• Archive for July, 2013

    Cushing’s Syndrome

    by  • 30/07/2013 • Endocrine

     Clinical condition resulting from prolonged exposure to excessive glucocorticoids – either exogenous administration (commonly) or endogenous hyper-secretion (very rarely).  p/c: M>F (4>1), depression, psychosis, thinned hair, ‘moon face’, ‘buffulo hump’, acne, hirsutism, HTN, IHD, centripetal obesity (‘lemon on a stick’), peptic ulcer, purple striae, dysmenorrhoea, impotence, proximal myopathy, thin skin, easy bruising....

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    by  • 29/07/2013 • Endocrine

     A catecholamine producing tumour of the adrenal medualla  Accounts for <0.5% of HTN and has equal sex incidence, seen in 30-50yo  The 10% rule applies: 10% malignant, 10% multiple, 10 bilateral, 10 extra-adrenal, 10 familial (von Hippel-Lindau syndrome, neurofibromatosis, multiple endorcrine neoplasia (MEN) II.  Produces paroxysmal symptoms = labile HTN...

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    by  • 28/07/2013 • Endocrine

     This is treatment resistant HTN (2% of HTN), with hypokalaemia. Occasionally potassium is normal if sodium intake is low. o Benign adenoma (=Conn’s syndrome = – 66% of hyperaldosteronism) o Bilateral adrenal hyperplasia (30%) o Rarely glucocorticoid remedial aldosteronism or adrenal carcinoma  Ix: o...

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    Addison’s Disease

    by  • 27/07/2013 • Endocrine

     Chronic adrenal failure with myriad of vague symptoms = fatigue, weight loss, anorexia, abdo pain, diarrhoea, postural hypotension, hyperpigmentation (in scars, buccal mucosa, palms/soles)  Can lead to acute adrenal failure (‘Addisonian/adrenal crisis’) = hypovolaemic shock, profound hypoglycaemia, coma and death.  Ix: o Always suspect adrenal failure in shock with hyponatriemia (+/-...

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    Adrenal Disease

    by  • 25/07/2013 • Endocrine

    Adrenal failure:  Failure of adrenals to produce steroids due to –  Atrophy/destruction of adrenal gland = primary adrenal failure o Rare, 50/mil, autoimmune cause = Addison’s. Adrenal destruction associated with vitiligo, premature ovarian failure, and hypothyroidism. F>M, gradual onset of symptoms, worldwide tuberculosis destruction of adrenal glands is more common.  Rarer...

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    by  • 23/07/2013 • Endocrine

     p/c: o Circumoral tingling and paraesthesia of hands and feet, tetany, especially in muscles supplied by long nerves and seizures o Chvostek’s sign = tap facial nerve just anterior to ear causing brief facial muscle contraction o Trousseau’s sign = inflation of BP cuff (3 mins) causing carpopedal spasm o Chronic hypocalcaemia results...

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    Calcium Metabolism

    by  • 22/07/2013 • Endocrine

     Acute hypercalcaemia: o The more rapid the rise and the higher the level, the more likely the patient will present with an acute brain syndrome (=p/c: confusion, drowsiness, coma, muscle weakness, psychosis) o Hypercalcaemia in 5-50/10,000 o In mild hypercalcaemia = p/c: thirst, polyuria (due to calcium induced nephrogenic diabetes insipidus), and also...

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    by  • 20/07/2013 • Endocrine

     Due to increased circulating free levels of thyroid hormones (T3 and T4).  F>M (5>1). Most common in middle ages. Prevalence = 2%  Causes:  Most common cause = autoimmune disease (Graves, TNG, and toxic adenoma) o Graves’ disease: 75% of all cases. Due to antibodies interacting with immunoglobulin IgG TSH receptors...

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    by  • 19/07/2013 • Endocrine

     The clinical effect of decreased production of thyroid hormones  Epidemiology: F>M (6>1), prevalence 1-5%, incidence 2/1000/y. most common from middle age onwards and associated with FH of a/i disease.  p/c: mentally slow (=depression, psychosis , cerebellar disturbances, deafness), facial puffiness, husky voice, bilateral carpal tunnel, slow relaxing reflexes, weigh gain,...

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    Diabetic Emergencies

    by  • 18/07/2013 • Endocrine

    Diabetic ketoacidosis (DKA):  Absolute insulin deficiency – occurs in DM T1 but NOT T2!  Lack of insulin = hyperglycaemia (=osmotic diuresis and dehydration) = raised ketone levels = metabolic acidosis  Precipitants: infection, missed insulin dose (hospital stay/psychological reasons), MI, trauma, undiagnosied DM T1  p/c: thirst, polyuria, dehydration ( – even...

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