Endocrinology- Concepts Flashcards
Thyroid illness
hyperthyroidism
hypothyroidism
goitre
carcinoma thyroid
pancreas illnesses
type 1 diabetes
type 2 diabetes
kidney illness
renin depended hypertension
testes illness
subfertility
testicular failure
bone illness
osteoporosis
osteomalacia
pituitary and hypothalamus illnesses
- hyperprolactinaemia
- hypopituitarism
- pituitary tumors
parathyroid glands illness
- hyperparathyroidism
- hypoparathyroidism
breast illness
- hyperprolactinaemia
adrenals illness
addison’s disease
cushing syndrome
conn syndrome
phaechromocytoma
ovaries illness
polycystic ovary syndrome (PCOS)
menopause
subfertility
What are the main causes of endocrine gland hyperfunction?
Neoplastic: Tumors causing overproduction of hormones.
Autoimmune: Conditions where the immune system stimulates excessive hormone production.
Iatrogenic: Hormone excess due to medical treatments, such as excessive hormone therapy.
What are the main causes of endocrine gland hypofunction?
Infectious/Inflammatory: Infections or chronic inflammation leading to gland destruction and reduced hormone production.
What causes hormone resistance in endocrine dysfunction?
Receptor mutations: Mutations in hormone receptors can prevent proper hormone action.
Enzyme defects:
Deficiencies in enzymes required for hormone action can lead to resistance
What is Cushing’s syndrome?
Cushing’s syndrome is a condition caused by prolonged exposure to elevated levels of cortisol, often due to pituitary adenomas, adrenal tumors, or ectopic ACTH production.
What are the common causes of Cushing’s syndrome
Pituitary adenomas (Cushing’s disease): Benign tumors producing excess ACTH.
Adrenal tumors: Primary adrenal tumors producing cortisol.
Ectopic ACTH syndrome: Tumors outside the pituitary producing ACTH (e.g., small cell lung cancer).
Iatrogenic: Prolonged use of corticosteroid medications.
What are the classic symptoms of Cushing’s syndrome?
Weight gain (central obesity)
Moon facies (rounded face)
Buffalo hump (fat accumulation on the upper back)
Skin changes (thin, easy bruising)
Muscle weakness
Hypertension
Hyperglycemia (high blood sugar)
How is Cushing’s syndrome diagnosed?
24-hour urinary free cortisol test: Measures cortisol levels in urine.
Low-dose dexamethasone suppression test: Assesses cortisol suppression response.
Late-night salivary cortisol test: Measures cortisol levels at night, which should normally be low.
What are the potential complications of Cushing’s syndrome?
Complications may include:
Osteoporosis and increased fracture risk
Cardiovascular disease (hypertension, dyslipidemia)
Diabetes or glucose intolerance
Increased risk of infections
Psychiatric issues (depression, anxiety)
How is Cushing’s syndrome treated?
Surgery: Removal of the tumor (pituitary or adrenal).
Medications: Drugs to inhibit cortisol production (e.g., ketoconazole, mitotane).
Radiation therapy: For pituitary tumors when surgery is not an option.
Cushing’s discriminating features
Skin:
- Easy Bruising
- Thin skin
- Facial plethora
- Typical striae (purple, > 1cm wide)
Muscle:
- Proximal weakness
Growth
- Short stature in children
What is pseudo-Cushing’s syndrome?
Pseudo-Cushing’s syndrome is a condition that mimics Cushing’s syndrome, characterized by elevated cortisol levels due to non-endocrine factors, such as stress, depression, or excessive alcohol consumption, rather than an adrenal or pituitary disorder.
How does alcohol consumption contribute to pseudo-Cushing’s syndrome?
Chronic alcohol use can lead to increased cortisol production, causing symptoms similar to Cushing’s syndrome, such as weight gain, facial changes, and skin alterations. It may also cause stress on the body, further elevating cortisol levels.
How does depression affect cortisol levels in pseudo-Cushing’s syndrome?
Depression is associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated cortisol levels. Symptoms may mimic those of Cushing’s syndrome, including fatigue, weight changes, and mood disturbances.
How can pseudo-Cushing’s syndrome be differentiated from true Cushing’s syndrome?
Pseudo-Cushing’s syndrome is typically characterized by:
Cortisol levels: While cortisol may be elevated, it often does not exhibit the same suppression response to dexamethasone as seen in true Cushing’s syndrome.
Reversible symptoms: Symptoms related to pseudo-Cushing’s usually improve with treatment of the underlying cause, such as reducing alcohol intake or addressing depression.
What is a pheochromocytoma?
A pheochromocytoma is a rare tumor of the adrenal gland that secretes catecholamines (e.g., epinephrine, norepinephrine), leading to episodes of hypertension and other symptoms.
How might pheochromocytoma be suspected in a patient with resistant hypertension?
Pheochromocytoma should be considered in cases of resistant hypertension, particularly if the hypertension is difficult to control despite multiple medications.
Is routine screening justified for pheochromocytoma?
Routine screening is not justified for the general population, but it is recommended for individuals with resistant hypertension, especially if there are clinical signs or a family history of endocrine tumors.
What symptoms should be asked about when evaluating for pheochromocytoma?
Headaches
Sweating
Tachycardia (rapid heart rate)
“Spells” or paroxysmal episodes of elevated blood pressure (occurring in approximately 50% of cases).
What family history should be considered when evaluating for pheochromocytoma?
A family history of conditions associated with pheochromocytoma, such as multiple endocrine neoplasia (MEN) syndromes, especially MEN2, or a family history of pheochromocytomas themselves, should be assessed.
What is an adrenal incidentaloma, and how should it be managed?
An adrenal incidentaloma is an adrenal mass discovered incidentally on imaging studies. It is important to always screen for hormonal activity, including assessment for pheochromocytoma, cortisol excess, and aldosterone excess, regardless of size
Hirsutism differential diagnosis
PCOS
Familial
Idiopathic
What is Polycystic Ovary Syndrome (PCOS)?
PCOS is a common hormonal disorder affecting people with ovaries, characterized by irregular menstrual cycles, excess androgen levels, and polycystic ovaries.
What are the common symptoms of PCOS?
Irregular or absent menstrual periods
Excess hair growth (hirsutism)
Acne and oily skin
Weight gain or obesity
Thinning hair or male-pattern baldness
Infertility
What are the diagnostic criteria for PCOS?
The diagnosis of PCOS typically requires at least two of the following three criteria (Rotterdam criteria):
Irregular or absent ovulation (irregular menstrual cycles).
Clinical and/or biochemical signs of hyperandrogenism (e.g., hirsutism, elevated testosterone levels).
Polycystic ovaries visible on ultrasound.
What are the potential complications associated with PCOS?
Infertility
Type 2 diabetes and insulin resistance
Endometrial hyperplasia and cancer
Cardiovascular disease
Sleep apnea
Depression and anxiety
What are the treatment options for PCOS?
- Lifestyle modifications: Weight loss through diet and exercise.
- Hormonal contraceptives: To regulate menstrual cycles and reduce androgen levels.
- Anti-androgens: Such as spironolactone for hirsutism and acne.
- Fertility treatments: Such as clomiphene citrate or letrozole for those seeking pregnancy.
- Metformin: To improve insulin sensitivity.
What lifestyle changes can help manage PCOS symptoms?
- Maintaining a healthy weight
- Following a balanced diet low in refined carbohydrates
- Engaging in regular physical activity (e.g., aerobic exercise, strength training)
- Managing stress through relaxation techniques or counseling
What is hirsutism?
Hirsutism is a condition characterized by excessive hair growth in women in areas typically associated with male-pattern hair distribution, such as the face, chest, and back.
What are the common causes of hirsutism?
- Polycystic Ovary Syndrome (PCOS): The most common cause.
- Hormonal imbalances: Excess androgens from conditions like adrenal hyperplasia or tumors.
- Medications: Certain drugs like anabolic steroids or hormonal treatments.
- Genetics: Family history of hirsutism can play a role.
How is hirsutism diagnosed?
Clinical assessment of hair growth patterns using the Ferriman-Gallwey scoring system.
Evaluation of underlying causes through medical history, physical examination, and laboratory tests (e.g., hormone levels).
What are the treatment options for managing hirsutism?
- Hormonal contraceptives: To reduce androgen levels.
- Anti-androgens: Such as spironolactone or finasteride.
- Topical treatments: Eflornithine cream for facial hair.
- Hair removal methods: Such as laser therapy, electrolysis, or waxing.
What does the guideline suggest regarding testing for elevated androgen levels in women with isolated mild hirsutism?
The guideline suggests against testing for elevated androgen levels in women with isolated mild hirsutism, as the likelihood of identifying a medical disorder that would change management or outcome is low (2QEEE).
