Endocrine pathology Flashcards
Anterior pituitary embryology
Ectoderm
Supra-optic tumour
Posterior pituitary
ADH
Water on the brain
Prolactinoma
Excess prolactin
Headache
Bitemporal hemianopia
Male - erectile dysfunction and reduced libido
Female - amenorrhoea and galactorrhoea
Management of prolactinoma
Bromocriptine
Transphenoidal surgery
Acromegaly symptoms
Increased GH
Increased hand size
HOCM
Management of acromegaly
Somatostatin
Surgery
SIADH
Posterior pituitary
HTN
Low sodium
Central diabetes insipidus physiology
Deprive patient of water
ADH does not increase, urine osmolality does not increase
If you give ADH —> increased urine osmolality
Nephrogenic diabetes insipidus physiology
Deprive patient of water
ADH does not increase, urine osmolality does not increase
If you give ADH —> urine osmolality does not change
Central diabetes insipidus causes
V1 receptor mutation
Reduced or absent ADH
Nephrogenic diabetes insipidus causes
V2 receptor mutation
Normal ADH
Aquaporin in collecting ducts
Enzyme in liver cause vitamin D hydroxylation
25-hydroxylase
Enzyme in kidney cause vitamin D hydroxylation
1 alpha hydroxylase
Which part of kidney does vit D get hydroxylated?
PCT
Scan used to locate parathyroid tumour
Sestamibi
Which thyroid drugs can be used in pregnancy?
Propythiouracul - pro pregnancy - ok in 1st trimester
SE of carbimazole
Pancytopaenia
T cell lymphoma
Small bowel
T - tiny - small bowel
B cell lymphoma
Testicle
B - big bollocks
Hashimotos thyroiditis
Hyper then hypo
Hurtle cells
Risk of non-hodgkins lymphoma
TPO antibodies
Subacute thyroiditis
Painful
Diagnosis of thyroid cancer
Radioactive iodine uptake scan
USS
FNA
Papillary thyroid cancer
Most common
Psammoma
Orphan Annie nuclei
Follicular thyroid cancer
Spread to blood
Invades capsule
Hemi thyroidectomy
Medullary thyroid cancer
Neuroendocrine tumour of parafollicular “C” cells
Congo red - amyloid
Men 2A and 2B = RET mutation
Why is medullary thyroid cancer not picked up on bone scan?
Parafollicular C cells do not take up iodine
Anaplastic thyroid cancer
Elderly
Hard mass
Poor prognosis
Tracheomalacia
Large thyroid removed –> breathing difficulties
Pre op management of Addisons
100my hydrocortisone on induction then QDS
Which part of adrenal gland does phaechromocytoma effect?
Adrenal medulla - chromatin cells
RET gene mutation
10s of pheochromocytoma
10% bilateral
10% malignant
10% extra adrenal
10% calcify
10% children
Scan to detect phaechromocytoma
MIBG scan
Potassium iodide given pre to saturate thyroid
Peri op management of phaeochromocytoma
Alpha blocker before beta blocker to reduce risk of stroke
MEN inheritance
Autosomal dominant
MEN 1
Parathyroid tumours
Pituitary tumours
Pancreatic tumours
Menin gene
MEN 2a
Medullary thyroid
Parathyroid tumours
Pheochromocytoma
RET gene
MEN 2b
Marfan
Mucosal neuroma
Medullary thyroid
Phaeochromocytoma
RET GENE
Gastrinoma association
MEN gene
