Endocrinology

Question 1

What are the symptoms of carcinoid syndrome?

Answer 1

• • Wheeze
• • Diarrhoea
• • Flushing
• • Itching
• • Hypotension
• • Pulmonary stenosis/TR

Symptoms worsened by:

• • Alcohol
• • Stress

Question 2

What is the pathophysiology of carcinoid syndrome?

Answer 2

• Tumour of neuroendocrine cells
• Secrete peptides (serotonin, histamine, bradykinins, prostaglandin)
• Metabolised by liver so only symptomatic when metastases or bronchial/thymic
• High concentration of somatostatin receptors (suppress hormone release)

Question 3

How do you investigate for carcinoid syndrome?

Answer 3

1. Confirm diagnosis
   - -3 x 24h 5-HIAA
2. Investigate cause
   - -CT TAP
   - -Bowel imaging e.g. endoscopy
   - -PET with C5 hydroxytryptophan
   - -Octreoscan - radiolabelled somatostatin analogue

Question 4

How is carcinoid managed?

Answer 4

1. MDT approach
2. Somatostatin analogue (octreotide)
3. Surgical - resect primary & debunking
4. Symptom control
   - loperamide
   - antihistamine
5. Niacin supplementation (can get pellagra)

Question 5

What are the symptoms of acromegaly?

Answer 5

• -Headache
• -Joint pains
• -Sweating
• -Increased shoe/denture size
• -Fatigue

Question 6

What are the clinical signs of acromegaly?

Answer 6

Head:

• -Coarse Facies
• -Prognathism (overbite)
• -Bitemporal hemianopia
• -Husky voice

Body

• -Hypertension
• -Spade like hands
• -Growing feet
• -Oily skin

Question 7

What are the complications of acromegaly?

Answer 7

• -Hypertension
• -Diabetes
• -Cardiomyopathy
• -Colorectal cancer
• -Carpal tunnel syndrome
• -Hypopituitarism

Question 8

How do you investigate for acromegaly?

Answer 8

Screening test: Random IGF-1
If elevated:
75g oral glucose tolerance test: should suppress GH
Anterior pituitary hormone profile
MRI pituitary

Question 9

How do you manage acromegaly?

Answer 9

MDT approach
Medical:
1. Somatostatin analogue: octreotide
2. Pegvisomant (GH receptor antagonist)

Surgical
1. Transsphenoidal resection

Radiotherapy

Question 10

What are the causes of gynaecomastia?

Answer 10

Physiological
-Neonatal/pubertal/age related

Congenital (e.g. klinefelter, Noonan, Kallman)

Acquired

• Idiopathic
• Chronic liver disease
• Chronic renal disease
• Thyrotoxicosis
• Drugs (spironolactone, digoxin)
• Testicular tumours (hCG)