AMK Flashcards
Cushing syndrome
Hypercortisolism - High cortisol levels in the body for long period of time
Cortisol - gluccocorticioid , produced by cells in Zona Fasciculata of adrenal cortex
Action of Cortisol
Cortisol - Hormone
In Stress - Increase :
- gluconeogenesis
- Proteolysis
- Lipolysis
Increases sensitivity of BV to adrenaline and Noradrenaline (catecholamines) - which cause vasoconstriction to Increase BP
Dampens Immune system
- cause decreased production of prostaglandins + Interleukins
- Inhibits T- Lymphocytes
Effecrs receptors in the Brain - influence mood and memory
Effects of Cushings syndrome on body
Bone, Skin, Muscle breakdown
(These contain Big stores of protein. High cortisol levels will break this down )
Hypertension - increased sensitivity of BV to catecholamines increases Vasoconstriction and BP
increase susceptibility to infection
Impaired normal brain fuction
ovarian or testicular function messed up
(inhibts gonadotrpin releasing hormone ) - little or no periods
Elevated Glucose levels - cause high insulin levels - insulin targets adipocytes causing them to accumulate more fat cause central / truckal obesity
(cortisol promotes gluconeogenesis)
Symptoms of Cushing’s syndome
Truncal obesity
Muscle wasting , thin extremities
Easy brusing
Abdominal striae
Fractures - Osteoporosis
Diabetes Mellitus
Hypertension
increased susceptibilty to infection
Poor wound healing
Emotional distrubances
amenorrhea - missed menstrual periods (one or more )
oligomenorrhea - infrequent menstral periods (Fewer than 5-8 a year)
TEA MAD PEIH
Truncal obesity , emotional distrubance , amenorrhea , Muscle wasting, abdomial striae, Diabetes, Poor would healing . Easy bruisng , infection . hypertension
Causes of Cushings Syndome
excess cortisol from Zona Fasiculata
(adenal carcinoma )
(adrenal adenoma - benign )
excess ATCH from pituary gland
(Pituary adenoma )
Treatment of Cushings Syndrome
surgical incision - e.g pituary adenoma
Adrenal steriod inhibitors - Ketoconazole , Metyrapone
Drugs - exogenous steriod
(adrenals may be atrophied so body needs outiside steriod until adrenal gland can recover )
HPA axis
hypothamulus (crh)
anterior pituituary gland - ACTH
ADRENAL GLAND -CORTISOL
Action of Thryoid Hormone
Heart
promotes normal cardiac output
bone -
promotes normal bone growth
stimulates Bone resorption
Increase Basal metabollic rate
(increases 02 usage, Glycolysis , Gluconeogenesis , lipolysis, LDL uptake )
Stimulates SNS - Fight or Flight
GI tract
(Increases Gut Motility )
Brain
(Increases myelination, dendrites , synaspes )
Promotes normal hydration of the skin
Possible Pathologies of Thyroid gland
Hyperthyroidism- overactive thyroid - too much thyroid hormones
Hypothyroidism - underactive thyroid hormone - too little thyroid hormone
Thryoiditis - inflammation
Thyroid adenoma
What is Hyperthryoidism , causes ?
Hyperthyroidism - too much thyroid hormone in body
CAUSES
- Autoimmune conditions - Graves disease ,
(immune system attacks thyroid gland causing it to grow and secrete too much thyroid hormone ) - Thryoid Adenoma
- inflamed/ damaged thyroid gland
- Neonatal hyper T -
(Maternal Graves disease - Maternal TSH passes across placenta to fetus causing it produce too high level of Thyroid hormone ) - Jod Basedow syndrome - iodine induced thyrotoxicosis
(iodine deficient person gets a hefty dose of iodine )
Symptoms of Hyperthyroidism ?
-Weight loss
- Heat intolerance
These caused by increased Basal metabolism - Rapid heart rate (palpitations )
- sweating
- Hyperactivity
- anxiety and insomnia
Thyroid eye disease - signs - bulging eyes ,red, uncomfortable,
(eye muscles, eyelids, tear glands, fatty acids become inflamed cause eyes to be pushed foward. Can acuse double vison - muscle stuffness eye cant move together with each other)
These caused by increased SNS stimulation.
- Osteoporosis
- Congestive heart failure (heart failure ) - red - long term complications
Diagnosis of Hyperthryoidism ?
Blood test - test for t3, t4, TSH levels
- Thyroid scan + radioactive iodine uptake test
(see how much of the tracer ( iodine) the thyroid gland takes up. If it takes up more or less than normal indicates a problem
more - hyperactive thyroid , less - hypoactive thyroid)
Action of Cortisol
Cortisol - Hormone
In Stress - Increase :
- gluconeogenesis
- Proteolysis
- Lipolysis
Increases sensitivity of BV to adrenaline and Noradrenaline (catecholamines) - which cause vasoconstriction to Increase BP
Dampens Immune system
- cause decreased production of prostaglandins + Interleukins
- Inhibits T- Lymphocytes
Effecrs receptors in the Brain - influence mood and memory
Types of Thyroiditis
Hashimotos - automimmune - cause underactive thyroid
rarely do surgery - only if goitre is very uncomfortable
- postpartum - immune system attacks after giving birth causes temporary hyperthyroidism , some can then have a spell of hypothyrodism
- silent - similar to postpartum just not related to birth and happens in bith men an women
- drug induced - can cause either hyperthyroidism or hypothyroidism
- Acute / infectious - infection - treat with antibiotics etc, pain relief - ibprofen
- radiation - induced
If hypothyroidism occurs give levothyroxine (t4)
What is Hypothyroidism , causes ?
Primary causes
- Hashimoto’s Thyroiditis
and some other types of thyroidtitis - Hyperthyroid medications e.g carbimazole, propylthiouracil
- Iodine deficiency
(iodine needed to make TH) - Medications
e. g lithium , Amiodarone
Secondary causes
- Hypopituitarism - causes reduced production of TSH
- tumors
- Infections
- Vascular - Sheerman syndrome - piturary necrosis (due to massive blood loss e.g after child birth )
- Radiation
Presentation of Hypothyroidism ?
Constipation
- Amenorrhoea
- Dry skin
- weight gain
- fatigue
- Hair loss/ coarse hair
- Fluid retention - oedema , acites, pleural effusion
(low temp , lead to fluid accumulation , )
What should be seen in investigatioN for Hypothyroidism ?
Blood test results -
Primary hypothyroidism - low t3 + t4
high TSH (no negative feedback from TH)
Secondary Hypothyroidism - low t3 + t4
- low TSH
Treatment of Hypothyroidism ?
Levothyroxine - T4 - replace TH
What is Hyponaturemia ?
Decrease in serum sodium concentration
- excess of total body water vs total sodium content.
CAUSES
0 renal disease
0 SIADH - syndrome of inappropriate antidiuertic hormone syndrome - most common
0 diuretic use - most common.
0 diarrhea
0 heart failure
0 liver disease.
What should be done before confirmation of SIADH ?
Cortisol and thyroid function test , as hyponatremia - is a consequence of :
- adrenal insufficiency
- Hypothyroidism
What is the main cation in the intracellular an extracellular space ?
Intracellular - k +
extracellular - na +
What are the different types of Hyponatremia ?
0 Hyponatremia - with fluid overload (Hypervalemia )
- peripheral oedema or fluid in lungs
0 with euvulemia (normal volume )
0 With Hyopvolemia
- dehydrated
- fast heart rate.
- low blood pressure.
What is Psuedonatremia ?
False reading
- Hyperglycemia -
glucose high ——-> draws water in ——-. diluting intravascular space ——-> serum osmolality increased ——-> sodium conc decreased - Mannitol - sugar alcohol (treat increased intracranial , intraocular pressure )
cannot move through cells —— > draws fluid into intravascular (extracellular ) compartment from intracellular & intrastitum .
osmolality - high number of dissolved solutes — > in this case mannitol and glucose.
- Hyperlipidaemia , Hyperproteinaemia
(normal osmolality - proteins and lipids interfere with laboratory analysis when blood sample taken. )
- TURP = Transurethral resection of the prostate -
large amounts of mannitol or glycine used for bladder irrigation.
- in this case osmolality normal - look for why / .
- in most cases of True Hyponatremia - low osmolality is associated unlike in pseudo where it is either high or normal.
Causes of Hypervolemic Hyponatremia which result in relative low sodium in urine?
CAUSES
- Congestive heart failure
(heart unable to pump blood out effectively —–> lack of arterial blood flow —–> increased thirst ——> secretion of ADH
(so hypervolemia - there is plenty of sodium more water causing dilution. ADH secretion further worsen problem causing water retention in kidney. )
SYMPTOMS
- Raised JVP
- Crackles in lungs
- Dyspnoea
- Wet cough
- peripheral oedema - in legs etc.
LOW SERUM OSMOLALITY- no increase in solutes only water.
0 liver cirrhosis
- reduce albumin synthesis ——> albumin attracts water inside blood vessels (intravascular space ) ——-> less albumin , less water as it moves to interstitual space —–> sodium follows ——> hyponatremia (low blood sodium )
- Cirrhosis ——- > portal hypertension (hepatic portal system - common complication of cirrhosis) ——> reduced blood flow to heart —–. less blood in arterial circulation —-. increased thirst —–> secretion of ADH.
- nephrotic syndrome
Damage of glomerulus ——-> protein leaks out —–> hypoalbuminemia —–> low albumin in BV , water not attracted —-> reduced arterial volume —–> trigger thirst —-> secretion of ADH
in all these LOW osmolality
low sodium in urine - as kidney still work so are absorbing NA.
Causes of Hypervolemic Hyponatremia which result in relative high sodium in urine?
0 Hyperthyroidism
0 Renal failure
