Endocrine Flashcards
causes of primary hyperaldosteronism
Adrenal adenoma
bilateral adrenal hyperplasia
familial hyperaldosteronism
inx for hyperaldosteronism
renin : aldosterone serum ratio
Both raised = secondary
Renin suppressed = primary
mx of hyperaldosteronism
aldosterone antagonist Spironolactone
Non-pituitary cause of acromegaly
GHRH secreting carcinoid tumour of pancreas or lung
signs/symptoms of acromegaly
skin tags big hangs, jaw, forehead and nose L labido cardiac hypertrophy, raised BP Arthralgia, back pain DM/glucose intolerance
Inx of acromegaly
MRI brain
glucose tolerance test - first line
serum GH
Patient presents with headache + nausea. Large nose and forehead and hypertension.
1) Diagnosis
2) Hormone involved
3) Initial blood tests (2). And diagnostic test
3) Potential visual feild defect
4) Sugical management
5) Medical management and MOA (2 different drugs)
1) Acromegaly
2) GH
3) Serum GH levels. Then glucose tolerance test. MRI brain (pituitary adenoma)
3) Bitemporal hemianopia
4) Trans sphenoidal removal of tumour
5) Somatostatin analogue (octreotide) or dopamine agonist (bromocistine). Somatostatin and dopamine both inhibit GH release.
Causes of secondary adrenal insufficiency
Low ACTH
Surgical damage
Sheehan’s syndrome (blood loss, during birth = pituitary necrosis)
Cause of primary adrenal insufficiency
Autoimmune
21-hydroxylase antibodies
Symptoms of Addison’s disease
Low Na –> abdo pain, cramps, nausea/vom
High K+ and high H+ –> metabolic acidosis
Hypovolume –> Postural hypotension
Hyperpigmentation
Symptoms of addisons that only affect women
Low androgens
Decreased sex drive
Decreased armpit and leg hair
Patient has hx of feeling tired, nausea/vom. and postural hypotension
1) Diagnosis
2) Cause of nausea and vomiting
3) Other electrolyte imbalance
4) Autoimmune abd
4) Gold standard inx.
5) Management
1) Addisons/adrenal insufficiency
2) Low Na
3) Low K+ , High H+. Metabolic acidosis
4) 21-hydroxylase antibodies
4) Short synacthen test
5) Hydrocortisone, fludrocortisone
Mx of Addison’s disease
15-25mg of hydrocortisone
50-200mcg of fludrocortisone
Management of addison ian crisis
A - should be patent, maintain
B - May be hypocapnic if acidotic. ABG.
C - BP support, 500mL of saline.
K+, do ECG. Give calcium glucoante 30mg 10% IV if needed.
D - glucose. Low cortisol could cause hypo. Give hydrocortisone 100mg IV stat
E - urine output, insert catheter if necessary. If course not clear check (pneumonia) other infection (rash)
How to manage Addisons patient in acute illness/operation
double dose of steroids.
Key symptoms of cushings
moon face buffalo hump abdominal striae Fat belly, skinny arms. Muscle wasting hypertension, cardiac hypertrophy depression insomnia osteoporosis Diabetes
causes of cushings
Ectophic acth - Small cell lung carcinoma
pituitary ademona
cushings inx
low dose dexamethasone suppression test, then high dose (8mg)
1) What are the 3 common diseases that make up MEN-1
2) What are the corresponding symptoms
Parathyroid hyperplasia - Hypercalcaemia
Pancreatic Tumours - Insulinomas cause hypoglycaemia. Gastrinomas cause recurrent ulcers and dyspepsia.
Pituitary adenoma - Acromegaly, hyperprolactinaemia, Cushings
Name the skin lesion associated with MEN-1.
Name the neurological condition also associated with this
Angiofibroma.
Tubulosclerosis
Patient presents with recurrent peptic ulcers. Routine blood show hypercalcaemia
1) Name of syndrome (of ulcers) and genetic disease.
2) 3 possible investigations that could be done
3) Other symptoms you may expect. And other affected organs.
1) Zollinger-Ellison syndrome; MEN-1
2) PTH, serum calcium. Serum Prolactin. Serum GH. Serum cortisol.
3) Pituitary, pancreas, parathyroid.
Symptoms:
Boney pain, renal stones, abdominal pain. Psychosis.
Hypoglycaemia (fatigue, Low GCS, seizures)
Recurrent peptic ulcers - dyspepsia
Tunnel vision. Headaches (morning). N/V.
Large forehead. Spade hands.
Titties
All the symptoms that come with cushings.
Patient presents with tachycardia, headache, tremors and D/V.
1) Likely diagnosis, possible related genetic condition
2) Other symptoms you might expect.
3) Cancer of what cells?
4) Investigations
5) Management (2 steps please chum)
6) Distribution of these tumours
1) Phaechomocytoma. MEN-2
2) Arrhythmias. AF. VT. Visual disturbance. Anxiety. Hyperactive. Confusion. Sweats and flushing
3) Sympathetic paraganglion cells
4) 24hr Catecholamines. Serum Free Metanephrines
5) Alpha blockade (phenoxybenzamine). Then B block if needed.
5) 10% Extra-adrenal. 10% bilateral. 10% Malignant. 10% Familial.
1) Signs specific to Graves disease
2) Blood test definitive for graves disease.
1) Pretibial myxoedema. Exophthalmos. Ophthalmoplegia.
2) TSH receptor antibodies.
Patient presents with secondary amenorrhoea. Morning headaches.
1) Likely diagnosis
2) Visual disturbance expected.
3) Management
1) Prolactinoma - pituitary adenoma
2) Bitemporal hemianopia
3) Dopamine agonists if tumour doesn’t require surgery. Bromocriptine or carbogaline
