Endo Disorders II Flashcards by megan king

what mass lesions can cause hypopituitarism

craniopharyngioma
Rathke’s pouch cyst
meningioma
non-functional pituitary macroadenoma
metastasis from lung
intrasella ICA aneurysm

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what drug causes lymphocytic hypophysitis

ipilimumab

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what hormone deficiency does haemochromatosis cause in pituitary

deficiency in gonadotropin

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list infiltrative lesions affecting pituitary

lymphocytic & granulomatous hypopthysitis
haemochromatosis
infection
systemic corticosteroids
genetic

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ischaemia causing necrosis & haemorrhage
sudden onset
headache
visual disturbances
vomiting
occular paresis CNIII, disruption to IV and VI

pituitary apoplexy

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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

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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)

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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

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posterior pituitary hypofunctino is associated with

arginine vasopressin (ADH) deficiency
central diabetes insipidus

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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

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short, obese stature
AR
resistance to GH
abnormalities in GHr
high serum GH
low IGF-1

Laron Syndrome

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polydipsia
polyuria
hypernatraemia
dilute urine
confusion

diabetes insipidus
(ADH absense/loss)

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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

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normal ADH
hypernatraemia
high plasma osmol
low urine osmol

nephrogenic DI

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decreased ADH
hypernatraemia
high plasma osmol
low urine osmol

central DI

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N/increased ADH
hyponatraemia
low plasma osmol
low urine osmol

primary polydipisa (psychogenic)

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water deprivatino test:
- plasma osmol increases
- urine osmol low
desmopressin admin (DDAVP):
- plasma osmol decreases

central DI

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water deprivatino test:
- plasma osmol increases
- urine osmol low
desmopressin admin (DDAVP):
- plasma osmol remains high

nephrogenic DI

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water deprivatino test:
- plasma osmol increases
- urine osmol increases
desmopressin admin (DDAVP):
- not required

psychogenic polydipsia

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hypoosmolality
euvolemic hyponatremia
concentrated urine
high urinary Na+
nausea, muscle cramps

SIADH

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causes of SIADH

antidepressant agents - SSRIs
SCLC - paraneoplastic
CNS infection, trauma

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drug cause of nephrogenic DI

Lithium

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bradycardia, HTN
cold intolerance
constipation
anaemia
carpel tunnel syndrome
dry skin, delayed DTR
myxoedema

hyperthyroidism

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TSH high
fT4 low
fT3 low/n

primary hypothyroidism (thyroid gland)

TSH low fT4 low T3 low

secondary / tertiary hypothyroidism (pituitary)

TSH normal T4 normal T3 decreased associated with acute illness

**Euthyroid sick syndrome** T4 *not* converted to T3 associated with **cytokines**; IL-1, IL-6, TNF-a, IFN-b

child iodine deficiency thyroid hypoplasia pale, puffy face protruding umbilicus poor brain development protuberant tongue pot bellied

congenital hypothyroidism - Cretinism

hashimotos thyroiditis is type ____ hypersensitivity

type 4 HS

What are the 3 phases of hashimitos thyroiditis

thyrotoxic phase hypothyroid phase euthyroid phase

damage to follicular cells, release colloid increased T3, T4 decreased TSH

Thyrotoxic phase - hashimoto thyroiditis

last 2-8 weeks permanent subacute granulomatous thyroiditis low T3, T4 high TSH

hypothyroid phase - hashimoto thyroiditis

what antibodies are seen in hashimoto thyroiditis

thyroid peroxidase **(TPOAb)** thyroglobulin **(TgAb)** antimicrosomal Ab

low T3 high TSH anti-TPOAb (+) anti-TgAb (+) painless diffuse thyroid enlargement lymphocytic infiltration Hurthle cells

hashimoto thyroiditis

complications of hashimoto thyroiditis

hashitoxicosis increased risk B cell lymphoma myxoedema coma

severe hypothyroidism Decreased CNS Hypothermia Bradycardia Hyponatraemia Hypoglycaemia Hypotension Precipitating illness

myxoedema coma (hypothyroidism)

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

tremor, tachycardia, anxiety, HTN, weight loss hyperdefecation warm, smooth skin hyperpigmentation heat intolerance, normo-anaemia, oligo-amenorrhoea madarosis (eyebrows)

hyperthyroidism

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

female diffuse goitre exophthalmos dry eyes, lig lag myxoedema

graves disease

Graves disease is type ____ hypersensitivity

type 2 HS

what is the pathogenesis of Grave disease

autoimmune auto-AB (IgG) against TSH receptor

haplotypes HLA-B8 and DR3 associated with

Graves disease

diffuse symmetric enlarged meaty appearance thyroid gland

Graves disease

pseudopapillary infolding scalloping of colloid hyperplastic follicular cells

Graves disease

process behind exophthalmos

activated B/T cell infiltrate --> TNF-a, IFN-y inflammatory response --> fibroblast proliferation, adipocyte differentiation --> production hyaluronic acid & GAG --> increased volume intraorbital fat & muscle tissue --> exophthalmous

hyperthyroidism goitre dysphagia, dyspnoea multinodular arely assoc. eye signs

toxic multinodular goitre

female 30-50yo following viral infection or drug use (lithium/amiodorone) transient pathcy inflammation of thyroid gland

subacute thyroiditis

2 types of subacute thyroiditis

subacute granulomatous thyroiditis (de Quervains) subacute lymphocytic thyroidits

treatment of subacute thyroiditis

NSAIDS steriods if severe

follows viral URTI CD8 T cells damage follicles colloid leakage & macropahe infiltrate severe neck pain - radiate to ear/jaw inflammatory infiltrate - multinucleated giant cells, disruptive follcies

de Quervains subacute granulomatous thyroiditis

inherited HLA-DR3, HLA-DR5 painless, silent lymphocytic infiltration sparse germinal centres

subacute lymphocytic thyroiditis

thyroid dysfunction within first year post-partum

post-partum thyroiditis

goitre - iron collar stony hard fibrosis tan-grey woody thyroid fibrosclerotic changes pathcy lymphocytic & eosinophilic infiltration

Riedel syndrome

what thyroid condition can mimic anaplastic carcinoma

Riedel syndrome

acute onset aggitation, delirium fever, coma diarrhoea, Afib, high output HF upregulation B1-adrenergic receptors low TSH, high T3/T4 recent stresor - infection, surgery, withdrawal antithyroid drugs

thyroid storm life threatening hypermetabolic state