ENDOCRINE Flashcards
infarction of macroadenoma can lead to
panhypopituitarism
often cystic
craniopharyngioma
most common cause of hypopituirasm
non function pituitary macro adenomas
panhypopituiriasm refers to
deficiency of all anterior pituitary hormones
panhypopituiriasm refers to
deficiency of all anterior pituitary hormones
what does hypoadrenalism cause
mild hypotension, hyponatraemia and CV collapse
what is the classical picture fo longstanding panhypopituiriasm
pallor with hairlessness
what identifies pituitary adenomas
MRI
difference in definitions between cranial and nephrogenic DI
cranial- insufficient levels of circulating ADH
nephrogenic - renal resistance to ADH
urine/serum osmolality should be
> 2
if cranial DI is diagnosed what should be done
CT or mRI to rule out brain tumours especially craniopharyngioma
what can be used before surgery for acromegaly
somatostatin analogues eg sandostain
what can increase risk of colon polyps or colon cancer and may be presenting feature
acromegaly
drugs that reduce dopamine
metoclopramide, phenothiazines
what is the main treatment for prolactinoma
cabergoline - v good so rarely need surgery
symptoms of rubella syndrome in baby
microcephalic;y, patent ductus arterioles and cataract
what tests for tubal patency
hysterosalpingiogram
what vitamin should take before pregnancy and for first 12 weeks
folic acid
what is a hydrosalpinges
Fallopian tube filled with water
what detects oestrogen defieicny
negative progesterone challenge test
kallamans is what class of pituitary failure
1 - hypothalamic pituitary failure
turners syndrome comes into what class?
3 ovarian failure
what is oligomenorrhoea
cycles greater than 42 days
diffeerence between primary and secondary amenorrhoea
primary - never mensutrated
secondary - menstruated then stop
what to do if infertility but got regular periods
midluteal serum progesterone
what to do if got irregular cycles
hormone evaluation
what challenge test should introduce a period
progesterone
what could consider if not responding to clomifene citrate for pros in getting pregnant
methotrexate
what acts as a co- gonadotrophin to LH
glucose
what lowers SHBG that can contribute to hyperandrogegism
insulin
inflammatory disorder eg chlamydia, gonorrhoea can cause what
hydrosalpinx
what is a hydrosalpinx
Fallopian tube is blocked and fills with serous or clear fluid near the ovary
pelvic inflammatory disorder presents as
abdo/pelvic pain
febrile
vaginal discharge
uterus on US may be fixed and retroverted and may show chocolate cysts
endometriosis
klinefelters biochem
primary hypogonadism - low testosterone and high LH/FSH
kallman and prader will have what biochem
low testosterone and low fish/LH
if primary hypogonadism in males what tests next
karyotyping or iron studies
in secondary hypogonadism what do you need to exclude
medications and prolactin and pituitary hormones
when does testosterone peak
morning
most common genetic cause of hypogonadism in men
klinefelters
klinefelters presents
infertile and small firm testes
increased incidence off what in klinefelters
cryptorchidism (abscence of testes from scrotum)
klinefelters increase risk of what
breast cancer and non Hodgkin lymphoma
red green colour blindness and clip palate are associated with
kallamsn
there is an isolated GnRh deficiency in
Kallman
are men autosomal dominant or recessive
dominant
men 1 3 symptoms
pituitary adenoma, hyperparathyroidism and pancreatic tumour eg insulinoma
Ret in men 2 is a
proto oncogene
mutations in RET activate what
receptor tyrosine kinase
men 2a or b more common
2a - 90-95%
men 2a features
medullary thyroid cancer, phaeochromocytoma and parathyroid tumours
men 2b features
MTC, phaechromocytoma and marfanoid features - mucosal neuromas
what is typically the first presentation of MEN 2
MTC
von hippel Lindau is tumors where
central nervous system
bone lesions in NF 1
sphenoid dysplasia or thinning of long bone cortex
cushings, acromegaly and thyroid carcinoma
carney complex
mccune Albright syndrome has mutations of what
GNAS
mccune Albright syndrome has mutations of what
GNAS
what is a trophoblast tumour secretion hCG
choriocarcinoma
what are thyrotoxicosis not associated with hyperthyroidism
thyroiditis
what drug can cause drug induces thyroiditis
amiodarone
what does a thyroid bruit reflect
hypervascualrity of thyroid - graves
pretibial myxoedema is seen in graves and what else
hashimotos thyroididts
what scan is done if suspect graves by antibodies are negative so look for toxic nodular disease
scintiscan
first line for graves
carbimazoel
what is first line treatment for relapsed graves dn nodular thyroid disease
radioiodien
what is used when radio iodine is contraindicated eg in pregnancy
thyroidectomy
what has a painful diffuse firm goitre
de quervains
what often occurs after viral infection in young woman
de quervains thyroiditis
in dequervains there is a hyperthyroid phase followed by
hypothyroidism phase
drug induced thyroiditis can be caused by
amiodarone and lithium
what does amiodarone inhibit
DI01
hormone results from amiodarone
increase t4, decrease t3 and normal TSH
hasmimotos like de quervains can have
hyoperthyroid then hypothyroid phase
de quervains tends to occur in what aged females vs hashimotos
dequervains - 20-50
hashimotos- 45-60
hurthle cell - follicular cells with eosinophils cytoplasm can be seen in
hashimotos thyroiditis s
periorbital oedema is only seen in
hypothyroidism
in hypothyrodisims wha cardiac feature
dilated cardiomyopathy
obstructive sleep apnoea can occur in what thyroidism
hypo
congenital hypothyrodisim is called
cretinism
after treatment for hypothyroidism what should be checked every 12 months
TSH
TSH is unreliable in
secondary hypothyroidism
long standing complication of autoimmune hypothyroidism
B cell non Hodgkins Lymphoma in the affected gland
TSh elevated and normal t3/4
subclinical hypothyroidism
when should you always treat sublcinctal hypothyroidism
pregnancy
subclinical hyperthyroidism is often seen in
multi nodular goitre
when is treatment generally advised in subclinical hypo/hyperthyroidism
hypo: TSH >10
hyper: TSH <0.1 or osteoporosis or AF
can benign thyroid nodules painful/ tenderness
yes
most common malignant thyroid nodule
papillary thyroid carcinoma
difference between benign and malignant thyroid nodule?
benign is mobile and malignant is immobile
if a lump moves on swallowing what does this mean
it is in the thyroid invested in pretracehal fascia
toxic nodule may have signs of what
hypothyroidism
what can tell the differcen between hot and cold nodules
scintigraphy
are hot nodules always malignant
no -only rarely malignant
what mainly diagnosis thyroid nodules
US- FNA
what tumour in thyroid has a thin fibrous capsule
follicular adenoma
why is the management for follicular adenoma lobectomy with biopsy instead of FNA
FNA cannot distinguish between follicular adenoma and follicular carcinoma
papillary carcinoma is associated with what
hasminotos and ionising radiation
follicular carcinoma rates are more in
iodine deficient areas
what carcinoma can be multifocal, often cystic and may be calcified (psammoma bodies)
papillary
follicular carcinomas spread via
haemtogenosu
what usually confirms papillary or follicular carcinoma
us - FNA
what is done 3-6 months post op of thyroidectomy
whole body iodine scan
what are patients treated with to minimise risk of recurrence of papillary or follicular carcinoma
levothyroxine to suppress TSH
tumour marker for papillary and follicular carcinoma
thyroglobulin as made by thyroid follilculae epithelial cell
what does not respond to RAI
anapaestic carcinoma
what are composed of spindle or polygonal cells in nests
MTC
what is associated with amyloid deposition
mTC
diarrhoea in MTC suggests production of what
VIP
thyroid lymphoma often has a background of what
auto-immune hypothyroidism
what presents as a rapid onset mass in thyroid
lymphoma
a rise in what stimulates goitre
TSH
