Endo Disorders II Flashcards
what mass lesions can cause hypopituitarism
craniopharyngioma
Rathke’s pouch cyst
meningioma
non-functional pituitary macroadenoma
metastasis from lung
intrasella ICA aneurysm
what drug causes lymphocytic hypophysitis
ipilimumab
what hormone deficiency does haemochromatosis cause in pituitary
deficiency in gonadotropin
list infiltrative lesions affecting pituitary
lymphocytic & granulomatous hypopthysitis
haemochromatosis
infection
systemic corticosteroids
genetic
ischaemia causing necrosis & haemorrhage
sudden onset
headache
visual disturbances
vomiting
occular paresis CNIII, disruption to IV and VI
pituitary apoplexy
blood loss during childbirth
postpartum pituitary necrosis / haemorrhage
severe lethargy
norexia, weight loss
failure post partum lactation
amenorrhoea weeks/months post delivery
GH, PRL, GnT deficiency
Sheehan syndrome
obese
female
HTN
defect in diaphragm of sella
excess CSF –> herniate SA space into sella
primary - empty sella syndrome
(2’ regression size pituitary)
(3’ transcription factor abnormality - pituitary differentiation)
mutation KAL1 and FGFR1
failure of migration of neurons
testicular hypotrophy
pubic hair present
hypo/anosmia
Kallman Syndrome (genetic)
Anosmia because migratory neurons arise in olfactory epithelium
posterior pituitary hypofunctino is associated with
arginine vasopressin (ADH) deficiency
central diabetes insipidus
sequence for testing pituitary hormones
test in pairs i.e. cortisol & ACTH
timing
deprivation test i.e. psychogenic DI
stimulatory test - if no increase, there is deficiency
MRI
biopsy
short, obese stature
AR
resistance to GH
abnormalities in GHr
high serum GH
low IGF-1
Laron Syndrome
polydipsia
polyuria
hypernatraemia
dilute urine
confusion
diabetes insipidus
(ADH absense/loss)
name the type of diabetes insipidus:
1) problem with no ADH
2) problem with kidney
3) no problem with function
1) central DI
2) nephrogenic DI
3) psychogenic polydipsia
normal ADH
hypernatraemia
high plasma osmol
low urine osmol
nephrogenic DI
decreased ADH
hypernatraemia
high plasma osmol
low urine osmol
central DI
N/increased ADH
hyponatraemia
low plasma osmol
low urine osmol
primary polydipisa (psychogenic)
water deprivatino test:
- plasma osmol increases
- urine osmol low
desmopressin admin (DDAVP):
- plasma osmol decreases
central DI
water deprivatino test:
- plasma osmol increases
- urine osmol low
desmopressin admin (DDAVP):
- plasma osmol remains high
nephrogenic DI
water deprivatino test:
- plasma osmol increases
- urine osmol increases
desmopressin admin (DDAVP):
- not required
psychogenic polydipsia
hypoosmolality
euvolemic hyponatremia
concentrated urine
high urinary Na+
nausea, muscle cramps
SIADH
causes of SIADH
antidepressant agents - SSRIs
SCLC - paraneoplastic
CNS infection, trauma
drug cause of nephrogenic DI
Lithium
bradycardia, HTN
cold intolerance
constipation
anaemia
carpel tunnel syndrome
dry skin, delayed DTR
myxoedema
hyperthyroidism
low T3
high TSH
anti-TPOAb (+)
anti-TgAb (+)
painless diffuse thyroid enlargement
lymphocytic infiltration
Hurthle cells
hashimoto thyroiditis
iodine induced hypothyroidism
excess iodine - inhibited organification
normal thyroid function
escape phenomena present
Wolf-Chaikoff effect
iodine induced hyperthyroidism
iodine deficient hypothyroidism
increased iodine exposure - excessive hormone sythesis
not occur in euthyroid individuals
Jod-Basedown phenomenon
low/absent
Radioactive iodine uptake seen in:
hasimoto thyroiditis
thyroid drug ingestion
high/normal
radioactive iodine uptake seen in:
Graves disease
toxic adenoma
toxic multinodular goiter
focal, high uptake RIU
toxic adenoma
diffuse high uptake RIU
Graves disease
diffuse symmetric
enlarged meaty appearance thyroid gland
Graves disease
pseudopapillary infolding
scalloping of colloid
hyperplastic follicular cells
Graves disease
goitre - iron collar
stony hard fibrosis
tan-grey woody thyroid
fibrosclerotic changes
pathcy lymphocytic & eosinophilic infiltration
Riedel syndrome
