Endocrine Diseases

Diabetes Mellitus

  • 10% Type 1 - weight loss, tiredness 
  • 90% Type 2 - similar symptoms caused by obesity

Diagnosed by GREY-TOPPED containing fluoride (inhibits the metabolism of glucose) and EDTA for blood testing. 

Glucose tolerance test: Body overcompensates for glucose so try and digest it over 2 hours. 

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Insulin Excess

Normally caused by a benign tumour. 

Diagnosis by prolonged fasting, measuring proinsulin, insulin and C-peptide when hypoglycaemic. 

Treatment

  • surgery 
  • diazoxide
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Primary Hypothyroidism

Everything is slowed down:

  • T4 and T3 is decreased
  • TSH is increases

Symptoms:

  • constipation 
  • tiredness 
  • weight gain
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Primary Hyperthyroidism

Everything is sped up:

  • T4 and T3 will increase
  • TSH is decreased

Symptoms:

  • Diarrhoea 
  • Weight loss
  • Thining skin
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Adrenal Cortex Functions

Hormones secreted from the adrenal. 

Cortisol is secreted by the adrenal glands as the end-product of the conversion of cholesterol. 

Roles of cortisol:

  • maintaining blood volume
  • maintaining blood pressure
  • stimulates gluconeogenesis 
  • stimulates protein and fat breakdown
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Addison's Disease

Due to a lack of cortisol, due to the failure of the adrenal glands. Easily treated with steroid replacement. 

Clinical features:

  • lethargy 
  • dehydration
  • ACTH contains the same amino acid sequences leads to pigmentation decrease in hands and feet

Diagnosis 

  • measures cortisol and serum electrolytes
  • short synacthen test - a synthetic analogue of ACTH. 
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Crushing''s Syndrome

Caused by excess cortisol, linked with hypertension, obesity and thinning skin. 

Diagnosis:

  • confirm cortisol increases
  • dexamethasone suppression test

Causes of Crushings: 

  • increased cortisol & -ve feedback on pituitary -> low ACTH = adrenal 
  • increase cortisol & no -ve feedback on pituitary -> increased ACTH = eptopic or pituitary 
  • Pituitary causes, cortisol will be partially suppressed
  • ectopic ACTH cortisol will not be suppressed 

CT/MRI scans are also useful to find tumours

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Growth Hormone Excess

Children - gigantism 

Adults - acromegaly 

Clinical features:

  • coarse facial features 
  • increase the size of hands and feet. 
  • sweating 

Diagnosis:

  • secretion is episodic 
  • oral glucose suppression test
  • IGF-1 is increased and used in monitor treatment
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Growth Hormone Deficiency

A rare cause of short stature in children. Increased GH during exercise. 

Diagnosis:

  • Glucagon stimulation test
  • Glucagon stimulates the production of GH

Treatment with synthetic GH

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Hyperprolactinaemia

High serum prolactin is common. Stress, psychoactive drugs all increase prolactin. 

Diagnosis: MRI

Clinical signs:

  • men - visual field abnormalities
  • women - menstrual problems 

Treatment: 

  • Drugs 
  • Surgery of pituitary 
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