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Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is a neuroblastoma?

A

Malignant tumour arising from neural crest tissue of the adrenal medulla (most commonly). It is seen in children mainly (avg age of 20 months).

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2
Q

What are the symptoms of neuroblastoma?

A

Abdominal mass, pallor, weight loss
Change in bowel habit - constipation
hepatomegaly
paraplegia
proptosis
bone pain, limp

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3
Q

When should you refer a suspected neuroblastoma?

A

For a child with a palpable abdominal mass or unexplained enlarged abdominal organ: refer very urgently (<48hr) for specialist assessment for neuroblastoma and Wilms’ tumour

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4
Q

What is Wilm’s tumour?

A

Also known as nephroblastoma, is a cancer of the kidneys that typically occurs in children (rarely in adults)

Occurs most between the ages of 3-4. Unlikely after the age of 5.

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5
Q

What are the symptoms of Wilm’s tumour?

A

Mass/swelling in abdomen
Abdominal pain
Fever
Blood in the urine.
High blood pressure.

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6
Q

What are the investigations for Neuroblastoma?

A

Urine test
- Raised urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels

Calcification may be seen on abdominal x-ray

Biopsy

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7
Q

What is Prolactin?

A

A polypeptide hormone responsible for milk production (lactation) as well as breast development.
- It also causes lactational amenorrhoea - prolactin inhibits the release of Gonadtropin releasing hormone, FSH, LH. Inhibits the entire hypothalamo-pituitary-ovarian axis.

It is released by lactotropes in the anterior pituitary gland.

It is inhibited by dopamine - which is in turn released by the arcuate nucleus of the hypothalamus.

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8
Q

Causes of high prolactin?

A

Pregnancy
Lactation
REM sleep
Prolactinoma
PCOS
Primary hypothyroidism

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9
Q

Drug causes of high prolactin?

A

Metoclopramide
Domperidone
phenothiazines e.g. chlorpromazine
Haloperidol
very rare: SSRIs, opioids

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10
Q

Features of high prolactin?

A

Amenorrhoea
Galactorrhea
Gynacomastia
Bitemporal hemianopia - if from prolactinoma

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11
Q

What is the management of obesity? (Lifestyle, medication)

A
  1. Lifestyle - diet + exercise
  2. Medical mx - Orlistat (pancreatic lipase inhibitor), liraglutide
  3. Surgical
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12
Q

What is a prolactinoma?

A

The most common type of pituitary adenoma (benign tumour of pituitary gland). They produce an excess amount of prolactin.

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13
Q

What are the symptoms of prolactinoma in a female?

A

Galactorrhoea
Amenorrhoea
Infertility
Osteoporosis

other symptoms may be seen with macroadenomas:
headache.
visual disturbances (classically, a bitemporal hemianopia (lateral visual fields) or upper temporal quadrantanopia)
symptoms and signs of hypopituitarism

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14
Q

What are the symptoms of prolactinoma in a male?

A

impotence
loss of libido
galactorrhoea

other symptoms may be seen with macroadenomas:
headache.
visual disturbances (classically, a bitemporal hemianopia (lateral visual fields) or upper temporal quadrantanopia)
symptoms and signs of hypopituitarism

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15
Q

How would you diagnose a prolactinoma?

A

MRI head

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16
Q

2 options

What is the treatment for a prolactinoma?

A

Symptomatic patients are treated medically with dopamine agonists (e.g. cabergoline, bromocriptine) which inhibit the release of prolactin from the pituitary gland.

Surgery is performed for patients who cannot tolerate or fail to respond to medical therapy. A trans-sphenoidal approach is generally preferred unless there is a significant extra-pituitary extension

17
Q

What is acromegaly?

A

Acromegaly is a rare endocrine disorder caused by excessive secretion of growth hormone (GH) from the pituitary gland.

This is most commonly secondary to a pituitary adenoma in over 95% of cases. A minority of cases are caused by ectopic GHRH or GH production by tumours e.g. pancreatic.

18
Q

What is Growth hormone?

A

A hormone released by somatotropes in the anterior pituitary gland secondary to the stimulation from GHRH (which is produced in the arcuate nucleus of hypothalamus)..

18
Q

What stimulates GHRH to be secreted?

A
  • Low glucose levels in the blood
  • Low fatty acid levels in the blood
  • High amino acid levels in the blood
  • Exercise
  • Increased stress trauma
18
Q

What are the functions of growth hormone?

A

Stimulates the liver to produce IGF-1 (insulin like growth factor 1)

Muscle hypertrophy - increases amino acid uptake and protein synthesis in muscles
Increases bone density - increases ativity of osteoblasts and stimulates endochondral ossification. Also increases protein synthrese e.g. collagen.

18
Q

Features of acromegaly?

A

Coarse facial appearance,
Large tongue, prognathism, interdental spaces
Spade-like hands
Iincrease in shoe size
Excessive sweating and oily skin: caused by sweat gland hypertrophy

Features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia
Raised prolactin in 1/3 of cases → galactorrhoea
6% of patients have MEN-1

18
Q

Investigations for acromegaly?

A
  1. Serum IGF-1 levels
  2. If raised IGF-1 levels, check growth hormone level, if acromegaly will be >1ug/L.
  3. Glucose tolerance test (can recheck GH, if >2ml/L then acromegaly)

Can also do pituitary MRI if concerns of macroadenoma.

18
Q

Complications of acromegaly?

A

hypertension
diabetes (>10%)
cardiomyopathy
colorectal cancer

19
Q

How would you manage acromegaly?

A

Trans-sphenoidal surgery is the first-line treatment for acromegaly.

Can use octreotide (somatostatin analogue), directly inhibits GH.
Can also use bromocriptine (dopamine agonist)
Pegvisomant (GH receptor antagonist)

External irradiation is sometimes used for older patients or following failed surgical/medical treatment

20
Q

What are thiazolidinediones?

A

They are agonists to the PPAR gamma receptor - work by increasing insulin sensitivity in peripheral tissues such as adipose tissue, skeletal muscle and liver.
E.g Pioglitazone

21
Q

What are the side effects of thiazelidinediones?

A

E.g. pioglitazone
Weight gain
Fluid retention
Liver impairment
Increased risk of bladder cancer
Increased risk of fractures

Need to monitor LFTs, contraindicated in heart failure

22
Q

What are the symptoms of hypoglycaemia?

A

Sweating
Anxiety
Blurred vision
Confusion
Aggression
Coma

23
Q

How to manage a hypoglycaemic episode?

A

Conscious patients - take 10-20g of short acting carbohydrate (e.g. glass of lucozade or non diet drink, three or more glucose tablets, glucose gel)

Unconscious patients: 1mg glucagon IM

24
Q

How do you diagnose T2DM

A

Can use plasma glucose or Hba1c.

If they are symptomatic:
Fasting glucose >=7 mmol/l
Random glucose >=11.1mmol/l (or after 75g glucose tolerance test)

If asymptomatic above criteria need to be demonstrated on 2 occasions.

If Hba1C is used:
>=48 is diagnostic
If asymptomatic must be repeated to confirm diagnosis.

Conditions where hba1c cannot be used:
Haemoglobinopathies
Haemolytic anaemia
Untreated IDA
Suspected gestational diabetes
Children
HIV
CKD
People on steroids

Medicine (5 decks)

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