Endocrine Flashcards
What is the most common cause of Acromegaly?
Pituitary Adenoma
Name all three causes of Acromegaly?
Pituitary Adenoma
Excess GHRH eg Lung Cancer or Pancreatic Cancer
When Acromegaly occurs alongside a GHRH Ectopic cancer like Lung or Pancreatic what is this called?
Paraneoplastic Syndrome
Growth hormone is released by what cells within what structure in response to GHRH?
Somatotropic Cells within Anterior Pituitary
GHRH is released from what structure?
Hypothalamus
GHRH stimulates what cells to release Growth Hormones?
Somatotropic
What is bitemporal hemianopia?
Loss of outer half of vision in both eyes due to pressure on optic chiasm
Which orthopaedic condition can be seen in Acromegaly?
Carpal Tunnel Syndrome
Name 12 common symptoms/signs of Acromegaly?
Coarse Facial Apperance
Spade Like Hands
Increase in Shoe Size
Macroglossia
Macrogathia
Interdental Spaces
Excessive Sweating
Headaches
Bitemporal Hemianopia
Galactorrhoea
Carpal Tunnel
Amenorrhoea
How to diagnose Acromegaly?
Serum IgF1 Levels increased
IgF1 is released/produced by what organ?
Liver
IgF1 + Growth Hormone release does what to GHRH?
Inhibits GHRH and Stimulates Somatostatin Release
How to confirm Acromegaly diagnosis?
OGTT
What will OGTT find in Acromegaly?
GH Suppressed
Raised prolactin can lead to what symptom?
Galatorrhoea
What type of surgery for Pituitary Adenoma in Acromegaly?
Transphenoidal
What medication is first line in Acromegaly and it’s actions?
Somatostatin Analogue eg Octerotide or Sandostatin
- Directly inhibits release of Growth Hormone
- Induces tumour shrinkage
Name common side effects of Somatostatin analogues eg Octerotide or Sandostatin?
Nausea, Diarrhoea, Cramp, Cholesterol Gallstones, Constipations, Hair Loss, Gallbladder Disease, Bradycardia
Second line medication in Acromegaly?
GH Receptor Antagonist eg Pegvisomant
What dopamine agonist can be used third line in Acromegaly?
Bromocriptine
If someone is unwell in Acromegaly and getting an infection what steroid should they take with an infection?
Hydrocortisone double or triple dose for 3-5 days
Name the common complications of Acromegaly? (7)
Hypertension
Diabetes
Cardiomyopathy
Colorectal Cancer/Polyps
Sleep Apnoea
Cardiomyopathy
Accelerated Osteoarthritis
Most common cause of Addisons Disease
Autoimmune Destruction of Adrenal Gland which reduces cortisol and aldosterone
Name Primary causes of Hypoadrenalism? (6)
Tuberculosis
Mets in Lung, Adrenal, Breast, Melanoma
Congenital Adrenal Hyperplasia
Menigoccal Septicemia (Waterhouse Frederichsen Syndrome)
HIV
Antiphospholid Syndrome
Name a secondary cause of Hypoadrenalism?
Pituitary Disorders
Name common symptoms in Addisons? (6)
Lethargy
Anorexia
Nausea/Vomit
Salt Crave
Skin Pigmentation
Vitiligo
Name 5 common electrolyte abnormalities in Addisons?
Hypotension
Hypoglycemia
Hyponatraemia
Hyperkalaemia
Metabolic Acidosis
How to Diagnose Addisons?
ACTH Stimulation Test (Short Synacthen Test)
What happens to bloods in Addisons? (4)
Reduced Na+ due to low aldosterone
Increased K+ due to low aldosterone
Decreased Glucose
High Urea
If Cortisol is High on ACTH Stimulation test what does that diagnose?
Addisons
How to Treat Addisons? (2)
Hydrocortisone and Fludrocortisone
Management of Intercurrent illness in Addisons?
Double Hydrocortisone
Fludracortisone dose stays same
What can cause an Addisonian Crisis?
Infection/Surgery
Adrenal Haemorrhage eg Waterhouse Frederichsen Syndrome
Steroid Withdrawal
Treatment of Addisonian Crisis?
Hydrocortisone 100mg IM or IV
What does the Adrenal Cortex produce? (5)
Aldosterone
Cortisol
Testosterone
Progesterone
Oestrogen
What does the Adrenal Medulla produce?
Adrenaline
Noradrenaline
What is Barter’s Syndrome?
Inherited cause of Severe Hypokalaemia due to defective chloride absorption at ascending loop of henle
Symptoms of Barter’s Syndrome? (5)
Fail to Thrive
Polyuria/Dypsia
Hypokalaemia
Normotension
Weak
What mode of inheritance is Congenital Adrenal Insufficiency?
Autosomal Recessive
What happens to the anterior pituitary when low cortisol is produced?
High levels of ACTH secreted which can stimulate production of adrenal androgens
Most common cause of Congenital Adrenal Insufficiency?
21 Hydroxylase Deficiency
How does 21 Hydroxylase Deficiency present? (3)
Virilisation of Female Genitals
Precocious Puberty in Males
Salt Losing Crisis
How does 11 Beta Hydroxylase Deficiency present?
Virilisation of Female Genitals
Precocious Puberty in Males
Hypertension/Hypokalaemia
Diagnosis of Congenital Adrenal Insufficiency?
ACTH Stimulation
What happens if Congenital Hypothyrodism is not treated within first four weeks of life?
Irreversible Cognitive Impairment
How is congenital hypothyrodism diagnosed?
Heel Prick Test
Symptoms of Congenital Hypothyrodism? (5)
Prolonged Neonatal Jaundice
Delayed Milestones
Short and Puffy Face
Macroglossia
Hypotension
Cushings Syndrome Pathophysiology?
Excess Corticosteroids and Glucocorticoids
Most common cause of Cushings Syndrome/Disease?
ACTH Dependent: Pituitary Tumour secreting ACTH
Causes of Cushings Syndrome? (4)
Pituitary Tumour
ACTH Independent eg Steroids for Asthma, IBD
Adrenal Adenoma/Carcinoma
Severe Alcohol/Depression
Symptoms of Cushings? (8)
Central Obesity
Purple Striae
Oedema
Plethoric Faces
Buffalo Hump
Moon Face
Proximal Muscle Atrophy
Poor Wound Healing
Signs of Cushings? (5)
Hypokalaemia Metabolic Acidosis
Hypertension
Often Osteoporosis/Osteopenia
Impaired Glucose Tolerance
Very Low Potassium with Ectopic ACTH Secretion
Diagnosis of Cushings Disease (with cause of Pituitary Adenoma)
Overnight Dexamethasone Suppression Test (Suppressed Cortisol and ACTH)
Diagnosis of Cushings Syndrome?
Overnight Dexamethasone Suppression Test (Not suppressed cortisol and suppressed ACTH)
Test to diagnose location of Cushings?
Plasma ACTH
- Suppressed: ACTH Indep Cause
- High ACTH: Dependent Cause
Treatment of Cushings? (5)
Surgery to remove Tumour
Steroid Replacement Therapy
Adrenal Hormone Synthesis inhibitors: Ketoconazole, Etomidate, Metyrapone
Destroy Adrenocortical Cells: Mitotone
Radiotherapy
Cushings increases the risk of what 4 conditions?
Increased Risk of Infection
Hypertension
Heart Failure
Diabetes
What is Carbimazole used for?
Thyrotoxicosis
Mechanism of Carbmiazole?
Blocks thyroid peroxidase = reduces thyroid hormone production
Carbmiazole adverse effects? (2)
Agranulocytosis
Crosses placenta but may be used in low doses in pregnancy
Side effects of Fludrocortisone? (2)
Fluid Retention
Hypertension
Side effects of Prednisolone? - Psychiatry (4)
Insomnia
Mania
Depression
Psychosis
Side Effects of Prednisilone (skin) - 7
Impaired Glucose Regulation
Increased Appetite
Hyperlipidemia
Moon Face
Buffalo Hump
Striae
Proximal Myopathy
Side effects of Prednisilone - Rheumatology/MSK (2)
Osteoporosis
Avascular Necrosis of Femoral Head
Side effects of Prednisilone - Infection/GI (5)
Susceptibility to Severe Infection
Reactivation of TB
Peptic Ulcers
Acute Pancreatitis
Neutrophilia
Side effects of Prednisilone - Neuro (2)
Growth Suppression
Intracranial Hypertension
Androgen Insensitivity Syndrome, 5a Reductase Deficiency, and Male Pseudohermatophoriditism carry what karotype?
46 XY
Androgen Insensitivity Syndrome inheritance?
X Linked Recessive
Androgen Insensitivity Syndrome physiology?
Results in end organ resistance to testosterone causing genotypically male children to have female phenotype
Presentation of Androgen Insensitivity Syndrome? (2)
Vagina and Testes
No Uterus
Diagnosis of Androgen Insensitivity Syndrome (2)
Elevated Testosterone, Oestrogen and LH
5a Reductase Deficiency Syndrome inheritance?
Autosomal Recessive
5a Reductase Deficiency Syndrome physiology
Inability of males to convert testosterone to dihydrotestosterone
5a Reductase Deficiency Syndrome presentation (3)
Ambigious Genitalia in Newborn Period
Hypospadias common
Virilization at Puberty
21 Hydroxylase Deficiency presentation? (4)
Simple Virilising
Salt Wasting
Late Onset/Non Classical
Turns little girls into little boys and little boys into little men
21 Hydroxylase Deficiency - Which would be most effective at suppressing adrenal androgen production in classical CAH?
Hydrocortisone
Carbimimazole is used to manage what condition?
Thyrotoxicosis
Mechanism of Carbimazole
Blocks thyroid peroxidase from coupling and iodinating tyrosine residues on thyroglobulin
Adverse effects of Carbimimazole?
Agranulocytosis
Most common cause of Thyrotoxicosis
Graves Disease
Features specific to Graves Disease
Exopthalmos
Opthalmoplegia
Pretibial Myxoedema
Digital Clubbing
Soft tissue swelling of hands and feet
periosteal new bone formation
Thyroid acropachy in Graves is a triad of?
Digital clubbing
Soft tissue swelling of hands and feet
Periosteal new bone formation
Which antibodies are specific to graves?
TSH Receptor Stimulating and Anti Thyroid Peroxidase antibodies
What does Thyroid sctinigraphy show in Graves
diffuse, homogenous increased uptake of radioactive iodine
How to treat Graves disease?
Propranolol for Symptoms
Carbimiazole
Radioiodine treatment
After radioiodine treatment how long should pregnancy be avoided?
4-6 months following treatment
Hashimoto Thyroditis is typically associated with?
Hypothyrodism
Features of Hashimoto Thyroditis
Goitre
Hashimoto Thyroditis is associated with the development of?
MALT Lymphoma
Causes of Primary Hypothyrodism
Hashimoto Thyroditis
Subacute Thyroditis (De Quervain)
Riedal Thyroditis
After Thyroidectomy/Radioiodine
Lithium/Amidarone/Carbmiazole
Iodine Deficiency
Hashimoto Thyroditis is an autoimmune disease associated with what three conditions?
IDDM
Addisons
Pernicious Anaemia
Features of Hypothyrodism?
Weight Gain
Lethargy
Cold Intolerance
Dry Skin and Hair
Non Pitting Oedema
Constipation
Menorrhagia
Decreased Deep Tendon Reflexes
Carpal Tunnel
Treating Hypothyrodism?
Levothyroxine
What happens in pregnancy to Thyroxine Binding Globylin?
Increases but Free Thyroxine uneffected
How to treat Thyroxicosis in Pregnancy?
Propylthiouracil in FIrst Trimester
Carbmiazole outside of this
Is thyroxine safe during pregnancy?
Yes and will need increased dose
How to recognise subclinical hyperthyrodism?
Normal T4 and Low TSH
Causes of Subclinical Hyperthyrodism?
Multinodular Goitre
How to recognise subclinical hypothyrodism?
TSH raised but T3/T4 Normal
Best prognosis thyroid cancer?
Papillary
Which is cancer is of parafollicular cells and secretes calcitonin?
Medullary Thyroid Cancer
Which thyroid cancer has to the worst prognosis?
Anaplastic
Management of Papillary and Foillcular thyroid cancer?
Total Thyroidectomy
Radioiodine
Subacute Thyroiditis (De Quervain) associated with?
Painful Goitre and Raised ESR
Precipitating events of Thyroid Storm?
Thyroid or Non Thyroidal Surgery
Trauma
Infection
CT Contrast
How to treat Thyroid Storm?
IV Propranolol
Propylthiouracil
On Thyroid Nuclear Sctinigraphy reveals patchy uptake what is this?
Toxic Multinodular Goitre
How to treat Toxic Multinodular Goitre
Radioiodine Therapy
