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Endo Flashcards

1
Q

Define acromegaly

A

Constellation of signs and symptoms caused by hypersecretion of GH in adults

note: most are caused by a pituitary adenoma

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2
Q

Outline the signs of acromegaly

A

coarsening of facial features
soft-tissue and skin changes - rings and shoes becoming tight
carpal tunnel syndrome
joint pain and dysfunction
snoring
alterations in sexual functioning
Can also get hyperprolactinaemia symptoms

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3
Q

List some appropriate investigations for acromegaly

A

serum insulin-like growth factor 1 (IGF-1) [lacks specificity]
oral glucose tolerance test (OGTT) - CONFIRMATORY [failure of GH suppression after 75g glucose load]
random serum growth hormone (GH)

Consider visual field testing
Consider MRI pituitary

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4
Q

Generate a management plan for acromegaly

A

1st line = transphenoidal surgery + consider radiotherapy
2nd line = somatostatin analogues (octreotide, lanreotide)
3rd line = dopamine agonists (cabergoline)
3rd line = GH receptor antagonists (pegvisomant - recombinant GH analogue)

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5
Q

What hormones does the adrenal gland produce and where are they produced?

A

CORTEX:
Mineralocorticoid (aldosterone) - zona glomerulosa
Glucocorticoids (cortisol) - zona fasciculata
Androgens (DHEA) - zona reticularis

MEDULLA:
adrenaline/noradrenaline

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6
Q

List some risk factors for adrenal insufficiency

A

Primary - Addison’s disease (usually autoimmune)
Secondary - hypothalamic/pituitary failure
Infections - TB
Infiltrative - mets, amyloidosis, lymphoma
Iatrogenic - sudden cessation of long term steroid therapy

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6
Q

Outline the presenting symptoms of adrenal insufficiency

A

Chronic Presentation - the symptoms tend to be VAGUE and NON-SPECIFIC
Dizziness
Anorexia
Weight loss
Diarrhoea and Vomiting
Abdominal pain
Lethargy
Weakness
Depression
INCREASED PIGMENTATION

Acute Presentation (Addisonian Crisis)
Acute adrenal insufficiency
Major haemodynamic collapse: shock, N+V, hypothermia and abdo pain
Precipitated by stress (e.g. infection, surgery)

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7
Q

List some appropriate investigations for adrenal insufficiency

A

morning serum cortisol (< 100 nmol/L is diagnostic)
plasma adrenocorticotrophic hormone (ACTH)
serum electrolytes
urea and creatinine
FBC
TFTs

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8
Q

What is the difference between the short synacthen and long synacthen test?

A

Short Synacthen Test
-Give IM 250 µg tetrocosactrin (synthetic ACTH)
-Serum cortisol < 550 nmol/L at 30 mins indicates adrenal failure

Long Synacthen Test
-1 mg synthetic ACTH administered
-Measure serum cortisol at 0, 30, 60, 90 and 120 minutes
-Then measure again at 4, 6, 8, 12 and 24 hours
-Patients with primary adrenal insufficiency show no increased after 6 hours

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9
Q

Generate a management plan for an Addisonian crisis

A

A-E approach
1. Rapid IV fluid rehydration
2. 50 mL of 5% dextrose to correct hypoglycaemia
3. IV or Im 100 mg hydrocortisone bolus
4. Followed by 100 mg 6 hourly hydrocortisone until BP is stable
5. Treat precipitating cause (e.g. antibiotics for infection)
Monitor

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10
Q

How is ongoing adrenal insufficiency managed?

A

Replacement:
-Glucocorticoids with hydrocortisone (3/day)
-Mineralocorticoids with fludrocortisone
[Hydrocortisone dosage needs to be increased during times of acute illness or stress]

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11
Q

Define carcinoid syndrome

A

Constellation of symptoms (esp liver mets) caused by systemic release of humoral factors from carcinoid tumours (slow-growing type of neuroendocrine tumours)

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12
Q

List the presenting symptoms of carcinoid syndrome

A

Paroxysmal FLUSHING
Diarrhoea
Crampy abdominal pain
Wheeze – due to bronchospasm
Sweating
Palpitations
Telangiectasia

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13
Q

List some appropriate investigations for carcinoid syndrome

A

serum chromogranin A/B (will be elevated)
urinary 5-hydroxyindoleacetic acid
metabolic panel
liver function tests
full blood count
CT/PET scan to localise tumour

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14
Q

Generate a management plan for carcinoid syndrome

A

Surgical resection + perioperative octreotide infusion

For unresectable - somatostatin analogue or interferon alpha
Consider chemotherapy, radiotherapy and immunotherapy
Consider palliative debulking

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15
Q

What are the risk factors for Cushing’s syndrome

A

ACTH dependent:
-pituitary adenoma (Cushing’s disease)
-ectopic ACTH from lung cancer/carcinoid tumours

ACTH independent
-adrenal adenoma
-adrenal carcinoma

Taking STEROIDS

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16
Q

Outline the presenting symptoms of Cushing’s syndrome

A

Myalgia
Thin skin/easy bruising
Poor wound healing
Weight gain - central obesity
Moon face
Interscapular fat bad
Hirsuitism
Acne
Menstrual irregularities

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17
Q

List the appropriate investigations for Cushing’s syndrome

A
  1. Urine pregnancy test (if appropriate)
  2. Bloods (U+Es, LFTs, BMs, CRP)
  3. 1 mg overnight dexamethasone suppression test
  4. Late-night salivary cortisol
  5. 24hr urinary free cortisol
    Can also do low dose dexamethasone test (over 48hrs)

Consider ix for cause:
-pituitary MRI
-high dose dexamethasone suppression test
-petrosal sinus sampling
-ACTH levels

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18
Q

Generate a management plan for Cushing’s syndrome

A

If iatrogenic - discontinue steroids

Medical:
-inhibit cortisol synthesis with metyrapone or ketoconazole

Surgical:
-pituitary adenoma - trans-sphenoidal resection
-adrenal adenoma - surgical removal

If refractory Cushing’s disease - bilateral adrenalectomy

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19
Q

List some complications of Cushing’s syndrome

A

Diabetes
Osteoporosis
HTN
Pre-disposition to infections

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20
Q

Define diabetes insipidus

A

Diabetes insipidus is a metabolic disorder characterised by an absolute or relative inability to concentrate urine due inadequate secretion or of insensitivity to vasopressin (ADH)

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21
Q

List some causes of diabetes insipidus

A

Central:
-Idiopathic
-Tumours e.g. pituitary
-Infiltrative (e.g. sarcoidosis)
-Infection (e.g. meningitis)
-Vascular (e.g. aneurysms, Sheehan syndrome)
-Trauma (e.g. head injury, neurosurgery)

Nephrogenic:
-Idiopathic
-Drugs (e.g. lithium)
-Post-obstructive uropathy
-Pyelonephritis
-Pregnancy
-Osmotic diuresis (e.g. diabetes mellitus)

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22
Q

Outline the presenting symptoms of diabetes insipidus

A

Polyuria
Nocturia
Polydipsia
Enuresis (in children)

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23
Q

List some appropriate investigations for diabetes insipidus

A
  1. Bloods (U+Es - Na, Ca, K, glucose)
  2. urine osmolality (decreased)
  3. serum osmolality (increased)
  4. urine dipstick (negative for glucose)
  5. water deprivation test
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24
Explain the results of a water deprivation test
Water restricted for 8 hrs and then desmopression given and osmolality measured. Normally water restriction = increased urine osmolality (>600 mosmol/kg) DI = urine osmolality is LOW (<400 mosmol/kg) Cranial DI - urine osmolality rises >50% after desmopressin Nephrogenic DI - osmolality rises <45% after desmopressin
25
Generate a management plan for diabetes insipidus
A-E 1. Give IV fluids if hypernatraemic (5% dextrose may be necessary) 2. Desmopressin 3. Maintenance of fluid balance If nephrogenic then can give thiazide diuretics or NSAIDs (these inhibit prostaglandin synthesis and prostaglandin inhibits ADH)
26
What HLA associations are linked to T1DM?
HLA-DQ, HLA-DR3/4
27
List some causes of T2DM
MODY (maturity onset diabetes of the young) – autosomal dominant Pancreatic disease e.g. chronic pancreatitis, pancreatic ca. Endocrinopathies e.g. Cushing’s syndrome, acromegaly, PCOS Drugs e.g. corticosteroids
28
Give some risk factors for T2DM
Genetic predisposition Older age Physical inactivity Obesity - ↑FFAs, hyperglycaemia Hypertension Dysplipidaemia Cardiovascular disease
29
List some appropriate investigations for suspected diabetes
1. Urine dip 2. Blood glucose 3. HbA1c (>48 mmol/mol or 6.5%) 4. Urine albumin:creatinine ratio 5. eGFR 6. U+Es 7. Lipids [If suspecting DKA then do ABG and ketones]
30
What are the blood glucose cut offs for diagnosing diabetes?
Fasting blood glucose >7 2hr post OGTT >11.1 Random >11.1 For diagnosis need: -Symptomatic + 1 positive result -Asymptomatic + 2 positive results
31
Generate a management plan for T1DM
Patient education MDT Diabetes specialist nurse DAFNE (dose adjusted for normal eating) Glycaemic control insulin (either basal bolus regimen or insulin pump)
32
Generate a management plan for DKA
IV fluid replacement with 0.9% saline Start IV dextrose when glucose reaches 15mmol/l Insulin infusion Potassium (in fluids) Monitor blood glucose, ketones, urine output and VBG
33
What advice is given for T2DM
Patient education Lifestyle measures - diet, weight loss, exercise BP control (ACEi +/- diuretic) Statins Smoking cessation
34
Outline the medication pathway for T2DM
1. Metformin (if C/I then usually start on sulfonylurea) 2. Metformin + sulfonylurea (or sulfonylurea + DDP4i) 3. Metformin + sulfonylurea + SGLT2/DPP4i/Pioglitazone 4. Substitute least effective of the three with GLP-1 (NOTE: do NOT give DPP4 and GLP 1 in combo) 5. Add in insulin
35
Generate a management plan for HHS/HONK
IV isotonic saline fluid replacement (unless 0.45% saline if Na+ >155mmol/l) Start IV dextrose when glucose reaches 15mmol/l Insulin infusion 3 U/hour Potassium (in fluids) Monitor blood glucose, ketones, urine output and venous blood gases
36
Outline the main complications of diabetes
Diabetic kidney disease Impaired vision (diabetic retinopathy) Peripheral vascular disease Peripheral neuropathy IHD Stroke/TIA Gangrene Infection Impotence/ED
37
Define Grave's disease
Hyperthyroidism due to presence of TSH receptor stimulating antibodies (most common cause of hyperthyroidism in UK)
38
List the presenting symptoms of Grave's disease
Heat intolerance Sweating Weight loss Palpitations Tremor Exopthalmos Pretibial myxoedema Diffuse goitre Anxiety Oligomenorrhoea/Amenorrhoea
39
List some appropriate investigations for Grave's disease
1. Thyroid examination 2. TFTs (low TSH + high T3/T4) 3. Autoantibodies (Anti-TSHr, Anti-TPO, anti-thyroglobulin) 4. Imaging (thyroid uptake scan - diffuse) 5. CRP Can do biopsy - will show tall follicles with scalloped borders
40
Generate a management plan for Grave's disease
1. Carbimazole or PTU (in pregs) - block organification of iodine - Risk of AGRANULOCYTOSIS 2. Beta blocker for HR 3. Radioactive iodine if treatment failure 4. Consider thyroid surgery (risk of damage to recurrent laryngeal nerve)
41
Generate a management plan for a thyroid storm
1. A-E approach 2. IV fluids + analgesia 3. Propranolol 4. Steroids 4. High dose carbimazole/PTU
42
What are the different types of hyperparathyroidism?
Primary - increased secretion of PTH independent to plasma Ca Secondary - increased PTH secretion secondary to hypocalcaemia Tertiary - autonomous PTH secretion following chronic secondary hyperparathyroidism
43
Outline some causes of primary hyperparathyroidism
Parathyroid adenoma Parathyroid hyperplasia Parathyroid carcinoma MEN syndrome
44
Outline some causes of secondary hyperparathyroidism
Chronic renal failure Vitamin D deficiency Malabsorption syndromes
45
List the presenting symptoms of primary hyperparathyroidism
Signs of hypercalcaemia: -Polyuria -Renal calculi -Constipation -Depression/anxiety -Fatigue -Memory loss -Paraesthesia
46
List the presenting symptoms of secondary hyperparathyroidism
Signs of hypocalcaemia or underlying cause -Tingling in fingers/toes -Myoclonus -Muscle cramps -Chvostek's sign -Trousseau's sign
47
List some appropriate investigations for hyperparathyroidism
1. serum calcium 2. Serum PTH 3. vitamin D level 4. U+Es + LFTs (albumin) 5. serum phosphate 6. ALP 7. 24 urinary calcium 8. Consider ABG 9. X ray (pepper pot skull in primary, rachitic rosary in secondary) 10. Renal ultrasound (if suspected calculi)
48
Generate a management plan for hyperparathyroidism
Managing the hypercalcaemia: -IV fluids -Consider bisphosphonate if Ca still high 1st line - parathyroidectomy + monitoring + vit D supplementation For secondary hyperparathyroidism - treat underlying cause (e.g. phosphate restriction for CKD)
49
List some complications of primary and secondary hyperparathyroidism
Primary: -Osteoporosis -Bone fractures Secondary: -Osteitis fibrosa cystica -Uraemia
50
List some causes of hypothyroidism
Acquired: -Hashimoto's thyroiditis (AI) -Iatrogenic (post-surgery, radioiodine, hyperthyroid meds) -Iodine excess (Wolff-Chaikoff effect) Congenital: -Thyroid agenesis
51
Outline the presenting symptoms of hypothyroidism
Cold intolerance Weight gain Lethargy Dry skin Memory issues Hair loss Ataxia Paraesthesia Menstrual irregularities Myxoedema coma - hypoventilation, hypothermia, hyponatraemia, confusion, coma, heart failure
52
List some appropriate investigations
1. Thyroid exam 2. TFTs (high TSH, low T3/4) 3. Antibodies (anti-TPO, anti-TG, AMA) 4. U+Es 5. lipids 6. Uptake scan
53
Generate a management plan for hypothyroidism
- low dose levothyroxine (25-200 mcg/day) NOTE: rule out underlying adrenal insufficiency before starting thyroid medication
54
Generate a management plan for myxoedema coma
Oxygen Rewarming Rehydration IV T4/T3 IV hydrocortisone Treat underlying cause (e.g. infection)
55
What are the features of MEN1?
Parathyroid tumours Pituitary adenomas Pancreatic islet cell tumours
56
What are the features of MEN2a and MEN2b?
MEN2a: Parathyroid tumours Phaeochromocytomas Medullary thyroid cancer MEN2b: Mucosal neuromas (e.g. GI tract) Medullary thyroid cancer Phaeochromocytomas
57
List some appropriate investigations for MEN1/2
serum calcitonin (MEN2) serum CEA (MEN2) plasma metanephrines (MEN2) serum parathyroid hormone and calcium (MEN1/2) fasting serum gastrin (MEN1) serum chromogranin A (MEN1) serum prolactin (MEN1) insulin-like growth factor-1 (MEN1) 24-hour urine metanephrines and catecholamines (MEN2) 24-hour urine calcium (MEN1/2) thyroid biopsy (MEN2)
58
Generate a management plan for MEN1/2
Treat the symptoms: -Hyperparathyroidsm - hypercalcaemia pharmacotherapy + surgery -Gastrinoma - PPI + surgery -Non-functioning pituitary adenomas - monitor + surgery -Prolactinomas - dopamine agonists -Thyroid cancer - surgery + hormone replacement -Phaeo - surgery + consider short term alpha 1 antagonists and steroid replacement.
59
How is obesity defined?
BMI >30kg/m^2
60
Define osteomalacia
Metabolic bone disease characterised by incomplete mineralisation of the underlying mature organic bone matrix following growth plate closure in adults note: in kids it is referred to as Rickets
61
List some risk factors for osteomalacia
Dietary Ca and Vit D deficiency CKD Limited sunlight exposure Anticonvulsant therapy
62
Outline the presenting symptoms of osteomalacia
diffuse bone pain and tenderness fractures proximal muscle weakness
63
List some appropriate investigations for osteomalacia
-Serum Ca -Serum vit D -Serum phosphate -U+Es -PTH -ALP -24 hr urinary calcium -bone x rays/DEXA
64
Generate a management plan for osteomalacia
Calcium and vitamin D supplementation Monitoring
65
Define osteoporosis
Skeletal disease characterised by low bone density and micro-architectural defects in bone tissue causing increased bone fragility. Defined as a T score ≤-2.5
66
List some risk factors for osteoporosis
Smoking Excess alcohol use Premature menopause Low BMI Drugs (steroids, thyroxine) Cushing's
67
Outline the presenting symptoms of osteoporosis
Usually asymptomatic May present with fractures Back pain/loss of height over time (due to vertebral fractures)
68
List some appropriate investigations for osteoporosis
DEXA Bloods - U+Es, Ca, ALP, Albumin, Vit D, PTH, TFTs Consider X rays
69
What is the difference between a T score and a Z score?
T-scores reflect how bone density compares with that of a typical, young, healthy person, whereas Z-scores uses an age-matched control
70
Generate a management plan for osteoporosis
Lifestyle measures - increased exercise, weight loss 1st line - Bisphosphonates Calcium and Vit D supplementation 2nd line - terparatide 3rd line - denusomab
71
What side effect is associated with bisphosphonate treatment?
Jaw necrosis
72
Define Paget's disease of bone
A chronic bone disorder that is characterised by focal areas of increased bone remodelling, resulting in overgrowth of poorly organised bone.
73
What are the 3 distinct phases of Paget's disease?
1. Initial short-lived burst of osteoclastic activity --> bone resorption 2. Mixed phase of osteoclastic and osteoblastic activity --> abnormally structured bone 3. Chronic sclerotic phase (bone formation outweighs bone resorption
74
Outline the presenting symptoms/signs of Paget's disease of bone
Mostly asymptomatic Gradual bone pain (most likely pelvis, long bones + skull) Frontal bossing (increased size of headwear) Prognathism Facial pain + HEARING loss (if skull involvement)
75
List some appropriate investigations for Paget's disease of bone
1. Examination 2. Plain X ray 3. Bone scans 4. Serum Ca 5. BONE specific ALP (used for treatment response) 6. serum ALP 7. Vit D (this should be normal)
76
What would X rays show in Paget's disease of bone?
lytic changes fractures sclerotic picture (later stages)
77
Generate a management plan for Paget's disease of bone
If asymptomatic: -Observe, regular f/u -Consider bisphosphonate or calcitonin Symptomatic: 1st line = bisphosphonate or calcitonin Physiotherapy Walking aids Hearing aids
78
Define phaeochromocytoma
Catecholamine-producing tumours that usually arise from chromaffin cells of the adrenal medulla note: it is NOT an adenoma like in Cushing's/Conn's
79
Which genetic syndromes can cause phaeochromocytomas?
MEN2a and MEN2b von Hippel-Lindau syndrome Neurofibromatosis type 1
80
Outline the presenting symptoms of phaeochromocytomas
PAROXYSMAL episodes Headache (due to malignant hypertension) Palpitations Chest pain Dyspnoea Sweating GI sx - N+V, epigastric pain, constipation Neuro sx - Weakness, tremor, anxiety
81
List some appropriate investigations for phaechromocytomas
1. 24 hr urinary catecholamine/metanephrine collection 2. Plasma free metanephrines and catecholamines 3. Genetic testing 4. Consider MRI or CT adrenal protocol for tumour localisation
82
Generate a management plan for phaeochromocytoma
If hypertensive crisis (>180/120) - 1st line phentolamine If no hypertensive crisis: 1st line = alpha blockers (phenoxybenzamine) THEN beta blockers (for reflexive tachycardia) IV fluids Surgical excision of tumour
83
What are the key presenting features of a non-functioning pituitary adenoma?
Headaches Bitemporal hemianopia Can have panhypopituitarism
84
What are the Rotterdam criteria for PCOS?
1. Oligomenorrhoea/Amenorrhoea (>2 years) 2. Hyperandrogenism (biochemical/clinical) 3. Evidence of cysts on ovaries on USS: -≥ 12 follicles in one ovary measuring 2-9mm in diameter -Ovarian volume > 10cm3 need 2 of the 3 criteria
85
List some risk factors for PCOS
Strong FHx premature adrenarche obesity low birth weight
86
Outline the presenting symptoms of PCOS
- Irregular or absent menstruation - Infertility - Hirsutism - Acne - Overweight/ obese - Scalp hair loss -Depression and other psych factors -ACANTHOSIS NIGRICANS
87
List some appropriate investigations for PCOS
1. Hormone profile (progesterone, oestrogen, testosteron, LH, FSH, DHEAS) 2. Prolactin 3. TFTs 4. OGTT 5. Fasting lipids panel 6. Pelvic ultrasound/TVUSS
88
Generate a management plan for PCOS
Conservative: -Weigh loss, lifestyle advice Medical: If NOT planning pregnancy - COCP, LNG-IUS or Co-cyprindol (useful for hirsuitism) If planning pregnancy - Clomiphene (+/- metformin) Surgical: Not planning pregnancy - laser/electrolysis Planning pregnancy - laparoscopic ovarian drilling, IVF
89
Outline some complications of PCOS
Infertility T2DM Pregnancy complications CVD NAFLD Endometrial cancer HTN OSA NOTE: NO INCREASED RISK OF BREAST OR OVARIAN CANCER
90
List some causes of primary aldosteronism
Adrenal adenoma (Conn's syndrome) Adrenal cortex hyperplasia Adrenal carcinoma producing aldosterone
91
Outline the pathophysiology of hyperaldosteronism
Excess aldosterone leads to increased Na+ and water retention This leads to hypertension It also causes increased renal K+ loss leading to hypokalaemia Renin is suppressed due to NaCl retention
92
Outline the presenting symptoms of primary hyperaldosteronism
Usually asymptomatic HTN Can get symptoms of hypokalaemia: -Muscle weakness -Polyuria/polydipsia -Parasthesia -Lethargy -Tetany -Mood disturbances
93
List some appropriate investigations for primary hyperaldosteronism
1. Ambulatory blood pressure monitoring 2. Serum K (LOW) 3. Serum Na (usually normal because of associated water resorption) 4. Urinary K (HIGH) 5. Aldosterone:renin ratio (HIGH due to renin supression) Consider the following confirmatory tests: -Salt loading -CT adrenal/MRI -Posture stimulation testing
94
Generate a management plan for primary hyperaldosteronism
Unilateral: -adrenalectomy + postop aldosterone antagonists Bilateral hyperplasia: -Spironolactone OR Eplerenone OR amiloride
94
What are the different types of prolactinoma?
Microadenomas: < 1 cm Macroadenomas: > 1 cm Giant Pituitary Adenomas: > 4 cm Malignant Prolactinoma (RARE)
95
Outline the presenting symptoms of a prolactinoma
Women ○ Amenorrhoea/oligomenorrhoea ○ Galactorrhoea ○ Infertility ○ Hirsuitism ○ Reduced libido Men ○ Symptoms are subtle and develop slowly ○ Reduced libido ○ Reduced beard growth ○ Erectile dysfunction Note: both can have sx caused by tumour size (headaches, bitemporal hemianopia, cranial nerve palsies)
96
List some appropriate investigations for a prolactinoma
1. Neuro exam 2. Pregnancy test (if appropriate) 3. Serum prolactin (>5000mU/L suggests true prolactinoma) 4. TFTs (hypothyroid stimulates prolactin release) 4. Pituitary MRI
97
Generate a management plan for a prolactinoma
1st line = dopamine agonist (cabergoline) 2nd line = COCP If macroadenoma or medical treatment ineffective - transphenoidal resection
98
What is SIADH characterised by?
Hypotonic hyponatraemia Concentrated urine Euvolaemic state
99
Which drugs can cause SIADH?
Vincristine Opiates Carbamazepine Chlorpropamide
100
List some causes of SIADH
Brain: -Haemorrhage/thrombosis -Meningitis -Abscess -Trauma -GBS Lung: -Pneumonia -TB Tumours: -SCLC -Breast cancer -Lymphoma -Leukaemia Metabolic: -Porphyria -Alcohol withdrawal
101
Outline the presenting symptoms of SIADH
Can be ASYMPTOMATIC Headache N+V Muscle cramp/weakness Confusion Drowsiness Convulsions Coma
102
List some appropriate investigations for SIADH
1. Serum Na (LOW) 2. Serum osmolality (LOW) 3. Serum urea, creatinine 4. Urine osmolality (HIGH) 5. Urine Na (HIGH) 6. Glucose, serum protein and lipids - to rule out pseudohyponatraemia 7. TFTs
103
Generate a management plan for SIADH
1st line: Treat underlying cause 1st line: Fluid restriction to 1L per day 2nd line: Vasopressin receptor antagonists (e.g. tolvaptan) 3rd line: NaCl + furosemide 4th line: demeclocycline In SEVERE/ACUTE cases - slow IV hypertonic saline and furosemide with close monitoring
104
Give some differentials for SIADH
Pseudohyponatraemia Psychogenic polydipsia Renal failure Addison's disease Hypothyroidism
105
What complication can be caused by correcting SIADH?
Central pontine myelinolysis (demylination of pons) - occurs with rapid correction of hyponatraemia Characterised by: -Quadriparesis -Respiratory arrest -Fits
106
What are the types of thyroid cancer (from most common to least)
Papillary – well-differentiated developed from follicular cells and spreads to N [Psammoma bodies, Orphan Anne nuclei] Follicular – well-diff developed from follicular cells and rarely spreads to N [Hurthle cells] Medullary – develops from C cells Anaplastic – v. rare – fast growing and poorly diff
107
List the presenting features of thyroid cancer
Slow-growing neck lump Discomfort swallowing Hoarse voice - RED FLAG!! Cervical lymphadenopathy
108
List some appropriate investigations for thyroid cancer
1. Examination 2. TFTs (usually normal) 3. Bone profile 4. Markers: -Thyroglobulin - papillary and follicular -Calcitonin - medullary 5. Thyroid US 6. Fine-Needle Aspiration Cytology (FNA) 7. Excision Lymph Node Biopsy Consider CT/MRI - for staging
109
Generate a management plan for thyroid cancer
Surgery Thyroid hormone replacement Consider chemotherapy and external radiation
110
Define thyroiditis
Inflammation of thyroid gland
111
What are the main types of thyroiditis
Hashimoto's - AI de Quervain's - viral Postpartum Drug-induced Ridel's - fibrosis (woody/craggy lump)
112
What happens to TFTs in thyroiditis
Increase in thyroid hormone synthesis causes hyperthyroidism Then the stores run out and pt becomes HYPOthyroid
113
Outline the presenting symptoms of thyroiditis
neck pain tender, firm, enlarged thyroid fever palpitations sx of hypothyroid sx due to thyroid gland enlargement (dyspnoea, dysphagia)
114
List some appropriate investigations for thyroiditis
1. Examination of thyroid 2. TFTs (TSH raised) 3. ESR/CRP 4. Antibodies (Anti-TPO, Anti-thyroglobulin, AMA) 5. Thyroid US 6. Radionucleotide isotope scanning (usually LOW)
115
Generate a management plan for thyroiditis
Mainly supportive care Thyroid supplementation Analgesia Consider corticosteroid If severe thyrotoxicosis - potassium iodide + pred

Year 6 (2 decks)

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