Endocrine Flashcards
Acromegaly
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
HIGH GROWTH HORMONE
-IGF-1 (Insulin Growth Factor 1)
Pathophysiology:
GH SECRETING PITUITARY ADENOMA
Presentation:
HYPERSECRETION = MASS EFFECT (overgrowth of structures compressing nearby structures e.g Optic Chiasm)
-Bitemporal hemianopia
-Headaches, visual field defects
Pronounced jaw
-Seperation of teeth
-Macroglossia (enlargement of tongue) - dry mouth, obstructive sleep apnoea
-Hypertension, Diabetes mellitis and Osteoarthritis
-Organomegaly
Treatment:
-Surgery removing adenoma
-Somatostatin analogues
Hyperprolactinaemia
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
HIGH PROLACTIN
Pathophysiology:
Either normal during breastfeeding OR Pituitary Adenoma OR anti-psycotics (as they they inhibit dopamine which is known for inhibiting prolactin)
Presentation:
MASS EFFECT - headaches and Bitemporal hemianopia
MEN: Reduced libido and errectile dysfunction, gynaecomastia (man boobs), infertility
WOMEN: Amenorrhoea (absence of periods) and Osteopenia
Treatment:
Dopamine agonists - Cabergoline / Bromocriptine
Pituitary Apoplexy
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
Acute haemorrhagic infarction of the PITUITARY GLAND
-Sheehan is this issue at post-partum
Pathophysiology:
MEDICAL EMERGENCY
Presentation:
-Sudden onset Headache
-Nausea
-Vomiting
-Drowsiness
-Often progresses to coma
HIGH MORTALITY
Treatment:
HYDROCORTISONE IS LIFE SAVING
Empty Sella Syndrome
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
Normal
Pathophysiology:
Benign condition where pituitary gland cannot be pictured on MRI
Presentation:
Headaches
Treatment:
Nothing- its benign (maybe analgesia)
Craniopharyngioma
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
Pituitary hormone dysfunction
Pathophysiology:
Benign tumours of the Rathke’s Pouch
Presentation:
-MASS EFFECT : headaches, bilateral hemianopia, visual defects
-Hydrocephalus (blockage of CSF flow)
Treatment:
Surgical resection
Syndrome of inappropriate ADH secretion
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
HIGH ADH
-Hypo - antraemia (sodium)
- osmorality
-Hyper - osmolar urine
Pathophysiology:
Similar effects to over hydration by IV
-Malignancy (ectopic ADH production, Small cell cancer, Meningitis)
Presentation:
-HYPOANTRAEMIA
-confusion, drowsiness and lowered Glasgow Coma Scale)
-Water retention (not oedema)
Treatment:
Restrict fluid
No improvement: DEMECLOCYCLINE = antibiotic that reduces efficacy of ADH
Diabetes insipidus
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
LOW ADH
Pathophysiology:
Neurogenic and Nephrogenic
Nephrogenic - Lithium and Demeclocycline
OR by damage to pit gland
Presentation:
-Polydipsia
-Polyuria
-Hypernatraemia
Treatment:
Cranial
Desmopressin (IV vs Intranasally)
Nephrogenic
-treat underlying
-low sodium diet
-Thiazide diuretics
Type 1 diabetes
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
Insulin (low / deficient)
Treatment:
1.Emergency
=Short acting (-lispro / aspart)
2.Young and active : Basal Bolus Regime
-Long acting (-Detemir/ glargine)
-Short acting with meals (-lispro / aspart)
- For someone sedentry e.g elderly
-Long acting (detemir / glargine)
or Intermediate acting (NPH)
4.Type 2 diabetics
Once a day regimine
Long acting before bed (-Detemir / glargine)
Type 2 diabetes
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
Insulin (insensitivity)
Treatment:
Metformin
-flozin (SGLT2 inhibitors)
Thyroid storm
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
HIGH T3 T4, Low TSH, Anti-TSH autoantibody present
Pathophysiology:
Patients with undiagnosed / uncontrolled hyperthyroidism can get this medical emergency
Presentation:
-Hyperpyrexia
-Tachycardia
-Atrial Fibrillation
-Altered mental state
-Nausea, Vomiting, Diarrhoea and abdominal pain
Treatment:
(Carbimazole) Block and replace (Levothyroxine)
Consider radioactive iodine
!Pregnant women CANNOT take Levothyroxine so put on Titration regimine (Carimazole titrated down gradually)
!Preganant / breastfeeding women are not eligable for RI therapy
De Quervain thyroiditis
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
Hyperthyroid to Hypo to Euthyroid (normal function )
Pathophysiology:
Self limiting due to a viral illness
Presentation:
Diffuse painful goitre, pain in neck and jaw
Treatment:
Ibeprofen
Hypothyroidism
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
LOW TSH, T3, T4
Pathophysiology:
-low dietry iodine
-Hashimoto’s autoimmune diseas
-Atrophic Thyroiditis
-Cretinism (congenital deficiency of iodine)
Presentation:
Treatment:
-Levothyroxine (can take months to improve)
Thyroid cancer
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
N/A rarely causes hyperthyroid
Pathophysiology:
Majority benign
Presentation:
Painless neck lump, dysphagia, hoarseness, SVC obstruction
Investigation:
Cold on Radioiodine scan
Hyperparathyroidism
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
HIGH PTH
Pathophysiology:
-Primary : Adenoma
-Secondary : Due to Hypocalcaemia (e.g Chronic Kidney Disease)
-Thiazide diuretics
Presentation:
-Bone pain
-Abdominal pain
-Pancreatitis
-Bone stones
-Shortened QT interval
-Lethargy , Myalgia
Treatment:
Cinacalcet
Hypoparathyroidism
Hormone and Level; Pathophysiology; Presentation; Treatment
Hormone and Level:
LOW PTH
Pathophysiology:
-Most commonly due to surgery / radiation (Iatrogenic)
-Haemochromatosis (destriction of Parathyroid)
Presentation:
-Hypocalcaemia
-Muscle twitching
(Chvostek sign :Twitching of facial muscles from tapping cheek)
-Lethargy
-Muscle spasms
-Psychosocial changes
-Prolonged QT interval
Treatment:
-Severe: IV Calcium Gluconate
-Calcium and Vit D replacement
