Breast and endocrine Flashcards by Anjali Yapa

Causes of gyenacomastia

METOCLOPRAMIDE

Metaclopramide/ Methyldopa
Ectopic oestrogen
Trauma skull/ Tumour breast/ testes
Orichitis
Cushings/ cimetidine
Liver cirrhosis
Obesity (increased oestrogen in fat tissue)
Paraplegia/ puberty/ physiological (new borns-oestrogen from mom)
RA
Acromegaly/ Anabolic steroids
Mumps (testicular failure)
Isoniazide
Digoxin/ Digitalis
Ethionamide

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What is the pathophysiology of gynacomastia

Increased ratio of oestrogen: androgens in the body

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What are androgens

Sex hormones that help with puberty

Testosterone
androstendione
Dihydroepiandrostendione (DHEA)
DHEA-sulphate

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Treatment of primary hyperparathyroidism due to a parathyroid adenoma

Surgical excision

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Cause of zollinger-ellison syndrome

Pancreatic gastrinoma made of pancreatic G cells which secrete gastrin

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What are the 3 ohases of gastric acid secretion

Cephalic
gastric
intestinal

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What are the stimulants for the 3 phases of gastrin secretion

cephalic= sight/ smell of food
gastric= stomach distension
intestinal= food enters duodenum

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What nerve provides the parasympathetic supply to give gastrin secretion

Vagus nerve

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Describe the events of cephalic phase of gastric secretion

sight/ smell of food= vagal stimulation
G-cells of antrum of stomach stimulated
G-cells secrete gastrin
Gastrin stimulates gastric acid/ pepsin/ histamine release from parietal cells/ mast cells

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Describe the events of gastric phase of gastric secretion

food enters stomach
causes distension of stomach
vagal stimulation from distension
gastrin secreted
gastric acid produced (60% in gastric phase)

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T/F: Histamine release inhibits gastrin secretion

FALSE- Histamine release stimulates gastric acid secretion

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T/F: Somatostatin inhibits gastric acid production

TRUE- somatostatin acts directly on parietal cells to inhibit gastric acid secretion

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What cells are involved in insulinoma

Beta islet cells of pancreas

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What is Whipples triad

-attacks brought on by fasting
-hypoglycaemic during attacks
-attacks improve with administration of glucose

Triad present in those with an insulinoma-have attacks of lightheadedness, mood swings, unconsciousness (sx of hypo)

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What cells are involved in glucagonoma

Alpha islet cells of pancreas

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Commonest causes of thyrotoxicosis

Graves
multinodular toxic goitre
solitary toxic nodule

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Which condition causes chronic fibrosis of the thyroid gland

Reidel’s thyroiditis

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How to differentiate between Graves and other causes of thyrotoxicosis

Graves has:
eye signs (exophthalmos, ophthalmoplegia)

pretibial myxoedema

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Describe the conditions associated with MEN type 1

3 P’s:

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic islet cell tumours

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Which MEN syndromes are associated with pheochromocytomas

MEN type 2A + 2B

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Which MEN syndrome is associated with phaochromcytomas, medullary thyroid cancer, parathyroid hyperplasia

(2P’s 1M)

MEN 2A

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What conditions are associated with MEN 2B (1 P, 3Ms)

phaochromcytomas
medullary thyroid cancer
marfanoid appearance
mucosal neuromas (neurofibramatosis)

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What is the gene mutation associated with the MEN syndromes

RET proto-oncogene

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What is the inheritance pattern for MEN syndrome

Autosomal DOMINANT (because MEN like to dominate)

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Describe the 2 ways in which chronic renal failure leads to hypocalcaemia

1: renal failure= reduced activation of Vit D = reduced Ca absorption in the intestines 2: renal failure= phosphates not excreted= increased phosphates in the blood bind to free Ca= reduced free Ca in blood

What histology would you see in papillary thyroid carcinoma

orphan annie nuclei psammoma bodies

What type of thyroid ca is common in young women with prev head/ neck irradiation

papillary Ca

What condition causes: raised serum calcium low urinary calcium normal/ raised PTH hypermagnesiemia

Familial Hypocalciuric Hypercalcaemia

What is the inheritance pattern for FHH

Autosomal dominant

Pathophysiology of FHH

FHH due to non-functioning Ca sensing receptor (CaSR) CaSR found on parathyroid + kidneys Parathyroid: -normally detects serum Ca and regulates PTH secretion via -ve feedback FHH= CaSR not working= PTH secreted without feedback despite high Ca Kidneys: -normally allows for Ca excretion in kidneys and stops reabsorption FHH= Ca not excreted in kidneys= low Ca levels in urine (hypocalciuric)

Management of symptomatic FHH

calcimimetics + pamidronate (bisphosphonates not used)

What is a complication of FHH and how is it managed

recurrent pancreatitis Mx= parathyroidectomy

Which type of cancer can cause high Ca low phosphate

SCC lung causes paraneoplastic syndromes= PTH mimicking peptide secreted

Indications for thyroid surgery

4C's: cosmesis compression (trachea/ oesophagus) carcinoma control (of thyrotoxicosis)

How can follicular carcinoma and adenoma be distinguished/ diagnosed

thyroid lobectomy + histology to confirm

Management of follicular carcinoma

total thyroidectomy (if confirmed by histology)

Where does papillary thyroid cancer mets to

(lymph spread) cervical lymph nodes

Where does follicular thyroid cancer mets to

brain bone lungs

Another name for MEN 2A syndrome

Sipples syndrome

Commonest causes of primary hyperparathyroidism

parathyroid adenoma parathyroid hyperplasia carcinoma

What are the factors associated with anaplastic thyroid Ca

F>M iodine deficiency history of multinodular goitre

Sx of anaplastic thyroid ca

hoarse voice thyroid mass (rapid growing) dysphagia

Where does anaplastic thyroid Ca mets to

brain bone lungs

Management of anaplastic Thyroid Ca

palliative (doxorubicin/ cisplatin)

Biochem difference between osteoporosis and pagets disease: (Ca, Phos, PTH, ALP levels)

Pagets: ALP= very raised Ca, Phos, ALP= normal osteoporosis: All normal

What other conditions is Hashimotos associated with?

pernicious anaemia coeliacs thyroid lymphoma

Which cancers can cause paraneoplastic syndrome

small cell lung ca bronchial carcinoma Thymic tumours medullary thyroid cancer islet cell tumours of pancreas

Cushings disease vs syndrome

Disease= pituitary adenoma causing raised ACTH= causes increased cortisol from adrenal Syndrome= increased cortisol from adrenal (any cause- pituitary adenoma/ steroid use/ paraneoplastic tumours/ ectopic sources)

Treatment of hyperthyroidism in pregnancy

1st trimester= PTU after 1st trimester= carbimazole PTU =not after 1st tri= affects liver development Carbimazole= not in 1st tri= teratogenic Not surgery= anaeasthetic risk to fetus

What condition causes secondary HTN hypernatraemia hypokalaemia metabolic alkalosis

Conns (Hyperaldosteronism)

Where is aldosterone made and where does it act

Aldosterone made: zona glomerulosa of adrenal cortex acts: DISTAL convoluted tubule + collecting ducts kidneys

Management options for Conns

Spironolactone (aldosterone antagonist) adrenalectomy

What are the biochemical disturbances found in Addison's disease

addisons= adrenal insufficiency hyponatraemia hyperkalaemia hypercalcemia

What condition causes hypercalcaemia cough/ SOB hilar lymphadenopathy afro-carribeans affected 30-40s

Sarcoidosis

Management of Sarcoidosis

Steroids

Investigations for Conns

Bloods (raised aldosterone) Adrenal scintigraphy CT/ MRI adrenals Diurnal/ positional aldosterone levels

What are the antibodies found in Hashimotos thyroiditis

anti-microsomal/ anti-thyroid peroxidase anti- thyroglobulin antibodies

What is a complication post bilateral adrenalectomy for cushings syndrome

Nelsons syndrome

what type of hernia is associated with congenital hypothyroid

umbilical hernia in children

Pathophysiology of Nelsons syndrome

Resection of both adrenals = reduced cortisol -ve feedback= pituitary secretes ACTH= increasing ACTH production causes swelling of pituitary pituitary swelling causes sx= headaches, cranial nerves affected

What enzyme deficiency causes congenital adrenal hyperplasia

21-hydroxylase deficiency

Pathophysiology of CAH

21-hydroxylase deficiency= not enough cortisol produced= increased ACTH released= increased precursors of cortisol= these precursors are used to make testosterone instead in females= leads to hermaphrodite in males= precocious sexual maturation

First line investigation for sx of acromegaly

Insulin like growth factor levels