Endocrine system key summaries
Osteoporosis
Diagnosis criteria and presenting symptoms FRAX/QFracture assessment, DXA scan, T-score -
2.5 or less Risk factors & fragility fractures
Treatment options first line, key alternatives, Bisphosphonates first line Daily, weekly &
initiation and maintenance doses monthly doses Calcium supplements
Main counselling points Lifestyle advice (exercise, smoking, diet, alcohol)
Links to support websites How to take
bisphosphonates & calcium, report symptoms of
jaw osteonecrosis and atypical fractures, notify
your dentist, maintain oral hygiene & attend
dental check-ups
Drug interactions/cautions Calcium, food and drink, nsaids
MHRA/CHM advice Atypical fractures, jaw osteonecrosis
Key disease monitoring information Check adherence , side-effects, review after 3-5
years if on bisphosphonates Identify high-risk
groups of people to assess fragility fracture risk
using tools
HRT – menopause
Diagnosis criteria and presenting symptoms Menopause — if the women has not had a period
for at least 12 months
FSH test not done routinely – recommended if:
- aged > 45 years with atypical symptoms.
- between 40–45 years with menopausal
symptoms, including a change in their
menstrual cycle
- < 40 years in whom premature
menopause is suspected
Treatment options first line, key alternatives, Hrt: used to relieve menopausal symptoms
initiation and maintenance doses - Oestrogen hrt: no uterus
- Combined hrt: uterus
+ Combined cyclical HRT and combined
sequential HRT (i.e. a form of cyclical hrt where
oestrogen is taken daily and progestogen is given
for 14 days every 13 weeks)): for women who
have menopausal symptoms but still have their
periods
- + Continuous combined HRT: for women
who are postmenopausal (I.e. not had a
period for at least 1 year)
- Available as oral, patches, gel
it's important to be aware that some of the risks
of HRT, such as blood clots, are higher with
tablets than with other forms of HRT (although
the overall risk is still small), skin patches, gel can
be a convenient way of taking HRT and does not
increase your risk of blood clots
, Alternative: Tibolone – combines oestrogenic and
progestogenic activity with weak androgenic
activity, given continuously without cyclical
progestogen, Clonidine can be used to reduce
vasomotor symptoms when hrt cied; beware of
ses
Main counselling points Risk-benefit: use minimum effective dose for the
shortest time usually 2 – 3 years; lifestyle – diet,
sleep, exercise, smoking cessation, vaginal gel for
vaginal dryness (no need for progestogen even if
with uterus); breast and cervical cancer
screening; advice on contraception: HRT does not
provide contraception, a woman is considered
potentially fertile for 2 years after her last
menstrual period if she is younger than 50 years
of age, and for 1 year if she is over 50 years of
age.
Drug interactions/cautions Small risk of cancer with hrt is often outweighed
MHRA/CHM advice by the benefits when used for menopausal
symptoms; endometrial cancer risk: depends on
dose and duration of oestrogen only HRT -
Women with uterus – addition of progestogen
cyclically (10days
per 28) reduces risk; risk of ovarian and breast
cancer disappears within a few years of stopping,
Increased risk of CHD in women who start
combined HRT more
than 10 years after menopause, increased vte
risk; tibolone higher stroke risk
Key disease monitoring information Review the woman at 3 months, then annually
thereafter; if HRT was started in the
perimenopause, discuss the option of changing
the treatment regimen
The NHS Breast Screening Programme: offered
every 3 years to women aged 50 years or over.
The Cervical Screening Programme: available for
all women aged 25 years and over with a
frequency of routine 3-yearly recall between 25–
49 years of age, then 5-yearly recall until aged 65
years.
Thyroid disease
Diagnosis criteria and presenting symptoms hypothyroidism (low t4, t3, high tsh) - tiredness,
weight gain, cold intolerance
hyperthyroidism (high t4, t3, low tsh) - weight
loss, heat intolerance nb: antibody test: helps
rule out grave’s disease (an autoimmune
condition that can cause hyperthyroidism)