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Year 6 > Endo Sofia > Flashcards

Endo Sofia Flashcards

1
Q

Tell me about carcinoid syndrome

A

Collection of Sx due to systemic release of hormones from carcinoid tumours (neuroendocrine tumours produce serotonin and e.g. PGs) Rare - 1 in 1million. Feature in MEN1

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2
Q

Symptoms of Carcinoid syndrome

A

FLUSHING + DIARRHOEA Sweating Abdo pain Wheeze Palpitations

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3
Q

Ix and Mx Carcinoid Syndrome

A

24 hr urine 5-HIAA (metabolite)

CT or MRI - to locate tumour

Mx

MEDICAL somatostatin analogues - octreotide radionuclide therapies

SURGICAL Resection tumours

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4
Q

Complications Carcinoid syndrome

A

Intestinal BO

Carcinoid crisis

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5
Q

What is carcinoid crisis

A

life-threatening event

Cause = stress, surgery

Sx = hypotension, tachycardia, wheezing

Mx = Octreotide

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6
Q

Tell me about Hypogonadism (M and F)

A

F = impaired ovarian function

M = decreased testosterone +/- sperm production

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7
Q

Causes FEMALE Hypogonadism

P, S

A

Primary

  • gonadal dysgenesis e.g. Turner’s (45X),
  • gonadal damage (radiation, surgery)

Secondary

  • functional (stress, wt loss)
  • tumour (prolactinoma
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8
Q

Signs/Sx FEMALE Hypogonadism

(pre pubertal, post pubertal)

Deficiency of ? leads to Sx?

A

PRE pubertal = primary amenorrhoea

POST pubertal = regression secondary sexual characteristics

Signs of cause e.g. visual change in pit tumour

Sx = OESTROGEN DEFICIENCY (vaginal dryness, painful urination, decreased libido, flushing, night sweats)

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9
Q

Female Hypogonadism Ix Mx Complications

A

Low serum oestradiol

FSH/LH - HIGH in primary, LOW in secondary

Karyotype - Chr abnormalities

Pit function - 9am cortisol, TFTs, prolactin

Mx = treat cause e.g. pit adenoma

HRT + managing COMPLICATIONS of low Oestrogen (osteoporosis, CVD)

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10
Q

Causes Male Hypogonadism

A

Primary = gonadal dysgenesis gonadal damage(iatrogenic, torsion, infection) Secondary = pit/hypothalamic lesions, hyperprolactinaemia

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11
Q

Signs/Sx MALE Hypogonadism Signs (pre-pubertal + post-pubertal)

A

Signs: Pre-pubertal - small penis, high pitch voice Post-pubertal - gynaecomastia, decreased hair (axillary, pubic) Sx = DELAYED PUBERTY, INFERTILITY< DECREASED LIBIDO

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12
Q

MALE Hypogonadism Ix Mx

A

Ix

serum LH/FSH + testosterone

Primary: HIGH LH/FSH + low testosterone Secondary: LOW LH/FSH + low testosterone

Pituitary function tests (cortisol, TFTs, prolactin) + MRI pituitary,

Karyotype (Chr abnormalities)

Mx = testosterone + Dopamine agonist (bromocriptine)

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13
Q

Tell me about Menopause

A

Absence menses for 12m Clinical diagnosis Occurs around 50 years old

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14
Q

Sx of Menopause

A

hot flushes night sweats urogenital symptoms depression weight gain osteoporosis

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15
Q

Menopause Hx (long Hx station)

A
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16
Q

Mx Menopause

A

HRT - topical/oral/patches/gels Oestrogen (+ progestin if uterus still intact to protect agains endometrial cancer)

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17
Q

Benefits/Risks HRT

A

Benefits - reduces Sx menopause, reduces risks osteoporotic fractures (as maintains BMD) Risks - endometrial cancer, CVD, DVT/PE, breast cancer

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18
Q

Causes early menopause

A

Surgical (remove ovaries)

Treatment -induced (chemo radiotherapy)

Idiopathic

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19
Q

Causes early menopause

A

Surgical (remove ovaries) Treatment -induced (chemo radiotherapy) Idiopathic

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20
Q

Tell me about Multiple endocrine Neoplasia

A

AD inheritance

Predilection to developing multiple endocrine tumours

Very rare

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21
Q

Types MEN

A

MEN 1 = pituitary, paraythroid, pancreas MEN 2a = parathyroid, thyroid (medullary), phaeo MEN 2b = phaeo, thyroid (medullary) , mucosal neuroma/Marfanoid

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22
Q

Sx of MEN 1

A

Pituitary adenoma - visual field defects , acromegaly (as maked GH), Cushings (makes ACTH), hyperprolactinaemia (amenorrhoea) Hyperparathyroidism = hypercalcaemia Pancreas (insulinoma or gastrinoma) - hypoglycaemia or Zollinger-Ellison syndrome

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23
Q

Sx MEN 2

A

Hyperparathyroidism = hypercalcaemia Medullary thyroid Ca = thyrotoxicosis Phaeochromocytoma = headache, visual changes, refractory HTN

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24
Q

Sx of hypercalcaemia (hyperparathyroidism)

A

Constipation Polyuria, polydipsia Depression Renal stones Fatigue

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25
MEN Ix Mx
Ix DNA testing - and of family U+E - high calcium Hormones - high prolactin, TFTs, IGF-1, OGTT Thyroid US + biopsy Urine metanephrine (phaeo) Mx - medical suppression of hormones and surgical removal of tumours
26
Tell me about Obesity How do you calculate BMI
BMI \> 30kg/m2 + increased weight circumference Combination genetics + energy intake \> use 1 in 4 M and F are obese BMI = weight (kg) / (height (m))^2
27
Signs + Sx of Obesity
Increase waist circumference + BMI Sx of COMPLICATIONS - CVD - osteoarthritis - OSA - T2DM and HTN - cancer
28
Obesity Ix Mx
Ix BEDSIDE - BMI, waist circumference, urine dip (glycosuria), Obs - BP BLOODS - HbA1c, lipids, TFTs IMAGING - for osteoarthritis Mx CONSERVATIVE - diet + exercise MEDICAL - as adjunct ORLISTAT (lipase inhibitor) SURGICAL - e..g gastric bypass (if BMI\>40 or \>35 + significant comorbidities)
29
RFs of obesity
Age \>40 Peri/post menopausal Hypothyroidism
30
Tell me about Polycystic Ovarian Syndrome
**Ovarian dysfunction + features hyperandrogenism** + polycystic ovaries In 5-10% women of reproductive age Cause unknown, but has FHx link
31
Sx PCOS
Oligo/amenorrhoea (as chronic anovulation) Androgen xs- hirsutism, acne, scalp hair loss Subfertility Obesity (as insulin resistance) Acanthosis nigricans ASx
32
PCOS Dx Ix
Dx = 2/3 of: oligo/amenorrhoea, clinical/biochemical hyperandrogens, PCO on USS Ix BEDSIDE - BMI, 2 sexual characteristic (hair/breast), visual fields, VE (structural abnormalities), pregnancy test BLOODS - High LH/testosterone = PCOS High FSH = premature ovarian failure high prolactin (prolactinoma), TFTs IMAGING - TVUSS (PCO), MRI brain (pit adenoma)
33
PCOS Mx Complications
CONSERVATIVE - diet + exercise (HTN + T2DM) MEDICAL - COCP (regulate periods), Clomiphene (induce ovulation in subfertility), Metformin (T2DM), HRT (in POF) SURGICAL - remove pit adenoma or adhesions in Asherman's (fibrous connections) Complications - T2DM + CAD + HTN - Subfertility - Obesity + it's complications
34
Tell me about Phaeochromocytomas Rule of 10s Epi
Adrenal medulla endocrine tumours Secrete Catecholamines (Adr) 10% bilateral 10% malignant 10% extra-adrenal Rare, associated w/ vHL, MEN 2, NFT1
35
Phaeochromocytoma Sx (Cardio, GI, Neuropsych) Signs
Sx = HEADACHES + SWEATING Cardio - CP, SOB, palpitations GI - abdo pain, nausea Neuropsychiatric - anxiety, tremor Signs = HTN, tremor, tachycardia, wt loss
36
Phaeochromocytoma Ix Mx
BEDSIDE - Obs, 24 hour urine metanephrines (metabolite of ADr) BLOODs - genetic testing IMAGING - CT/MRI (locate tumour) Mx MEDICAL - a blockers for HTN (phentolamine) then b blockade - as once on alpha blocker, Adr receptors are blocked, so pts get reflex tachycardia (as BP drops), so give beta blocker SURGICAL - open or laparoscopic adrenalectomy (or chemo/radiotherapy)
37
Phaeochromocytoma complications
Hypertensive crisis Hypotension MI
38
What is a hypertensive crisis? Mx?
Systolic BP \>250 In Phaeo or during surgical removal Phaeo Mx a blockade (phentolamine) FIRST then B blockade If beta blockade alone is used, this can precipitate a hypertensive crisis due to unopposed alpha-adrenergic stimulation
39
Tell me about non-functioning pituitary tumours
Benign tumours of the pituitary gland Commonest = pit adenoma - can be non functioning (no hormone production) or functioning ? cause, associated with MEN1 Commonest is MACROADENOMA \>1cm
40
Sx non-functioning pituitary tumour
Slow Sx progression, headaches Bitemporal hemianopia - if compress optic chiasm Panhypopituitarism (depends on hormones affected) - Prevent inhibitory dopamine reaching the pituitary -\> Hyperprolactinaemia - Low TSH, LH/FSH, ACTH, GH
41
Non-functioning pituitary tumour Ix Mx
Ix BEDSIDE - visual fields BLOODS - pit function (9am cortisol, TFTs, IMAGING - MRI pituitary gland Mx MEDICAL URGENT hydrocortisone Thyroxine replacement Oestrogen replacement (as no FSH/LH) GH replacement Carbegoline (DA, suppresses prolactin) SURGICAL - if tumour large enough
42
Anterior pituitary hormones
1. ACTH (cortisol, adrenals) 2. TSH (thyroxine) 3. Prolactin (stimulated by TRH!!, inhibited by hypothalamus DA) 4. GH 5. FSH/LH
43
Posterior pituitary hormones
Oxytocin ADH (failure = diabetes insipidus)
44
Causes prolactinaemia PRIMARY + SECONDARY
PRIMARY 1. Prolactinoma (functioning pit. tumour) 2. Non-functioning pit. adenoma - compression stalk -\> stops inhibitory dopamine -\> increased prolactin SECONDARY 1. EXCLUDE PREGNANCY 2. Primary hypothyroidism (low t4, high TSH -\> high TRH (which stimulated TSH and prolactin from anterior pituitary)
45
Symptoms of high prolactin NB think - prolactin = pregnancy hormone
amenorrhoea galactorrhoea M = gynaecomastia, infertility, galactorrhoea
46
Tell me about thyroid cancers PFMAL
Papillary - commonest, good Prognosis, 'Orphan Annie eyes', Psammoma bodies Follicular - good prognosis Medullary - MEN2, make CALCITONIN, C cells Anaplastic - older pts, poor prognosis Lymphoma - association Hashimoto's (NB adenoma = benign, can be functioning or non-functioning) RFs - ? cause, childhood irradiation, Hashimoto's, MEN 2
47
Sx/signs thyroid cancer
ASx, slow-growing neck lump hoarse voice (recurrent laryngeal nerve) dysphagia EUTHYROID cervical lymphadenopathy
48
Thyroid cancer Ix Mx Complications of excision (2)
Ix BEDSIDE - obs BLOODS - TFTs (usually euthyroid) Tumour markers (thyroglobulin P+F, Calcitonin M) IMAGING - FNA (histology + Dx), CT/MRI (staging) Mx = Excision + levothyroxine Complications 1) hoarse voice (recurrent laryngeal nerve) 2) hypocalcaemia (parathyroid removal)
49
Tell me about Thyroid Nodules
Abnormal growth thyroid cells -\> lump Most are BENIGN ADENOMAS that are non-functioning (can be functioning -\> thyrotoxicosis) F\>M
50
Sx Thyroid nodule
Most ASx Neck lump(s) Rarely - pain, stridor or dysphagia
51
Signs Thyroid nodule
Drink water + see if nodule moves DOWN on swallowing Cervical lymphadenopathy (malignant)
52
Ix Thyroid nodule Mx
BEDSIDE - Obs BLOODS - TFTs (often euthyroid), tumour markers IMAGING - FNA (cytology), USS (character) Mx Treat cause
53
DDx of a thyroid mass Smooth Multinodular Solitary nodule Other causes
Smooth - Simple Goitre, Graves, Hashimoto’s Multinodular goitre (MNG) - Usually benign Solitary nodule - Thyroid adenoma, Thyroid cysts, Carcinomas Other - hyperparathyroidism (2 to low VitD)
54
Tell me about Osteoporosis RFs (lifestyle, drugs, endocrine)
BONE LOSS Normal calcium Normal bone structure RFs = old age, low Ca, EToH, smoking, exercise Endocrine - menopause, Cushing's, Acromegaly Drugs - STEROIDS
55
Signs/Sx of Osteoporosis
Asymptomatic Until FRACTURE (pathological - no trauma before) Fracture - wrist, hip, spine Kyphosis, back pain
56
Osteoporosis Ix (meaning T and Z scores) Mx
Ix Bloods - all NORMAL (Ca, PTH, Ph) Imaging - DEXA osteoporosis = T score
57
DEXA T score meaning Z score meaning
T-score – sd from mean of YOUNG HEALTHY POPULATION (useful to determine # risk) Z-score – sd from mean of AGE-MATCHED CONTROL (useful to identify accelerated bone loss)
58
Tell me about Paget's disease
Bone remodelling Xs osteoclastic resorption + increased osteoblastic activity Paget's disease is common (UK prevalence 5%) Affects skull, spine/pelvis, and leg long bones
59
Sx Paget's disease
Focal pain, warmth, deformity, Fracture (pelvis, femur, skull, tibia) SC compression Malignancy Cardiac failure
60
Paget's disease Ix Mx
Ix BLOODS - ELEVATED ALP (as increased activity of osteoclasts + blasts) IMAGING - Isotope bone scan/ XR Mx = bisphosphonates ( for pain)
61
Complications Paget's disease
Deafness (cranial nerve entrapment) Bone sarcoma (1% if affected for \> 10 years) fractures Skull thickening High-output cardiac failure

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