand, and gives you everything you need to know!