Endo Flashcards
30% of all pituitary adenomas
Females = Amenorrhea, galactorrhea, infertility Males = vague sxs (decreased libido)
What is it? Tx?
Lactotropic adenoma (prolactinoma)
Tx = Bromocriptine (surgery for large tumors/failed pharm)
(smaller than 10mm = microadenoma)
Somatotropic adenoma (growth hormone)… Has two different presentations based off puberty. what are they?
Tx = surgical excision, BONE CHANGES ARE PERMANENT
pre puberty = Gigantism (growth of long bones = ~8ft tall)
Post puberty = acromegaly (growth of hands/feet/face/jaw)
Complication of post puberty somatotropic adenomas?
Internal organ enlargemetn… cardoresp comps may cause death
Cushing from over stimulation of adnreal cortex results from?
Corticotropic adenoma (ACTH)
Causes of hypopituitarism?
which is rare, btw
Congenital (primary empty sella syndrome, dwarfism, hypogonadism)
Tumors (decreases circulation/destroys pituitary gland)
Circulatory disturabances (Sheehan’s syndrome)
Trauma (head injury/trauma)
Postpartum ischemia
Massive hemorrhage/HOTN from childbirth
(Similar process to acute renal tubule necrosis)
Sheehan syndrome
can cause hypopituitarism
COLD INTOLERANCE
HOTN
General weakness
Poor appetite
SSx of hypopituitarism
Cold intolerance/HOTN being the key dffierentiator
Damage to hypothalamus, pituitary stalk, tumors, trauma
-> insufficient ADH
Ssx?
Diabetes inspidus
Polyuria
Polydipsia
BUT NO polyphagia
(Water restriction does not affect urine output)
Tx = vasopressin
Most common cause of hyperthyroidism?
Clinical features/
Graves Dz (autoimmune)
Ssx appear slowly
Restlessness/nervousness Tremors/excessive sweating Heart palpitation *High t3/t4 *LOW TSH
Tx = I131, surgical excision
Typical Graves dz pt?
Characterized by?
20-40 y/o woman
Thyrotoxicosis
Exophthalmos
Dermopathy - pretibial myxedema - dough like skin that doesn’t pit (<4%)
Most common hypothyroidism
Hashimoto’s
Autimmune dz associated with other dz (Sjogrens)
Females are 10x more likely
Other less common forms of hypothyroidism
Thyroidectomy
Iodine deficiency (rare… cretinism/goiter)
Features of hypothyroidism
SLOWING OF ALL METABOLIC PROCESSES
Low T3/T4 (HIGH TSH)
Sleepiness/cold sensitivity/constipation/ wt gain
TX = synthetic thyroid supps
Iodine deficiency presents with?
Must r/o cancer when seeing this sign
Nodular goiter
Hypothyroid symptoms
Normal to low thyroid hormones (HIGH TSH)
Tx = incomplete thyroidectomy
Common benign tumor usually presenting as solitary nodule
Can’t be differentiated from normal tissue on I123 scan
Diagnosis by biopsy
Follicular adenoma
Most common malignant thyroid nodule
Inactive
Does not take up I123 on scan (“cold nodule”)
Biopsy -> partial/total thyroidectomy
Papillary thyroid carcinoma
15% of malignant thyroid tumors
Hot nodule (seen on I123 scan)
Susceptible to I131 ablation
Follicular thyroid carcinoma
Increased secretion of PTH
Most commonly from?
Hyperparathyrdiism usually from benign parathyroid adenoma
(usually asymptomatic; however severe cases may lead to pathological fxs of bones/kidney stone formation)
Labs = high Ca, low PO
Labs = low Ca, high PO
Muscle spasms/cramps
Chvostek’s sign (facial twitching from tapping)
Trousseau’s sign (wrist flex from BP cuff)
Hypoparathyroidism (rare)
Hypercortisolism?
Causes?
Cushing’s
1. Pituitary adenoma = too much ACTH Cushing’s Dz (MC)
- Adrenocortical tumor = too much corticosteroids = Cushing’s syndrome
- Exogenous glucocorticoids = Prolonged tx of autoimmune d/o
Central truncal obesity
Moon faces
BUffalo hump
Facial redness
Cutaneous striae
Facial hair/thinning/acne
Cushings
Tx for Cushing’s?
Excision of tumor
Medical suppression of endocrine system
OR if due to exogenous steroids, taper/cease steroids
Chronic adrenocortical inufficiency
Addison’s dz
Progressive destruction of adrenal cortex
Slow insidious onset
Progressive weakness/fatigue
BRONZING hyperpigmentation (stimulated melanocytes)
Addison’s
Tx = life long corticosteroid supplements
ACTH test administration should trigger corticosteroid release…
If no response, suspect?
Addison’s
Catecholamine secretion tumor
Rare neoplasm of adrenal medulla
Strong familial association w/ MEN (multiple endocrine neoplasia)
Pheochromocytoma
Classic triad =
HA
Diaphoresis
Tachycardia
Pheochromocytoma
ABRUPT onset of HTN
Many people w/ pheochromocytoma don’t have classic triad. Other ssx?
Tachycardia, palpitations, tremor, apprehension
What labs will be elevated in pheochromocytoma?
Epi/norepinephrine elevated
24-HOur Vanillylmandelic acid (VMA) test will be elevated
(VMA = epi/norepinephrine metabolite)
Tx for pheochromocytoma?
Surgical resection (excellent prog)
Developmental malignancy of neonates/children <5
Large abd tumor frequently found by parents
Elevated VMA urine test!
Neuroblastoma
tx = combo of surgery, rad, chemo
(Early detection = 90% cure)
Cushing’s disease AKA….
3 most common causes?
… hyper cortisolism tied to ACTH
- Pituitary adenoma- produce excess ACTH (70% of cases) = DISEASE
- Adrenocortical tumor = excess corticosteroids = SYNDROME
- Exogenous glucocorticoids- prolonged steroid tx of AI d/o
