Endocrinology

Question 1

Acromegaly sx

Answer 1

Acromegaly = excess GH secondary to pituitary adenoma in 95% of cases. Can also be caused by ectopic GNRH or GH production by tumours e.g. pancreatic.

• Coarse facial appearance, spade like hands, increased in shoe size.
• Large tongue, prognathism, interdental spaces
• 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 with galactorrhea
• 6% of cases associated with MEN1

Question 2

Acromegaly ix

Answer 2

Serum IGF-1 levels. If raised then OGTT with no suppression of GH to <2mu/L = acromegaly.
Will also do pituitary MRI

Question 3

Acromegaly mx

Answer 3

Transphenoidal surgery first line
If tumour inoperable or unsuccessful:
* Octreotide (somatostatin analogue) which inhibits release of GH
* Pegvisomant (GH receptor antagonist) which inhibits GH binding to receptor. Given once daily subcut. Doesn’t reduce tumour volume.
* Bromocriptine (dopamine agonist), effective in only minority of patients.
* External irradiation for older patients following failed surgical or medical treatment.

Question 4

Acromegaly cx

Answer 4

• Hypertension
• Diabetes
• Cardiomyopathy
• Colorectal cancer

Question 5

Addisons sx

Answer 5

Addisons = autoimmune destruction of the adrenal glands resulting in reduced cortisol and aldosterone.

Pt will have:
* Lethargy, weakness, anorexia, nausea and vomiting, weight loss, salt craving
* Hyperpigmentation in palmar creases in primary addisons but not secondary adrenal insufficiency
* Vitiligo
* Loss of pubic hair in women
* Hypotension
* Hypoglycaemia
* hypoNa and hyperK
* in crisis; collapse, shock, pyrexia

Question 6

Other causes of hypoadrenalism

Answer 6

• TB
• Mets
• Waterhouse Friedrichsen syndrome in meningococcal sepsis (bleeding into the adrenals)
• HIV
• Antiphospholipid syndrome
• Secondary causes; tumours, irradiation, infiltration
• Exogenous glucocorticoid therapy

Question 7

addisons ix

Answer 7

• Short synacthen test:
  o Plasma cortisol measured 30 mins before and after giving synacthen 250 microg IM. May also see autoantibodies. If cortisol remains low after injection then addisons.

Question 8

addisons mx

Answer 8

• Hydrocortisone to replace cortisol 20-30mg per day, most given in first half of day.
• Fludrocortisone to replace aldosterone 50-200microg
• Hydrocortisone doubled when sick.

Question 9

addisonian crisis mx

Answer 9

usually due to sepsis

• Hydrocortisone 100mg im or iv
• 1 litre saline with dextrose if hypoglycaemia over 30-60mins
• 6 hourly hydrocortisone until stable

Question 10

Bartters syndrome sx

Answer 10

• AR childhood condition with severe hypokalaemia without hypertension.

Question 11

corticosteroid side effects