Overview Toxic Multinodular Goitre (TMNG) is the second most common cause of hyperthyroidism caused by a long-standing goitre and/or iodine deficiency which results in an increased risk of mutation and consequent TSH-independent autonomic function of thyroid nodules to produce excess thyroid hormones. Common clinical manifestations include hyperthyroidism and a painless thyroid goitre with palpable nodules. […]

Overview Hyperlipidaemia is an umbrella term which encompasses genetic and acquired disorders that raise lipid levels within the blood. Hyperlipidaemia does not independently cause clinical symptoms, rather can lead to other disorders that can manifest in possible life-threatening presentations. Most notably, hyperlipidaemia causes atherosclerosis which may lead to cardiovascular, cerebrovascular, and peripheral vascular disease.1 Objectively, […]

Overview Osteomalacia (adults) and rickets (children) are disorders of impaired bone mineralisation leading to soft, poorly mineralised bone. It arises when there is insufficient calcium–phosphate supply to the mineralising matrix due to vitamin D deficiency, calcium deficiency, phosphate deficiency (often FGF23-mediated). Nutritional rickets still occurs worldwide, while hypophosphataemic forms (e.g., XLH, tumour-induced osteomalacia) are rarer […]

Overview Paget’s disease of bone (PDB) is a chronic skeletal disorder characterised by focal areas of accelerated and disorganised bone remodelling. The disease begins with excessive osteoclastic bone resorption followed by a compensatory increase in osteoblastic bone formation. The result is structurally weak, enlarged, and deformed bone that is prone to fracture and complications such […]

Overview Type 1 diabetes is B-cell destruction leading to absolute insulin deficiency. It accounts for 5-10% of all diabetes. Type I diabetes is divided into two types: Immune mediated and idiopathic. The traditional paradigm is of childhood onset with acute symptoms of DKA. Diagnosis The age of onset and rate of B-cell destruction is quite […]

56 year old lady recurrent presentations to your practice for polyuria and increased thirst. Random serum glucose and urinary glucose have returned normal. Patient has otherwise been well, complains of no dysuria, haematuria, fevers or night sweats. Overview Diabetes Insipidus (DI) is associated with inadequate arginine vasopressin (known as antidiuretic hormone) secretion or renal response […]

This section will mainly focus on Primary Parathyroidism Overview Primary Hyperparathyroidism (PHPT) is generalised disorder calcium, phosphate and bone metabolism due to increased secretion of parathyroid hormone normally leading to hypercalcaemia and hypophosphatemia. PHPT may present with recurrent nephrolithiasis, peptic ulcers, mental and muscle changes and less frequently bone resorption. Frequently, routine blood tests will […]

Overview The term thyroiditis refers to a varied group of disorders all characterized by some form of thyroid inflammation. It includes conditions characterized by thyroid pain and tenderness and those with goiter without pain.Inflammation of the thyroid gland often leads to a transient thyrotoxicosis followed by hypothyroidism. Clinical Manifestation Acute thyroiditis De Quervain Hashimoto’s (hypothryoidism) […]

Overview Hypothyroidism is a clinical state resulting from underproduction of the thyroid hormones T4 and T3. Most cases (95%) are due to primary hypothyroidism, a failure of the thyroid gland to produce thyroid hormones. Autoimmune thyroiditis (Hashimoto’s disease) is the most common cause of primary hypothyroidism. It affects women much more than men. In the developing world, […]

Overview The most common cause of hyperthyroidism are Graves disease, multinodular goitre, an autonomously functioning thyroid nodule  (adenoma) and subacute thyroiditis. Graves Disease is more common in women. Multinodular goitre is more common in the elderly. Graves disease typically manifests in middle aged women. Thyroid diseases are more common in women. Anatomy and Physiology The thyroid […]

Classification Diabetic Retinopathy Overview Diabetes is the most common cause of blindness in the working population. Blindness is preventable. Annual retinal screening is advised for patients at risk. Pre-symptomatic screening enables laser photocoagulation to be used, aimed to stop production of angiogenic factors from the ischaemic retina. Clinical features The fundus are usually bilateral and […]

Overview Affects 5-10% of pregnancies. Incidence varies between nutritional and genetic factors. Risk of GDM increases with age. Women born in Southern Asia are at particularly higher risk. 50% change of mother to develop Type II Diabetes later in life. Pregnancy Physiology Aetiology and Risk Factors Risk Factors Previous GDM Increase BMI Maternal age >40yo Family […]

Diabetic Ketoacidosis Overview Diabetic Ketoacidosis may be the presenting feature in a patient not previously recognised as having diabetes. In a patient with known diabetes, it may be precipitated by omitting insulin doses, or by the insulin. Diabetic ketoacidosis has a mortality rate of 8- to 50% in the elderly. Clinical Presentation Aetiology (5I’s) + Initial Diagnosis […]

Overview Aetiology and Risk Factors Aetiology Risk Factors Clinical Manifestation Clinical Presentation Physical examination Assessment of weight and obesity Limitations of BMI on: Muscular people Elderly people Young children (centile charts) Classification BMI Risk of morbidities Underweight <18.5 Increased Normal weight 18.5–24.9 Low Overweight >25 Increased Obese I 30–34.5 Moderate Obese II 35.0–39.9 Severe Obese […]

Overview Graves’ disease is the most common cause of hyperthyroidism, caused by an autoimmune reaction in which TSH receptor autoantibodies stimulate the thyroid gland, leading to an increase in the production of thyroid hormones. It’s named after Dr Robert James Graves, an Irish physician who in 1835 gave one of the first thorough clinical descriptions […]

Overview Diabetes Mellitus type II is a progressive disorder defined by deficits in insulin secretion and action (insulin resistance). 1 in 12 people have diabetes (50% do not know they have it). Diabetes type II accounts for over 90% of all diabetes cases. The remaining 10% include type I diabetes. People with type II diabetes […]

Overview Addison’s disease is a disease characterised by adrenal insufficiency. Adrenal insufficiency results in a decrease of the adrenal gland hormones: mineralocorticoids, glucocorticoids and to an extent androgens. There are many causes of addison’s disease. The most common cause in the developed world is autoimmune (approximately 70% cases). Signs and symptoms of adrenal sufficiency don’t […]

Overview Cushing’s disease is a ACTH dependent syndrome characterised by excess corticosteroid production from the adrenal glands. It is ACTH dependent because it is triggered by an ACTH-secreting pituitary tumour. Cushing’s syndrome is an over arching term to describe hypercortisolaemia dependent of independent of ACTH. Adrenal Cushing’s syndrome is different because it is hypercortisolaemia independent […]