Endocrinology Flashcards
What is Acromegaly?
Excess Growth Hormone due to a pituitary adenoma
What does Acromegaly cause?
Physical Attributes - not on face
Spade-like Hands and feet
Sweating
Proximal Myopathy
What does Acromegaly cause?
Conditions
Hypertension Cardiomegaly and HF Diabetes (due to poor glucose tolerence) Visual Field Disturbances (compression) Fluid retention - Carpal Tunnel, OS Apnoea Osteoarthritis
How do you investigate Acromegaly?
Glucose Tolerence Test Insulin Sensitivity Bloods - glucose, GH, other pit hormones Bloop Pressure Urine Dip - glucose MRI Pituitary Fossa
How do you treat Acromegaly?
Transphenoidal Approach
Radiotherapy (if cannot excise)
Medications to lower GH - receptor blocker, somatostatin analogues
What does Acromegaly cause?
Physical Attributes - facial
Coarse Features - square jaw, large nose and ears
Frontal Bossing
Wide Spaces between teeth
Macroglossia
What is Cushing’s?
Excess cortisol production due to ectopic secretion, an ACTH pituitary adenoma (DISEASE) or a adrenal adenoma
Iatrogenic
What are the physical features of Cushing’s syndrome?
Moon Face Acne Buffalo Hump Abdominal Fat Purple Striae Oedema - fluid retention Bruising Thin Skin and Hair
What are the disease states related to Cushing’s?
Eyes- Glaucoma, Cataracts High BP Easy Bleeding Steroid Diabetes Fluid Retention GORD Compressive - Visual Fields, Headaches Osteoporosis Immunocompromised Oligomenorrhoea Mood Change
How do you investigate Cushing’s
TFTs (hypothyroid)
Early Morning Cortisol
Dexamethosone Suppression - low dose then high (halves Cortisol in DISEASE)
Bloods - glucose, FBC, Clotting (INR), pituitary hormones
MRI Pituitary
24 hour urine Cortisol
How do you treat Cushing’s?
Iatrogenic: Stop steroids
Adenoma: Transphenoidal Pituitary Removal or medical treatment if prolactinoma
Bilateral Adrenectomy
Radiotherapy (if adrenal carcinoma)
Treat Cancer (if ectopic) and fluconazole to lower Cortisol
What is Addison’s Disease?
Primary Adrenal Failure
Autoimmune destruction of the adrenal cortex, leading to insufficiency
What is Adrenal Failure?
Causes
Where adrenals are not able to produce steroids leading to symptoms
Can be due to long-term steroid treatment, sepsis, metastatic cancer, infections (TB)
What are the physical symptoms of Addisons?
Cachexia/Weight Loss Pigmentation - especially gums, folds of skin Thin Hair Thin Nails Amenorrhoea Impotence Dehydrated
What are the other symptoms of Addisons?
Postural Hypotension Tiredness, Lethergy Loss of thirst, appetite Mood changes - depression High K+ and low Na+ (loss of aldosterone) Hypoglycaemia Weakness Abdominal Pain and Vomiting
Investigations
Short synacthen test
BP - standing and sitting
Bloods - U&Es, cortisol, antibodies, ACTH, glucose, ABGs
Glucose fingerprick test
What is an addisonian crisis?
SEVERE Addisons. Usually due to a missed dose or upregulation of dose in illness
Can lead to death due to hypovolaemic shock, heart attack, hypoglycaemia
How do you treat an addisonian crisis?
Steroids IV -hydrocortisone Fluids - IV, aggressive Glucose Monitor electrolytes - K+ may treating Treat cause if has one
How do you treat Addisons
Hydrocortisone
Fludrocortisone
Emergency Kit
Sick Day Rules, Steroid Card
What is Thyrotoxicosis?
Hyperthyroidism
What are the causes of hyperthyroidism?
Autoimmune - Graves disease Toxic Goitre (old) Toxic Adenoma Ectopic Thyroid Tissue (Struma Ovarii, metastatic) Exogenous
What are the symptoms of hyperthyroidism?
Weight Loss Gain of Appetite Not able to sleep Palpitations Anxiety/Panic Disorders Mood Changes Menstrual changes Heat Intolerence
What are the signs of hyperthyroidism?
Tachycardia/Arrhythmias (AF) Fine Tremor High BP Goitre Exophthalmos, lid lag and retraction Sweaty
Investigating Thyroid?
TFTs, thyroid antibodies Cortisol BP ECG Thyroid Examination Technetium Uptake Scan USS
What is Grave’s Disease?
Risks?
Autoantibodies IgG bind to the thyrotrophin receptor causing goitre and upregulating hormone production
Middle aged, female, pregnancy, stress, other autoimmune conditions
Treatment of Hyperthyroidism?
Beta Blockers
Carbimazole
Radioactive Iodine
Thyroidectomy and Levothyroxine
Treating a thyrotoxic storm?
Severe hyperthyroidism Manage peripheral symptoms (Beta blockers, digoxin may be needed) Treat precipitant (infection etc) Fluids Carbimazole - iodine -surgery
What is Hypothyroidism?
Where there is insufficient thyroid hormone production
What are the normal levels for thyroid hormones?
TSH 0.4 - 4
T4 9 - 25
T3 3.5 - 7.8
What is Sick Euthyroidism?
Where the thyroid production is decreased when you are unwell
Normally all tests are low
What are the causes of Hypothyroidism?
Autimmune - Hashimoto’s
Trauma
Iodine Deficiency (following HyperT treatment)
Pituitary Adenoma (secondary)
Drug Induced - antithyroid, lithium, amiodarone
Who gets hypothyroidism?
Also known as myxoedema More common in middle aged females Associated with other autoimmune conditions Down's Syndrome Genetic
What is Hashimoto’s?
Autoimmune lymphocytic infiltration of the thyroid gland, leading to atrophy
What are the symptoms of Hypothyroidism?
Tiredness and lethergy Mood- depression Weight gain Loss of appetite Heavy periods Cold Intolerence Carpal Tunnel Syndrome Goitre Slow reflexes
Signs of Hypothyroidism?
Weight gain (toad face) Bradycardia Low BP Thin Hair/Skin Cold Periorbital Oedema Low cognition
What is a toad-like face?
Seen in Hypothyroidism
Loss of hair - scalp, 1/3 eyebrows, dull expression, puffy lids, pale
How do you treat Hypothyroidism
Levothyroxine (replacement of T4)
Can do:
Liothyroxine (T3)
What is a Pheochromocytoma?
Noradrenaline/Catecholamine releasing medullary tumour of Chromaffin Cells
Most unilateral
Follow rules of 10:
10% bilateral, 10% malignant, 10% familial, 10% extra-adrenal
Investigating a Pheochromocytoma?
24 hour Urine Metadrenaline Test
ECG, BP
Bloods - TFTs, Cortisol
Abdominal CT/MRI
Treating a Pheochromocytoma?
Alpha Blockers (and Beta Blockers if have heart disease) Adrenalectomy
Symptoms of a Pheochromocytoma?
The main three:
Headache
High Heart Rate
Sweating
Others: Feeling doom/anxiety Weight loss Loss of sleep Heat intolerance Palpitations Horner's syndrome
Signs of a Pheochromocytoma?
Sweaty
BP high
Tachycardia
What can trigger a Pheochromocytoma?
Compression to area of adrenal glands/Trauma
What is hyperaldosteronism?
Raised aldosterone
Can be:
Primary: Adenoma- Conn’s, Hyperplasia
Secondary: renal stenosis/hypoperfusion (sepsis etc)
What are the signs of hyperaldosteronism?
Fluid retention
High Na+, low K+
High BP
Polyuria and dipsia
Treatment of hyperaldosteronism?
Treat underlying cause: Conn’s - removal
Spironolactone pre-op and for adrenal hyperplasia
Investigating hyperaldosteronism?
Bloods: U&Es, Renin, Aldosterone
BP
Urine - glucose
What is Diabetes Insipidus?
Insufficient ADH production leading to polyuria (>3L a day) and polydipsia
Causes of Diabetes Insipidus?
Nephrogenic: Lithium,CKD, mutation
Neurogenic: Pituitary Stalk Compression/Damage to Pit.
Hypothalamus - infection, tumour, surgery
Investigations of Diabetes Insipidus?
Blood and urine glucose and ketones
Serum and urine osmolarity, Na+
(Urine will be hypo-osmolar compared to normal)
Blood - U&Es (Na+ high due to attempted fluid retention)
Fluid deprivation test for 8 hours to see urine osmolarity: <300
Then give desmopressin to see response
Treatment of Diabetes Insipidus?
Desmopressin (ADH analogue)
ADD thiazide and NSAIDs if nephrogenic
Diagnosis of Diabetes Insipidus - Osmolarity?
Primary Polydipsia?
<300
>800
What does giving desmopressin do?
if Diabetes Insipidus is nephrogenic then there is no response
If it is neurogenic then there is a response
Signs of Diabetes Insipidus?
Thirst
Polyuria (nocturnal as well)
Hypernaturaemia
Palpable Bladder
What do you do an Insulin Tolerance Test for?
GH and Cushings (ACTH)
Hypoglycaemia normally stimulates the production of these
What are some causes of Hypopituitarism?
Sheehan's syndrome - post-pregnancy necrosis of the pituitary Trauma Infection Radiation Surgery Adenomas
What are some signs that it is a pituitary adenoma?
Headaches
Changes in other Pituitary hormones
Visual field defects (temporal hemianopia)
What order are hormones lost in pituitary failure?
GH FSH and LH Prolactin TSH ACTH
How do you treat a prolactinoma?
Dopamine Agonists - Bromocriptine or Cabergoline
