ENDOCRINE 1 Flashcards
adrenal insufficiency is what primary causes
secondary causes
primary AI Addisons
TB, mets, HIV, anti phosphorus
Pit disease tumours, irradiation, infiltration
who does adrenal insufficiency occur in and what is it
20-50s
decreased production of cortisol plus minus aldosterone
symptoms/signs of adrenal insufficiency
anorexia, weight loss, fatigue, lethargy, weakness, nausea and vomiting, pigmentation especially of the palmer creases, postural hypotension, hypoglycaemia, vitiligo, loss of pubic hair in females
ix results for adrenal insufficiency glucose sodium potassium cortisol calcium what ABs what test is done
decreased glucose decreased Na increased K decreased cort increased calcium 21 hydroxyls ABs ACTH synacthin test: cortisol measured before and 30 mins after giving synacthin 200mcg IM. doesn't rise in Addisons
treatment of adrenal insufficiency
hydrocortisone 3 doses
fludrocortisone - minerocorticiod replacement for postural hypotension
addisons crisis is what
causes
acute deficiency of adrenal hormones
undiagnosed addisons, not adhering to treatment, infection, injury, pregnancy
symptoms of addisons crisis
ix
treatment
hypotension, severe abdominal pain, severe vommiting and diarrhoea, confusion, hypovalaemic shock, LOC, coma and death
decreased sodium or normal. increased potassium or normal. increased calcium. decreased cortisol
1L 0.9% saline, hydrocortisone 100mg IV/IM, glucose if hypoglycaemic
what is cushings high mortality if what pituitary causes adrenal causes ectopic causes iatrogenic is what
high levels of cortisol
left untreated
benign pit adenoma leading to increased ACTH
adrenal adenoma, hyperplasia, carcinoma
outside of adrenal axis - SCLC
steroids - commonest cause
what is pseudocushings
causes
ix
signs and symptoms present - not related to hypothalamic adrenal pit axis
idiopathic, alcohol, stress, depression, eating disorder
fails to be suppressed by dexa , false positive insulin stress test
symptoms of cushings
central obesity, mood face, buffalo hump, thinning of skin, dry skin, telengectasia, excessive sweating stretch marks, proximal muscle weakness, hirsutism, oligo/amen
investigations for cushings screening
1mg overnight dexa suppression test measured at 8sm <50 is normal
24 hour urine free cortisol <200 normal
diurnal cortisol variation midnight/am
late night salivary cortisol
diagnostic test for cushings
2mg/day suppression test <50 over 16 hours is normal
in what type of cushings will cortisol be suppressed
pituitary - cushings disease
treatment of cushings
reduce dose of steroids
adenoma - transphenoidecomy or adrenelectomy
bilateral adecetomy if cause unknown to prevent Nelsons - lifelong hydrocortisone
metyoprone, ketocondzone, pasicreotide
causes of hyperaldosteronism
idiopathic hyperplasia
adrenal adenoma - Conns
carcinoma - rare
symptoms of hyperaldosteronism
decreased K, aldosterone:rennin ratio if raised do a 2L saline suppression test pr a fludrocortisone suppression test
HRCT abd. adrenal vein sampling
treatment of hyperaldosteronism
spironolactone/amiloride for hyperplasia
adrenlectomy for adenoma
what is a phae
derived from what
life threatening what
assoc with what
adrenal medullary tumour
chromatic cells - secretes catecholamines
hypertension or arrhythmias
MEN2, NF1, VHL syndrome
symptoms of phao
investigations
10%
rx§
headaches, sweating, palpitations, nausea, weakness, anxiety, hypertension, epigastric pain, constipation, decreased weight, pallor, fever, postural hypotension, hypertensive retinopathy
increased BG, increased Ca, increased Hb
24 hour urinary metanephrines. MRI to locate tumour
10% extra adrenal, 10% malignant, 10% bilateral, 10% not assoc with hypertension, 25% familial (young and bilateral)
alpha blocker - phenoxybenzamine
BB - propanol, atenolol, metoprol
surgery
congenital adrenal hyperplasia genetic lack of what testosterone aldosterone cortisol symptoms treatment
AR
21 hydroxyls in 90%
increased
decreased
decreased
civilisation of female genitilia, precious puberty in males, salt losing crisp at age 1-3w
glucocorticoid and mineralocorticoid replacement
acromegaly is what caused by what
symptoms
complication of what
excuses secretion of GH. pit tumour
thickened soft tissue - skin, large jaw, large hands, sweaty, headache, bi temp semi, OSA/snoring, early CV death, htn
colorectal cancer +/- colonic polyps
ix of acromegaly
IGF1 - age and sex matched
GTT should suppress GH to <0.4, in acromegaly no change or paradoxical rise. remains >1
visual fields, Ct/MRI of pit, pit function tests
treatment of acromegaly
transphenoidal surgery 90% success if micro 50 macro
if GTT still >1 bromocrtiptine/cabergoline
or octeotride somatostatin analogie
or pegvisoment GH antagonist
follow up ofacromegaly
IGF1, GH<1, other pit hormone, colon cancer surveillance, CV risk factors, sleep apnoea
proloactinoma normal causes and other causes
female presentation
male presentation
pregnancy, BF, stress, sleep
dopamine antagonist, anti psychotics, anti dep, hypothyroid, stalk lesions (iatrogenic, RTA), proloactinoma
early presentation, galactorrhea, menstrual irregularity, inferility
late presentation, impotance, visual disturbance, headache, ant pit malfunction
investigations for prolactinoma
treatment
effect of treatment on prolactin, menstruation, pregnancy rate, tumour
PRL concentration, MRI of pit: micro <1cm, pit stalk, optic chasm
visual fileds. pit function tests
DA: cabergoline 2xwkly, bromacrptine TDS, quinagolide OD
prolactin normalised in 96%
menstruation regained in 94%
preg rate 91%
tumour shrinkage §
hypopituarism caused by what
can’t produce or insufficiency supply pf hypothalamic releasing hormones
pit tumours, mets, local brain tumours, granulomatous disease, iatrogenic, AI, infection, meningitis
symptoms of hypopit
GH, TSH, ACTH, LH/FSH
menstrual irregularities, infertility, impotance, gynacamastia, loss of facial hair in men, loss of axillary and pubic hair, dry skin and hair, hypothyroid, growth retardation in children
growth failure, hypothyroid, hypo adrenal, hypogonadism
ix of hypopit
ACTH cortisol
TSH thyroxin
LH/FSH testosterone/oestriadol
GH - IGF1
treatment for hypopit
thyroxine hydrocortisone 10-25mg/daily ADH desmospray or tablets GH nightly SC injection oestorgen/progesterone F testosterone replace in men
testosterone types and risks
IM every 3-4w/prolonged 10-14w
gel
oral - restaridol
prostate enlargement
expands already present prostate cancer
polycythaemia
hepatitis in oral tablets
