Endo surgery Flashcards
Bilateral enlargement of breasts in man.
Soft tissue enlargement without clearly defined palpable borders or nodules no other findings. Next step in management?
Weight loss !! Patient has pseudo Gynaecomastia
In true Gynaecomastia, A central mobile rubbery mass is felt. Sometimes tender.
Tertiary hyperparathyroidism = parathyroid hyperplasia = CKD cause
Surgical procedures especially induction of anaesthesia and also beta blockers can trigger phaeochromocytomas
Episodic headaches, hypertension, hyperglycaemia, blurry vision during episodes can be seen with phaechromocytomas
First step in management
Urine or plasma metanephrines
Patient with no medical history of chronic conditions. However after trauma and broken bones, elevated finger stick glucose at 156. But normal HBA1c. Diagnoses and next step in management?
Stress hyperglycaemia
No treatment as mild elevation!!
Over 180 = treatment with short acting insulin!!!
Other risk factors = infection, hypoxia, ICU admission
Painless loss of vision in right eye and headaches. Blood pressure is 190/100. Retinal and cerebellar hemangioblastomas. Father had very high blood pressure, significant hearing impairment. Most likely cause of elevated blood pressure?
Catecholamine secretion!! = pheaochromocytoma h
Patient has von hippel Lindau disease = retinal and cns hemangioblastomas which can hemorrhage, renal cancer, pancreatic neuroendocrine tumour, tumour of middle ear causing hearing loss, phaeochromocytomas!!
Note causes of phaeos include:
VHL
MEN syndromes
NF type 1
Just sporadic on its own
Hypercalcemia can occur in cases of bprolonged immobilisation eg a quadriplegic. PTH will be low. Treat with bisphosphonates
PTH high and high calcium = Primary or tertiary hyperparathyroidisjm, lithium
PTH low and high calcium. Malignancy, vitd toxicity immobilisation
Delirium , tachycardia, hypertension tremor nausea lid lag. Patient had just undergone surgery for bone fracture. Next step in management p?
Thyroid function tests and propanolol
Concerning for thyroid storm
Risk factors = surgery in a patient with undiagnosed hyperthyroidism, trauma, infection, iodine contrast, childbirth
Arrhythmias eg a fib may occur
Irregular periods and amenorrhea, slightly raised prolactin and MRI with 7mm pituitary microadenoma. Most important reason for treating the patient now?
What are the indications for treatment of prolactinoma?
How do you treat
To prevent bone loss!!,
Prolactin suppresses gnrh = less fsh and lh = estrogen deficiency = oligo/amenorrha and infertility
But ALSO
Estrogen deficiency causes bone loss -> osteoporosis
Indications for treatment =
Macroprolactinoma so at least 10mm
Risk or presence of neurological symptoms
Hypogonadism
Galactorrhea
Dopamine agonists = cabergoline, bromocriptine
if drugs don’t work = surgery
Euthyroid sick syndrome
Labs and presentation?
Management
Low T3 and normal T4 and TSH
Severe acute illness
Observation no treatment
Subclinica, hypothyroidism presentation and labs? Management?
Elevated TSH, Normal T3 and T4
