Endocrine shorts Flashcards
Ddx for a Neck mass
Thyroid -Graves disease -MNG -Thyroiditis -Adenoma or Malignancy -Thyroglossal Cyst LN -Infective, Malignancy (Lymphoma)
Investigations of a Thyroid Mass
TFTs - determine the activity of the Mass - Hypo or Hyper Thyroid Autoantibodies - TrAB, TPO, Tg Imaging -Technichium uptake scan -USS FNA biopsy of any mass CT Neck - assess for any obstruction/invasion of surrounding tissues Thyroid eye disease - CT Orbits
Ddx of Thyroid Eye disease (Graves Opthalmopathy)
Infiltrative malignancy - Multiple Myeloma
Other infiltrative - IgG4 Disease
Orbital Myopathy - Mitochondrial myopathy
Myasthenia Gravis
What are the 4 Pathognomonic features of Graves disease
- Graves opthalmopathy - Propotosis, Exopthalmos, Lid Lag, Lid retraction
- Pretibial myxoedema
- Thyroid Bruit
- Graves Achropachy - Clubbing
Management of Graves
- Beta Blockers - Symptomatic management
- Anti-Thyroid medications - Carbimazole and Propylthiouracil (PTU)
- Radioactive iodine - lifelong thyroxine replacement
- Eye disease - Smoking cessation, Steroids (If visual impairment), Decompressive surgery
Acromegaly - Clinical signs
GI - Frontal bossing, Prognathism with teeth Splaying, Macroglossia, Large Nose, Spade like hands
Hands - Spade like hands, Clammy/diaphoretic, Carpal Tunnel Syndrome (Phalens and Tinnels), Osteoarthritis
Pulse
BP - HTN
Arms - Axillary Skin Tags
Face - Frontal bossing, Prognathism with teeth splaying, Macroglossia, Crowded pharynx, Large nose, EOM, Bitemporal hemianopia
Neck - Goitre
Chest - Gynecomastia, Cardiomegaly or valvular pathology, CCF
Abdomen - Organomegaly
LL - Oedema (CCF), Joint replacements
To Finish exam - Testicular exam for atrophy, U/A for glycosuria or proteinuria, Fundoscopy - Retinopathy, HTN changes
Acromegaly - Signs of Active disease (5)
- Number of axillary skin tags
- Diaphoresis/Clammy hands
- HTN
- Glycosuria on U/A
- VF Defect
Investigation of Acromegaly
Confirm the diagnosis
Screening - IGF-1 levels - Elevated (No Diurnal variation)
Confirm Dx - OGTT - measure GH levels - No suppression
-MRIB - Assess for pituitary adenoma = most common cause
Investigate for complications
- Pituitary panel (Hypopit) - PRL, LH/FSH, TSH, ACTH
- Hba1C, Fasting BSL - DM
- Sleep Study - OSA
- U/A - proteinuria
- Colonoscopy - Colonic Polyps and Increased risk of CRC
- TTE - Cardiomegaly and LVEF, Valvulopathies
Management of Acromegaly
- Transphenoidal resection of pituitary adenoma - FIRST LINE
- If Surgery fails/not an option - medical management
- Somatostatin analogue - Octreotide
- GH Receptor Antagonist - Pegvisomant
Clinical findings of Cushings disease
GI - Moon like faces, Prominent Suprascapular Fat pad, Central adiposity, Atropic skin, Easy bruising
Hands - BSL pin pricks
Arms - Atrophic Skin, Easy bruising, Hyperpigmentation’s (Acanthosis Nigricans), HTN - BP, Proximal Myopathy
Face - Oral Thrush, EOM, VF (Bitemporal Hemianopia), Acne, Hirsuitism, moon facies
Abdomen - Central adiposity, Large Purple striae, Lipodystrophy from insulin injections, Scars (Organ Tx or adrenalectomy)
LL - Proximal Myopathy
Complete exam - Fundoscopy, U/A (protein and Glucose)
Ddx of Cushings Syndrome
- Iatrogenic - Steroid use
- Cushings disease - Pituitary adenoma
- Adrenal pathology - Adenoma, Hyperplasia or Malignancy
- Ectopic ACTH secretion - Other malignancies
Ix Cushings disease
- Confirm Cortisol Excess
- 24 hour urinary free cortisol - High (>3x ULN)
- Low dose 1 mg Dexamethasone suppression test -failure to suppress cortisol level - ACTH level - Dependant or independant
- If Independant to ACTH - Imaging of Adrenals (CT)
- If dependant to ACTH - High Dose Dexamethasone suppression test - Pituitary or Ectopic
- Pituitary - Suppressed
- Ectopic - Not suppressed - Pituitary source - MRI of pituitary looking for adenoma
- Also can do Inferior petrosal sinus sampling - Screen for complications - DM, OP (DEXA), TTE (HTN), Panhypopit (Pituitary Hormone profile)
