Endo Flashcards
Levothyroxine risks
osteoporosis
arrhythmias
Cushings Syndrome causes
Cushing’s disease
Adrenal adenoma
Paraneoplastic syndrome
Exogenous steroids
Cushing’s disease
Pituitary adenoma secreting ACTH
Prolactinoma symptoms
In women: oligomenorrhoea or amenorrhoea, galactorrhoea, infertility, vaginal dryness
In men: erectile dysfunction, reduced facial hair
Both: headache, visual field defects
Prolactinoma investigations
MRI brain: microadenoma appears as lesions in the pituitary; macroadenoma appears as a space-occupying tumour
Serum prolactin
most common pituitary tumour
Pituitary adenoma - benign, non-secreting
Pituitary adenoma features
Headache
Visual field defects
Pituitary adenoma investigations
MRI brain
maybe hormone tests
Pituitary adenoma management
Neurosurgery: usually performed trans-sphenoidal
Radiotherapy: for residual tumour after surgery, or for recurrence
Most common hormone secreting tumour of the pituitary
prolactinoma
What hormones does anterior pituitary secrete
GH,
LH/FSH,
TSH,
ACTH
prolactin
What hormones does posterior pituitary secrete
ADH
oxytocin
Hashimotos thyroiditis associated with what cancer
MALT lymphoma
hypertension
headaches
palpitations
sweating
anxiety
phaeochromocytoma
Phaeochromocytoma investigations
24 hr urinary collection of metanephrines
Phaeochromocytoma management
surgery
stabilise first with:
alpha-blocker (e.g. phenoxybenzamine), given before a
beta-blocker (e.g. propranolol)
Sick euthyroid syndrome
low T3/T4 and normal TSH with acute illness
What is important to monitor in HHS
serum osmolality
Diabetic neuropathy management
amitriptyline, duloxetine, gabapentin or pregabalin
Try another if doesn’t work
tramadol as exacerbation therapy
capsaicin cream
Most common cause primary hyperaldosteronism
bilateral idiopathic adrenal hyperplasia
Conn’s syndrome
adrenal adenoma
Primary hyperaldosteronism features
hypertension
hypokalaemia e.g. muscle weakness
metabolic alkalosis
Primary hyperaldosternosim investigations
plasma aldosterone/renin ratio is the first-line investigation - should be high aldosterone low renin in primary
CT
if the CT is normal adrenal venous sampling (AVS) can be used to distinguish between unilateral adenoma and bilateral hyperplasia
Conn’s syndrome management
surgery
bilateral adrenal hyperplasia management
spironolactone
Grave’s disease autoantibodies
TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)
Orlistat mechanism of action
inhibits gastric and pancreatic lipase to reduce the digestion of fat
What antibodies in Hashimoto’s thyroiditis
anti-thyroid peroxidase (TPO)
anti-thyroglobulin (Tg) antibodies
When do you add glucose in treatment of DKA?
once blood glucose is < 14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in addition to the saline regime
What blood abnormality can prednisolone cause
neutrophilia
Subclinical hypothyroidism treatment
Treat subclinical hypothyroidism if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart
levothyroxine for 6mths
subclinical hypothyroidism
TSH raised but T3,T4 normal
Types of thyroid cancer from most common to least
Papillary
Follicular
Medullary
Anaplastic
Lymphoma
Which thyroid cancer can be associated with hashimotos thyroiditis
lymphoma
Medullary thyroid cancer
what cells
what secrete
what disease
Cancer of parafollicular (C) cells,
secrete calcitonin,
part of MEN-2
Management of papillary and follicular cancer
total thyroidectomy
followed by radioiodine (I-131) to kill residual cells
Follow up for papillary and follicular cancer
yearly thyroglobulin levels to detect early recurrent disease
Papillary thyroid cancer invasion
lymphatic
Follicular thyroid cancer invasion
Vascular invasion predominates
Medullary thyroid cancer invasion
Both lymphatic and haematogenous metastasis are recognised,
nodal disease is associated with a very poor prognosis.
WHich thyroid cancer young females which old
young: papillary
old: anaplastic
Anaplastic thyroid cancer invasion
Local invasion is a common feature
May appear macroscopically encapsulated, microscopically capsular invasion is seen. Without this finding the lesion is an adenoma.
follicular thyroid cancer
Histologically tumour has papillary projections and pale empty nuclei
Papillary thyroid cancer
pseudo-cushings
mimics Cushing’s
often due to alcohol excess or severe depression
causes false positive dexamethasone suppression test or 24 hr urinary free cortisol
insulin stress test may be used to differentiate
low T4 low TSH
secondary hypothyroidism
get a pituitary MRI
Tests and antibodies used to distinguish between T1 and T2 DM
c-peptides
anti-GAD
ICA
IAA
IA-2A
DKA management insulin therapy
In the acute management of DKA, insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin
Subacute thyroiditis management
usually self-limiting - most patients do not require treatment
thyroid pain may respond to aspirin or other NSAIDs
in more severe cases steroids are used, particularly if hypothyroidism develops
Gynaecomastia
spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids
Worst prognosis thyroid cancer
anaplastic
Falsely low HbA1c causes
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
Falsely high HbA1c causes
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
Signs specific to Grave’s disease
exophthalmos
ophthalmoplegia
pretibial myxoedema
thyroid acropachy
thyroid acropachy
digital clubbing
soft tissue swelling of the hands and feet
periosteal new bone formation
