Breast and endocrine Flashcards
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
What is the pathophysiology of gynacomastia
Increased ratio of oestrogen: androgens in the body
What are androgens
Sex hormones that help with puberty
Testosterone
androstendione
Dihydroepiandrostendione (DHEA)
DHEA-sulphate
Treatment of primary hyperparathyroidism due to a parathyroid adenoma
Surgical excision
Cause of zollinger-ellison syndrome
Pancreatic gastrinoma made of pancreatic G cells which secrete gastrin
What are the 3 ohases of gastric acid secretion
Cephalic
gastric
intestinal
What are the stimulants for the 3 phases of gastrin secretion
cephalic= sight/ smell of food
gastric= stomach distension
intestinal= food enters duodenum
What nerve provides the parasympathetic supply to give gastrin secretion
Vagus nerve
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
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)
T/F: Histamine release inhibits gastrin secretion
FALSE- Histamine release stimulates gastric acid secretion
T/F: Somatostatin inhibits gastric acid production
TRUE- somatostatin acts directly on parietal cells to inhibit gastric acid secretion
What cells are involved in insulinoma
Beta islet cells of pancreas
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)
What cells are involved in glucagonoma
Alpha islet cells of pancreas
Commonest causes of thyrotoxicosis
Graves
multinodular toxic goitre
solitary toxic nodule
Which condition causes chronic fibrosis of the thyroid gland
Reidel’s thyroiditis
How to differentiate between Graves and other causes of thyrotoxicosis
Graves has:
eye signs (exophthalmos, ophthalmoplegia)
pretibial myxoedema
Describe the conditions associated with MEN type 1
3 P’s:
Pituitary adenoma
Parathyroid hyperplasia
Pancreatic islet cell tumours
Which MEN syndromes are associated with pheochromocytomas
MEN type 2A + 2B
Which MEN syndrome is associated with phaochromcytomas, medullary thyroid cancer, parathyroid hyperplasia
(2P’s 1M)
MEN 2A
What conditions are associated with MEN 2B (1 P, 3Ms)
phaochromcytomas
medullary thyroid cancer
marfanoid appearance
mucosal neuromas (neurofibramatosis)
What is the gene mutation associated with the MEN syndromes
RET proto-oncogene
What is the inheritance pattern for MEN syndrome
Autosomal DOMINANT (because MEN like to dominate)
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
