Endocrinology

A disease of insulin insufficiency due to autoantibody destruction of the pancreatic beta islet cells

DKA - patient is unwell, hyperventilating, ketones (sweet smell) on breath, polyuria, polydispia, fatigue

Disease of decreased insulin secretion and increased insulin resistance

polyuria, polydipsia, unexplained weight loss, visual blurring, thrush, lethargy

Fasting blood glucose > 7 mmol/L, random blood glucose > 11.1 mmol/L, Hba1c > 6.7% after an OGTT

Acromegaly, phaeochromocytoma, hyperthyroidism, pregnancy

OGTT 7.8-11.1 mmol/L

Increased birthweight, neonatal hypoglycemia, sacral agenesis

Central obesity, hypertension, hyperglycaemia, dyslipidaemia (increased triglycerides, decreased HDL)

1. Lifestyle measures, 2. BP control, 3. Metformin (a biguanide - SFX include diarrhoea, abdo pain), 4. If Hba1c > 7% 16 weeks later add gliclazide (a sulfonylurea - SFX hypoglycaemia), 5. If Hba1c > 7.4% 6 months later add insulin or glitazone

Injection site lipohypertrophy

urine albumin:creatinine ratio > 3 reflects early renal damage. Inhibition of RA system via candesartan will protect kidneys

Microaneurysms, haemorrhages and hard exudates (dots, blots and lipid deposits)

Cotton wool spots (infarcts), haemorrhages and venous beading

Formation of new vessels. Urgent referral needed.

Decreased acuity

Osmotic changes in the lens induced in acute hyperglycaemia reverse on normoglycaemia

New vessels occur on iris, occurs late and may lead to glaucoma

Beta blockers for rapid symptom control and until carbimazole takes effect (10-20 days due to long half life of T4). If relapse on suspension of treatment - radioiodine therapy and surgery. Radioiodine therapy is contra-indicated in pregnant women as it is teratogenic.

BRADYCARDIC - Bradycardic, Reflexes relax slowly, Akinesia, Dry skin/hair, Yawning/drowsy, Cold peripheries, Ascites, Round face, Depressed, Immobile, Congestive cardiac failure

80% solitary adenoma, 20% hyperplasia of all glands, <0.5% parathyroid cancer

Relate to hypercalcaemia - Stones, moans, bones and groans. Weak, tired, depressed, thirsty, dehyrated but polyuric, fractures, osteoporosis

Raised Ca and PTH. Decreased phosphate. Raised alk phos (bone activity). Pepper-pot skull.

Low Ca, high PTH. Caused by decreased vitamin D intake and chronic renal failure. Correct with phosphate binders.

High Ca, very high PTH. Occurs after prolonged secondary hyperparathyroidism, causing glands to act autonomously having undergone hyperplastic or adenomatous change.

Failure of target cell response to PTH. Signs include short metacarpals, round face, short stature, calcified basal ganglia.

Clinical state produced by chronic glucocorticoid excess + loss of normal feedback mechanisms of hypothalamic-pituitary-adrenal axis + loss of circadian rhythm of cortisol secretion

Majority are iatrogenic (steroids). Endogenous causes are rare but most often increased ACTH via pituitary adenoma (Cushing's disease)

Due to small cell lung cancers and carcinoid tumours. Special features include pigmentation, hypokalaemic metabolic alkalosis, weight loss and hyperglycaemia. Even a high dose dexamethasone suppression test fails to suppress cortisol production

Signs - central obesity, moon face, buffalo hump, skin and muscle atrophy, bruises, purple striae on abdo, osteoporosis, infection prone. Symptoms reflect heavy steroid use - increased weight, mood changes, proximal weakness, gonadal dysfunction, acne, recurrent Achilles tendon rupture

No cortisol suppression on high dose dexamethasone suppression test

Destruction of the adrenal cortex leading to glucocorticoid and mineralocoritcoid deficiency

80% autoimmunity, others include TB, metastases (lung, breast, renal), lymphoma

Lean, tanned, tired, tearful, weak, anorexic, dizzy, faints, myalgias/arthralgia, nausea, vomiting, abdo pain, diarrhoea. Pigmented palmar creases and buccal mucosa

Low Na, high K and Ca. High urea. Bloods show anaemia and eosinophilia. Low serum cortisol. Short ACTH stimulation test (tetracosactide)

GH, FSH, LH, Prolactin, TSH, ACTH.

Amenorrhoea or oligomenorrhoea, infertility, galactorrhoea, decreased libido, increased weight, dry vagina, erectile dysfunction

Spade-like hands and feet, big tongue and facial features, excessive sweating, headaches, decreased libido, arthralgia, finding that rings/clothes become too small, weight gain.