Endo Flashcards
Condition with lethargy, salt-craving, hyperpigmentation, hypotension
Addison’s
Addison’s investigations and management
9am serum cortisol
Shorth synACTHen test (no rise in cortisol)
Hydrocortisone
Fludrocortisone
(IM hydrocortisone + fluids for crisis)
Addison’s cause
UK - autoimmune
Worldwide - TB
Conn’s features
Hypokalaemia (muscle cramps, polyuria, polydipsia)
Hypertension
Conn’s investigations and management
Bedside: blood pressure
Bloods: raised aldosterone:renin ratio (high aldosterone causing negative feedback on renin)
Imaging: CT abdo
Adrenal adenoma: surgery
Adrenal hyperplasia: spironolactone
Conn’s cause
Bilateral adrenal hyperplasia - too much aldosterone
Cushing’s investigations and management
Overnight dexamethasone suppression test
- suppressed: normal
- not suppressed: Cushing’s syndrome
- suppressed by high dose: pituitary
- not suppressed by high dose: ectopic (high acth) or adrenal (low acth)
Inferior pituitary petrosal sinus sampling
Surgery
Cushing’s cause
Disease: ACTH-producing pituitary tumour
Ectopic: small cell lung cancer
Adrenal adenoma
Iatrogenic - steroids
Pseudo - alcohol excess
Acromegaly investigations and management
1) IGF-1
2) OGTT to confirm (no suppression of growth hormone)
3) Pituitary MRI
Trans-sphenoidal surgery
OR
Somatostatin analogue e.g. octreotide
OR
Dopamine agonist e.g. bromocriptine
Acromegaly cause
Pituitary adenoma
Thyroiditis investigations and management
Bloods: TFTs, ESR
Imaging: thyroid scintigraphy uptake increased then decreased
Self-limiting
NSAIDs for pain
Steroids if severe
Grave’s management
1) Propranolol
2) Carbimazole
3) Thyroxine to prevent hypo
4) Radioiodine if resistant
Hypothyroidism investigations and management
TFTs
Anti-thyroid peroxidase (Hashimoto’s)
Anti-thyroglobulin (Hashimoto’s)
Levothyroxine (start at 25mcg if >50 or cardiac disease, start at 50-100mcg otherwise)
Check TFTs after 8 weeks
Pregnancy requires 25mcg more due to increased demands
Pituitary adenoma features not specific to type of hormone (cushing’s, prolactinoma, acromegaly)
Headache due to stretching of dura
Bitemporal hemianopia
Pituitary adenoma investigations and management
Bloods: pituitary blood profile (GH, prolactin, ACTH, LH, FSH, TFTs)
Imaging: visual field testing, MRI brain with contrast
Surgery
Radiotherapy
Hormone replacement
