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Endocrine System > Endocrine Surgery > Flashcards

Endocrine Surgery Flashcards

1
Q

What is a summary of thyroid physiology?

A

TRH from hypothalamus stimulates release of TSH from anterior pituitary
Stimulating T4 and T3
There is a short and long feedback loop

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2
Q

What are thyroid hormone effects?

A

Increase in carbohydrate/ lipid catabolism
Increase protein synthesis
Increase in basal metabolic rate
Growth and maturation

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3
Q

Describe thyrotoxicosis

A

Clinical syndrome of excess circulating thyroid hormones - commonly due to hyperthyroidism
Primary - Graves disease
Secondary - TSHoma, thyroiditis

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4
Q

What is a goitre?

A

Enlargement of the thyroid gland
Endemic, sporadic and multinodular (most common)
Benign

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5
Q

What are types of thyroid neoplasms?

A

Adenomas
Carcinoma - papillary, follicular, medullary and anaplastic

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6
Q

What are the causes for goitre?

A

Genetics, MNG, AITD, iodine deficiency, malignancy and TSHoma

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7
Q

What is a sign of goitre?

A

Pemberton’s sign - red face if arms lift up as obstructed venous supply
Also can get stridor

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8
Q

What investigations are needed for goitre?

A

TFT, US and CT

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9
Q

What are the complications of a thyroidectomy?

A

Neck tension/ tenderness, voice problems, swallowing problems, irritated windpipe, haematoma, decreased PTH and recurrent laryngeal nerve injury

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10
Q

Explain thyroid cancer

A

Medullary arises from calcitonin secreting C cells
Usually good prognosis in papillary and follicular
Anaplastic very poor prognosis
Spreads to lymph nodes, bone and lungs

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11
Q

What is the investigation for thyroid cancer?

A

Fine needle aspiration cytology

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12
Q

What is the treatment for thyroid cancer?

A

Surgery and radio-iodine

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13
Q

What are parathyroid glands embryologically derived from?

A

Pharyngeal pouches and ultimobranchial body

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14
Q

Describe PTH physiology

A

PTH acts on kidneys and bone to release Ca and decrease excretion of Ca
Vit D goes to liver + kidneys and activated calcitriol acts on small intestine to increase dietary absorption of Ca + release Ca from bones

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15
Q

What are common primary disorders of parathyroid glands?

A

Adenoma, hyperplasia and carcinoma

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16
Q

What are secondary causes of hypercalcaemia?

A

Renal failure and hypo vitamin D

17
Q

What surgery is used for parathyroid glands?

A

Targeted parathyroidectomy - one gland
Bilateral neck exploration

18
Q

Describe the hormones of adrenal gland

A

Cortex
Zona glomerulosa - mineralocorticoids
Zona fasciculata - glucocorticoids
Zona reticularis - androgens and oestrogen
Medulla - epinephrine and norepinephrine

19
Q

Describe Conn’s syndrome

A

Excess mineralocorticoids
Hyperalderonism
Increased Na reabsorption, increased K/H excretion and increased ECF volume
Hypertension and possible hypokalaemia

20
Q

Describe the synthesis of catecholamines

A

Tyrosine - dopamine - norepinephrine and epinephrine
Tyrosine hydroxylase needed

21
Q

Describe pheochromocytoma

A

Excess catecholamines
Medulla stimulated by sympathetic system
Extra adrenal chromaffin tissue
10% tumour - 10% familial, malignant, multiple and extra-adrenal

22
Q

What are the symptoms and signs of pheochromocytoma?

A

Tachycardia, palpitations, pallor, tremor, headache and sweating
Hypertension, orthostatic hypotension, retinopathy, and fever

23
Q

What are the investigations for pheochromocytoma?

A

Urine/ plasma metanephrines MIBG
Scans

24
Q

Describe neuroendocrine tumours

A

Tumour of gut endocrine cells
Carcinoid - cancer like
Secrete serotonin and chromogranin
Measure urinary 5-HIAA and serum chromogranin

25
Q

What are the clinical features of neuroendocrine tumours?

A

Asymptomatic and intestinal obstruction/ bleeding
Advanced disease - flushing, diarrhoea and bronchospasm

26
Q

Describe pancreatic neuroendocrine tumours

A

Rare
Pancreatic endocrine cells
MEN Type I
Insulinoma - hypoglycaemia
Gastrinoma - peptic ulcer
Glucagonoma - DM, migratory skin erythema

27
Q

Describe multiple endocrine neoplasia

A

Rare and autosomal familial syndromes
Endocrine tumours in multiple organs
Germline gene mutations

28
Q

What is MEN1?

A

Tumour of parathyroid glands often accompanied with tumours of anterior pituitary + endocrine pancreas

29
Q

What is MEN2?

A

Medullary thyroid cancer often accompanied with pheochromocytoma and parathyroid tumours

Endocrine System (23 decks)

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