endocrine Flashcards
triad for pheochromocytoma
headache
sweating
tachycardia
a cause of 2ndary HTN in young px
what are the types of thyroid cancer + how do you differentiate them
PAPILLARY CANCER
- most common (70%)
- 30-40yrs
- more local invasion via lymphatics
- F
- v good prog
FOLLICULAR CANCER
- second most common
- more common in areas of low iodine + in women
- 30-60
- more likely to spread to lungs + bones haematologically
MEDULLARY CANCER
- Derived from calcitonin producing C-cells -> can present with hypocalcaemia and diarrhoea secondary to raised calcitonin.
- Assoc with Multiple endocrine neoplasia (MEN) syndrome type 2A + B although 75% are sporadic.
- Often metastasis to lymph nodes
- Prognosis worse
- Disease activity can be monitored with calcitonin levels.
ANAPLASTIC CANCER
- least common
- 60-70
- aggressive, presents with rapidly growing masses. pressure sx
- invasion of the trachea, recurrent laryngeal nerve or other local structures by the time of presentation.
- poor prognosis – median survival: 8 months
THYROID LYMPHOMA
- 10% of thyroid cancers
- Non-Hodgkins
- 50-80
- Assoc with Hashimoto’s thyroiditis
sx of prolactinoma (benign tumour of pituitary gland)
excess prolactin in women:
- amenorrhoea
- infertility
- galactorrhoea
- osteoporosis
excess prolactin in men:
- impotence
- loss of libido
- galactorrhoea
other symptoms:
- headache
- visual disturbances (classically, a bitemporal hemianopia (lateral visual fields) or upper temporal quadrantanopia)
- symptoms and signs of hypopituitarism
prolactinoma tx
dopamine agonists e.g. cabergoline, bromocriptine
(inhibit release of prolactin from pituitary)
surgery
what is a somatroph pituitary adenoma
pituitary adenoma that secretes growth hormone causing sx of acromegaly
diagnostic marker for carcinoid syndrome
urinary 5-hydroxyindoleacetic acid measurements (5 HIAA)
- measured in 24 hr urine collection
myxoedemic coma
rare, life-threatening clinical condition that represents severe hypothyroidism with physiologic decompensation
most common causes of hypercalcaemia
Malignancy and primary hyperparathyroidism
what is subacute thyroiditis (De Quervain’s thyroiditis)? + the phases
temp inflam of thyroid gland
There are typically 4 phases;
phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR, flue-like illness
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal
what is a thyroid storm/thyrotoxic crisis + how does it present?
rare and more severe presentation of hyperthyroidism with high fever, tachycardia and delirium, high BP.
It can be life-threatening and requires admission for monitoring.
what is subclinical hyperthyroidism
normal T3 + 4 levels
low TSH level
what are the risks of subclinical hyperthyroidism
AF
osteoporosis
what is subclinical hypothyroidism
high TSH
normal T4
primary hyperthyroidism
thyroid behaves abnormally and produces excessive thyroid hormones.
high T3 and T4
low TSH level.
secondary hyperthyroidism
pituitary behaves abnormally and produces excessive TSH (e.g., pituitary adenoma), stimulating the thyroid gland to produce excessive thyroid hormones.
TSH, T3 and T4 will all be raised.
Primary hypothyroidism
thyroid behaves abnormally and produces inadequate thyroid hormones. Negative feedback is absent, resulting in increased production of TSH.
TSH is raised, and T3 and T4 are low.
Secondary hypothyroidism
pituitary behaves abnormally and produces inadequate TSH (e.g., after surgical removal of the pituitary), resulting in under-stimulation of the thyroid gland and insufficient thyroid hormones.
TSH, T3 and T4 will all be low.
causes of secondary adrenal insufficiency
inadequate ACTH due to loss or damage to pituitary -> lack of stim to adrenals -> low cortisol
- tumours (pituitary adenoma)
- surgery to pituitary
- radiotherapy
- sheehan’s syndrome (where major PPH -> AVN to pituitary)
- trauma
causes of tertiary adrenal insufficiency
inadequate CRH by the hypothalamus
usually result of px taking long-term oral steroids (>3wks) causing -ve feedback
when they are withdrawn the hypothalamus cannot release the amounts needed fast enough
therefore need to be tapered down
cause of primary adrenal insufficency
addison’s
damage to adrenals - AI
sx of adrenal insufficiency
Fatigue
Muscle weakness
Muscle cramps
Dizziness and fainting
Thirst and craving salt
Weight loss
Abdominal pain
Depression
Reduced libido
signs of adrenal insufficiency
Bronze hyperpigmentation of the skin (ACTH stimulates melanocytes to produce melanin)
Hypotension (particularly postural hypotension – with a drop of more than 20 mmHg on standing)
biochemical findings in adrenal insufficiency
hyponatraemia (low Na)
maybe:
hyperkalaemia
hypoglycaemia
raised creatinine + urea due to dehydration
hypercalcaemia
ix for adrenal insufficiency
short Synacthen test (ACTH stim test)
- failure of cortisol to double after dose of synthetic ACTH = addison’s / v signif atrophy of adrenals after long time w 2ndary
ACTH is high in primary and low in secondary