Endocrinology Flashcards

Question

Endocrinology disease pathology: What are exocrine glands?

Answer 1

One whose secretions pass into the gut, respiratory tract or exterior of the body

Answer 2

low levels - produce more | once levels rise, feedback to stop producing more

Answer 3

Underproduction / non-functioning Overproduction Mass Malignancy

Answer 4

Hypothalamus - releasing hormones to pituitary which sends stimulating hormones to thyroid/adrenal - negative feedback to the hypothalamus

Answer 5

4g 90% of total weight

Answer 6

defined as adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection. Typically, it is caused by Neisseria meningitidis

Answer 7

``` Skin pigmentation Hypotension Muscle weakness Hypoglycaemia Hyponatraemia Hyperkalaemia Renal dysfunction ```

Answer 8

``` Obesity - trunk neck enlargement swollen face Hypertension Osteoporosis Hyperglycaemia Myopathy Skin atrophy - fragile Polycythaemia Susceptibility to infection ```

Answer 9

Tumour of catecholamine producing chromaffin cells | Paroxysmal hypertension

Answer 10

``` Familial – autosomal dominant Neurofibromatosis Von Hippel-Lindau disease Medullary carcinoma of thyroid Parathyroid adenomas ```

Answer 11

Most are benign 5 – 10% are malignant Metastasise to lymph nodes, lungs, liver and bone

Answer 12

Serum T3, T4, TSH, calcitonin Ultrasound Radioactive iodine uptake studies FNA Core biopsy Excision biopsy / lobectomy Bone scan

Answer 13

``` Hypothyroidism Iodine deficiency Developmental Autoimmune Radiotherapy, radioiodine therapy Drugs ``` Hyperthyroidism Autoimmune Toxic adenomas Masses

Answer 14

Middle aged, women Auto-antibodies against Thyroglobulin and Thyroid peroxidase Lymphocyte (CD8) mediated destruction of thyroid follicles - thyroxin in the body goes up and then keeps going down Initial hyperthyroidism followed by hypothyroidism Painless enlarged thyroid need lifelong thyroxin replacement

Answer 15

Life long thyroxine Risk of developing other autoimmune disease Risk for thyroid malignancy

Answer 16

when taking blood: Elevated T3 and T4. Low TSH Increased uniform radio-iodine uptake Treated with anti-thyroid medications, radio-iodine ablation and surgery

Answer 17

cyst dominant nodule in multi nodular goitre benign neoplasms malignant neoplasms

Answer 18

Follicular adenoma usually solitary encapsulated Commoner than malignant neoplasms

Answer 19

Papillary adenocarcinoma Follicular adenocarcinoma Medullary carcinoma Anaplastic carcinoma Lymphoma

Answer 20

60-70% of cases Children and young adults Lymphatic spread Excellent prognosis

Answer 21

5-10% of cases Elderly, but familial cases earlier Lymphatic and blood stream spread Variable prognosis

Answer 22

10-15% of cases Elderly Aggressive local spread Very poor prognosis

Answer 23

A. Endocrine glands are ductless glands that usually release a product into the bloodstream for transport to body targets B. Hormones are chemical signals produced by an endocrine gland that act at some distance from the gland C. Targets are organs, tissues or cells capable of responding to the hormone due to the presence of a receptor that binds the hormone

Answer 24

– thyroxine (T4) and tri-iodothyronine (T3) regulate basal metabolic rate – calcitonin which has a role in regulating blood calcium level

Answer 25

it stores large amount of inactive hormone within extracellular follicles

Answer 26

• Clasps anterior and lateral surface of pharynx, larynx, oesophagus and trachea “like a shield” • Parathyroid glands usually lie between posterior border of thyroid gland and its sheath (usually 2 on each side of the thyroid) • Internal jugular vein and common carotid artery lie postero-lateral to thyroid

Answer 27

 Free Thyroxine (T4)  Free Triiodothyronine (T3)  Thyroid Stimulating Hormone(TSH)

Answer 28

Primary hypo: - primary failure of thyroid, not enough t3 and t4, TSH increases to overcome, goitre (swelling in the neck) secondary hypo: Low TSH from the pituitary T3 and T4 low and/or low TRH dietary iodine deficiency - low t3 and t4, increase TSH

Answer 29

```  weight gain  lethargy  increased sleep  constipation  cold intolerance  dry skin  hair loss  menorrhagia  deafness  muscle weakness ```

Answer 30

```  facial puffiness  periorbital oedema  bradycardia  hoarseness  delayed reflexes ```

Answer 31

```  Dyshormonogenesis  Iodine Deficiency  Autoimmunity  Post Radioactive Iodine  Post Thyroidectomy  Iodine Excess ```

Answer 32

```  Pituitary Tumours  Pituitary Granulomas  Empty Sella  Isolated TRH deficiency  Hypothalamic disorders ```

Answer 33

```  Congenital hypothyroidism  Treatment of hyperthyroidism  Neck Irradiation  Pituitary Surgery or Irradiation  Patients on lithium and amiodarone ```

Answer 34

 Thyroid function tests, Thyroid antibodies  Treat with levothyroxine needs to have recent thyroid function tests if doing tx on pt

Answer 35

```  Delayed eruption  Enamel hypoplasia  Macroglossia  Micrognathia  Thick lips  Dysgeusia ```

Answer 36

```  Autoimmune thyroid disease o Graves Disease o Postpartum thyroiditis  Toxic nodular goitre  Toxic adenoma ``` ``` Rare:  Amiodarone induced  De Quervain’s thyroiditis  Thyrotroph adenoma  hCG hyperthyroidism ◦ Hydatidiform mole ◦ Choriocarcinoma ```

Answer 37

```  Weight loss  Heat intolerance  Anxiety, irritability  Increased sweating  Increased appetite  Palpitations  Loose bowels ```

Answer 38

```  Goitre  Tremor  Warm moist skin  Tachycardia  Eye signs  Thyroid bruit  Muscle weakness  Atrial fibrillation ```

Answer 39

 Diffuse goitre  Eye signs  Pretibial myxoedema - redness and inflammation of the shins  Vitiligo and features of other autoimmune disease/ coeliac etc  FH of autoimmune thyroid disease

Answer 40

 TSH receptor Abs  TPO Abs  Thyroglobulin Abs  Thyroid Radioisotope scan

Answer 41

 Medical Drug side effects e.g. nausea, vomiting, leucopenia leading to agranulocytosis, aplastic anaemia, drug fever, cholestatic jaundice if it comes back  Surgical  Radioactive iodine

Answer 42

 Accelerated dental eruption  Maxillary or mandibular osteoporosis  Increased susceptibility to caries  Periodontal disease  Increased sensitivity to epinephrine which may result in arrhythmias or palpitations  Surgery, oral infection and stress may precipitate thyroid crises

Answer 43

```  New onset - 50% of population have nodules anyway  Increase in size  Onset of pain  Associated speech disturbance  Lymphadenopathy  Patient / Doctor concern ```

Answer 44

``` LH FSH PRL - dopamine inhibits constantly GH TSH ACTH ```

Answer 45

Tumour mass effects Hormone excess Hormone Deficiency

Answer 46

Hormonal tests | • If hormonal tests abnormal or tumour mass effects perform MRI pituitary

Answer 47

Cranial Nerve Palsy and Temporal Lobe Epilepsy Headaches CSF rhinorrhoea Visual Field Defects

Answer 48

``` GH Short stature Abnormal body composition Reduced Muscle Mass Poor Quality of Life Rx: Growth Hormone ``` LH/FSH Hypogonadism Reduced Sperm Count Infertility Menstruation Problems Rx: Testosterone in males; oestradiol ± progesterone in females TSH Hypo Thyroidism Rx: Levothyroxine ACTH Adrenal Failure Decreased Pigment Rx: Hydro cortisone ADH iabetes Insipidus (ADH deficiency - Decreased water absorption in kidney resulting in polyuria & polydipsia) Rx: DDAVP

Answer 49

 Pituitary tumours - 10-20% of population asymptomatic  Radiotherapy  Trauma  Infarction  Infiltration e.g. sarcoidosis, haemochromatosis  Infection e.g. tuberculosis, syphilis  Sheehan’s syndrome (post partum pituitary necrosis)

Answer 50

* Excessive growth hormone secretion with resultant high IGF-1 levels. * Prevalence of 40-60 cases/million population. * Incidence of 4 cases/million per year. * Equal sex incidence * Delayed diagnosis by 7 to 10 years

Answer 51

```  Coarse facial features  Enlargement of supraorbital ridges  Separation of teeth  Prognathism  Macroglossia ```

Answer 52

```  Coarse facial features  Enlargement of supraorbital ridges  Separation of teeth  Prognathism  Macroglossia ```

Answer 53

IGF1, dynamic tests, MRI pituitary

Answer 54

Surgical resection – TSS, TFS - biochemical control 80% microadenomas 50% macroadenomas Somatostatin analogues – 40% complete responders  Pegvisomant reduces IGF-1 to levels > 90% Radiotherapy in unsuccessful surgery

Answer 55

 Jaw Malocclusion - class III  Difficulty in speech due to macroglossia  Teeth mobility  Missing teeth  Teeth separation  Thickening of alveolar processes  Enlarged posterior roots  In 50% upper airways obstruction caused by pharyngeal hypertrophy and macroglossia with obstructive sleep apnoea.

Answer 56

``` Excess glucocorticoids due to Pituitary tumor 70-80% Adrenal tumor 10-20% Ectopic ACTH tumor 10% Iatrogenic ```

Answer 57

``` Weight gain 90% Menses probs 60% “Moon face” 75% Acne 40% HTN 75% Bruising 40% Striae 65% Osteopenia 40% Glucose intol. 65% Hyperpig 20% Muscle weak 60% K+ meta. alk. 15% Plethora 60% Hirsutism 65% Edema 40% ```

Answer 58

 Hormonal tests: Dynamic suppression tests (Dexamethasone suppression tests) measuring cortisol, ACTH  Radiological (If hormonal tests are abnormal)  MRI pituitary (pituitary tumour)  CT adrenals (adrenal tumour)  CT chest, abdomen, pelvis (ectopic ACTH tumour)

Answer 59

 Surgery  Drugs  Consider radiotherapy for pituitary disease if surgery fails

Answer 60

Lack of cortisol production | Produce too much ACTH but glands not producing enough cortisol - leads to them being pigmented

Answer 61

primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones.

Answer 62

```  Autoimmune Tuberculosis Fungal infections Adrenal hemorrhage Congenital adrenal hypoplasia  Sarcoidosis  Amyloidosis Metastatic neoplasia ```

Answer 63

 After exogenous glucocorticoids  After treatment of Cushing’s  Hypothalamic or pituitary tumours

Answer 64

``` Weakness Skin and mucous membrane pigmentation Loss of weight, emaciation, anorexia, vomiting, diarrhea Hypotension Salt craving Hypoglycemic episodes ```

Answer 65

 Hormonal tests: - Dynamic stimulation tests (Synacthen test) measuring cortisol - ACTH, adrenal antibodies  Radiological (If hormonal tests are abnormal)  MRI pituitary (pituitary disease)  CT or MRI adrenals (adrenal disease)  CXR if suspecting TB

Answer 66

Hydrocortisone replacement treatment

Answer 67

 On treatment therapy e.g asthma, rheumatoid arthritis ◦ Prednisolone > 7.5mg ◦ Hydrocortisone > 30mg ◦ Dexamethasone > 0.75mg  On replacement therapy ◦ Addison’s e.g. Hydrocortisone 20/10mg ◦ ACTH deficiency 10/5/5mg Simple Procedures: double dose one hour before surgery, double dose oral medication for 24 hours Major Procedures/GA: hydrocortisone 100mg im at induction and double dose oral medication for 24 hours

Answer 68

* Hyperthyroidism – render euthyroid * Phaeochromocytoma – treat before any surgery * Cushing’s – avoid infections and pathological fractures; steroid cover * Refer to endocrinologist

Answer 69

* Primary aldosteronism - producing too much aldosterone, retaining salt in the body, affects adrenal glands * Phaeochromocytoma - too much adrenaline * Acromegaly - too much gh * Cushing’s syndrome - too much cortisol * Hypothyroidism * Hyperthyroidism first 4 most important

Answer 70

* Average person has 1kg of calcium * 99% in the skeleton * Ionised calcium in ECF <1% – Cofactor in coagulation – Skeletal mineralisation – Membrane stabilisation • Neuronal conduction

Answer 71

increase calcium reabsorption decrease phosphate reabsorption increase hydroxylation of 25-OH vit D increase bone remodelling bone resorption increases ....

Answer 72

new slide put in | Miguel de bono