Endocrinology and Autoimmune

Question 1

Does Grave’s disease cause hypo/hyperthyroidism?

Answer 1

hyperthyroidism

Question 2

what are the symptoms of Grave’s disease?

Answer 2

thyrotoxicosis
pretibial myxoedema
eye signs - exophthalmos and ophthalmoplegia

Question 3

What is the management of thyrotoxicosis (grave’s)?

Answer 3

propanolol
carbimazole
radioiodine

Question 4

What are the causes of thyrotoxicosis?

Answer 4

grave’s disease

toxic multi nodular goitre

Question 5

What causes grave’s disease?

Answer 5

TSH receptor stimulating antibodies - autoimmune

Question 6

Does Hashimoto’s thyroiditis cause hypo/hyperthyroidism?

Answer 6

hypothyroidism

Question 7

What causes Hashimoto’s?

Answer 7

anti TPO antibodies - autoimmune

Question 8

what are the symptoms of Hashimoto’s?

Answer 8

hypothyroidism

firm, non-tender goitre

Question 9

what is the treatment for hashimotos and hypothyroidism?

Answer 9

levothyroxine (t4)

Question 10

What is the requirement when taking levothyroxine?

Answer 10

taken before eaten or drunk anything

Question 11

How is Riedel’s thyroiditis presentented and managed?

Answer 11

middle aged woman with hard, fixed painless goitre

levothyroxine

Question 12

How does subacute thyroiditis present?

Answer 12

follows viral infection
painful goitre
4 phases - initially hyper the prolonged hypo

Question 13

What are the causes of hypothyroidism?

Answer 13

hashimoto's
riedel's
subacute thyroiditis
iodide deficiency
pituitary tumours
pituitary lesions

Question 14

What are the TSH and free T4 levels for subclinical, primary and secondary hypothyroidism?

Answer 14

SC - high TSH, normal free T4
1 - high TSH, low free T4
2 - low TSH, low free T4

Question 15

What are the TSH and free T4 levels for subclinical, primary and secondary hyperthyroidism?

Answer 15

SC - low TSH, normal free T4
1 - low TSH, high free T4
2 - high TSH, high free T4

Question 16

What is the difference between Cushing’s disease and Cushing’s syndrome?

Answer 16

disease - symptoms caused by pituitary tumour secreting ACTH, causes adrenal hyperplasia

syndrome - symptoms mimic disease - long therm corticosteroids, adrenal carcinoma (not pituitary)

Question 17

What are the signs and symptoms of cushing’s?

Answer 17

weight gain
buffalo hump
moon face
mood changes 
central obesity
irregular periods
hyperglycaemia
hypernatraemia
hypokalaemia

Question 18

what is the investigation and its results for cushing’s?

Answer 18

dexamethosone test
not suppressed at low dose, but suppressed at high dose = pituitary tumour
if not suppressed, suggests ectopic production such as small cell lung cancer

Question 19

what is the management for cushing’s?

Answer 19

stop iatrogenic medications

surgery to remove the tumour

Question 20

What causes Addison’s?

Answer 20

autoimmune destruction of adrenal glands

causes hypoadrenalism

Question 21

What are the signs and symptoms of addison’s?

Answer 21

lethargy
nausea and vomiting
salt craving
hyperpigmentation
hypotension
vitigo
hypoglycaemia
hyponatraemia
hyperkalaemia 
metabolic acidosis

Question 22

what are the investigations for Addison’s?

Answer 22

ACTH stimulation

serum/urinary cortisol

Question 23

What is an addisonian crisis and how is it treated?

Answer 23

shock
pyrexia
collapse
fluids and hydrocortisone

Question 24

what is the management of Addison’s?

Answer 24

hydrocortisone (glucocorticoid) and fludrocortisone (mineralocorticoid)

Question 25

What are the different layers of the adrenal gland and what do they secrete?

Answer 25

medulla - catecholamines - adrenaline and noradrenaline
zona reticularis - androgens - sex hormones
zona fasicularis - glucocorticoids - cortisol
zona glomerulosa - mineralocorticoids - aldosterone

Question 26

Lupus (SLE): clinical features

Answer 26

butterfly rash
photosensitive rash
discoid rash
arthralgia/arthritis
fatigue
weightloss
raynauds
alopecia
female aged 15-45
high ESR, normal CRP

Question 27

lupus: management

Answer 27

serositis/arthritis - NSAIDs, hydroxychloroquine, or corticosteroids.

more severe disease - cyclophosphamide or mycophenolate mofetil plus corticosteroids.

Question 28

causes and differences between acromegaly and gigantism

Answer 28

excess growth hormone

acromegaly - after puberty - grow outwards

gigantism - before puberty - grow up and out