Abdominal Distention and Weight Gain Flashcards
Why can a pituitary tumour affect vision?
The optic chiasm is located directly above the sella turcica of the sphenoid bone, which contains the pituitary gland. Therefore, pituitary tumours can push/compress the optic nerve or other nerves nearby related to the extraocular muscles.
What signs on examination are indicative of Cushing’s Disease? (7)
Abdominal/truncal obesity
Abdominal striae
Neck fat (hump)
Skin bruising
High BP
Proximal myopathy
Facial plethora
What signs on examination are indicative of hypothyroidism? (2)
Bradycardia
Dry skin
What clinical features suggest Cushing’s Syndrome as a differential diagnosis? (2)
The physical findings of cushingoid appearance and presence of cardiovascular risk factors (BP, Glycosuria).
How can the complications of obesity be broadly classified?
Metabolic
Cardiorespiratory
Other
What is metabolic syndrome?
The triad of diabetes, hypertension, and obesity.
What BMI range is considered to be a healthy weight?
18.5–24.9 kg/m2
Which BMI ranges categorise the three classifications of obesity?
Obesity I: 30–34.9 kg/m2
Obesity II: 35–39.9 kg/m2
Obesity III: 40 kg/m2 or more.
When is medical management of obesity considered?
If there is a BMI of 28kg/m2 with associated risk factors, or a BMI 30kg/m2
What is Orlistat?
A pancreatic lipase inhibitor that causes reduced fat absorption.
What is Liraglutide (Saxenda)?
A GLP1 analogue that slows gastric emptying, subsequently increasing satiety
What are the indications for surgical management of obesity? (3)
-If patient has BMI > 40 or BMI 35-40 with other significant weight-related disease
-Patient has tried all non-surgical approaches
-Patient has been or is willing to receive Tier 3 weight management services
What four initial screening tests for Cushing’s Syndrome are used to establish underlying hypercortisolaemic state?
-Urinary Free Cortisol (UFC) - at least two measurements
-Late-night salivary cortisol - two measurements
-1-mg overnight Dexamethasone Suppression Test (DST)
-Longer low-dose DST (2 mg/d for 48 h)
What is Dexamethasone?
An exogeneous steroid that causes suppression of the pituitary gland through negative feedback, inhibiting ACTH secretion.
What is normally seen in the dexamethasone suppression test (DST)?
In a normal subject, there is reduction in cortisol levels following administration of low-dose dexamethasone.
What is seen in a patient with Cushing’s Syndrome in the dexamethasone suppression test (DST)?
No reduction in cortisol output after low-dose dexamethasone, but inhibition of cortisol output following high-dose dexamethasone.
What is seen in a patient with an adrenal tumour or ectopic ACTH in the dexamethasone suppression test (DST)?
No reduction in steroid production after low or high dose dexamethasone.
What are the main causes of ACTH-Independent Cushing’s Syndrome? (3)
Adrenal adenoma
Adrenal carcinoma
Adrenal hyperplasia
What are the main causes of ACTH-Dependent Cushing’s Syndrome? (3)
Pituitary adenoma
Ectopic ACTH (bronchial carcinoid commonest)
Unknown source of ACTH