common endocrine presentations Flashcards
what is the deawhat investigation is used for the definitive diagnosis of acromegaly ?
first line iis IGF-1
if raised then perform oral glucose test to see the suppression of the growth hormone
what is the GI association with acromegaly ?
carries a high risk for colonic polyps and cancer colon
what is the cause of acromegaly ?
mostly due to pituitary adenoma
if not - then GH secreting tumors
what is the first line management of acromegaly ?
trans-sphenoidal surgery
if surgery is not possible for cases of acromegaly what is the best management ?
somatostatin analogue ( octreotide )
or radiotherapy
what are the different result interpretations associated with thee dexamethasone suppression test ?
used to test the level of ACTH and cortisol
1- not suppressed by low dose - cushing syndrome
2- not suppressed by low dose but suppressed by high dose - cushing disease
3- not suppressed by high or low dose - ectopic secretion of ACTH
what is the cut off value to exclude cushing syndrome in association with the low dose dexamethasone suppression test ?
less than 1.8 mcg or 50 nmol
what is the best treatment for cushing disease ?
transsphenoidal surgery
or adrenalectomy
what is the second line treatment for cushing’s disease ?
bilateral adrenalectomy or radation
what is the medical treatment for cushing’s disease ?
11 SAGA
1-11 beta hydroxylase : osilodrostat
2- somatostatin analogues : pasireotide
3- adrenal steroid inhibitors : ketoconazole
4- glucocorticoid receptor antagonist : Mifepristone
5- adrenolytic agents : Mitotane
what is the action of somatostatin analogues ?
inhibits the production of ACTH which leads to decreased cortisol production
what test is used to test for primary adrenal insufficiency ?
short synacthen test
a synthetic form of ACTH (synacthen ) is given in an attempt to stimulate the adrenal gland
what is the difference in lab findings between primary and secondary hypoadrenalism ?
in primary hypoadrenalism - High ACTH with low cortisol levels
in secondary ACTH - Low ACTH and Low cortisol
what hematological malignancies are associated with primary adrenal insufficiency ?
hodgkin and non hodgkin lymphoma
what is the main autoantigen in idiopathic autoimmune adrenocortical insufficiency ?
21 hydroxylase
what is the association of hashimoto’s and addison’s known as ?
schmidt syndrome
HHAI DOC
what is polyglandular autoimmune syndrome type 1 ?
addisons disease
hypoparrathyroidism
candidiasis
what is the other name for polyglandular autoimmune syndrome type 1 ?
APECED
what mutation results in APECED ?
AIRE mutation
what are the diseases in polyglandular autoimmune syndrome type 2 ?
addison’s
type 1 DM
hashimotos
Graves
what is the treatment for addison’s disease ?
replacement with oral steroids
dose to be increased in infection and surgery
what is the treatment of hyperprolactinemia secondary to pituitary adenoma ?
1st line - bromocriptine , cabergoline
transsphenoidal pituitary adenomectomy if medical therapy fails
what are the causes of hyperprolactinemia ?
pituitary adenoma
drug induced hyperprolactinemia
pregnancy
primary hypothyroidism
what must first be excluded in hyperprolactinemia ?
pregnancy
if a patient presents with hypothyroidism and hyperprolactinemia , what is the best next step in management ?
treat thee hypothyroidism first
what is the best test used to diagnose cushing ?
24h urinary cortisol
dexamethasone suppression test
how should serum prolactin samples be taken ?
preferably in the morning and the patient should be fasting
