Endocrinology- micellaneous

Question 1

Acromegaly
- Definition
- Causes
- Signs and symptoms

Answer 1

Definition
- Excess GH in adults

Causes
- Pituitary tumour stimulating XS GH release (pituitary somatotroph adenoma)
- Ectopic production of GH or GHrH.

Symptoms
- Coarse facial features
- Acroparaesthesia
- Amenorrhea
- Snoring
- Arthralgia
- Sweating
- Hypertension
- Diabetes
- Decreased libido

Question 2

Function of GH

Answer 2

Stimulates bone and soft tissue growth
- Via IGF-1

Question 3

Acromegaly investigations

Answer 3

Bloods
- Hyperglycaemia
- Hypercalcaemia (bone turnover)
- Hyperphosphataemia (bone)

GH glucose test

Question 4

What is the most common type of thyroid cancer?

Answer 4

Papillary carcinoma (75%)

Question 5

Papillary carcinoma of the thyroid typically metastasises via…

Answer 5

Lymphatics

Question 6

What population of people does thyroid papillary carcinoma typically affect?

Answer 6

Younger women (35-40)

Question 7

What thyroid cancer has the worse prognosis

Answer 7

Anaplastic carcinoma

Question 8

Medullary carcinoma of the thyroid arises from what cells/ tissue?

Answer 8

Parafollicular C cells

Question 9

Medullary carcinoma of the thyroid produces what 2 things?

Answer 9

Calcitonin

CEA

Question 10

What thyroid cancer is associated with the MEN2A and 2B syndrome

Answer 10

Medullary carcinoma

Question 11

Follicular carcinoma of the thyroid spreads via ______ and is most likely to metastasise to what areas?

Answer 11

Spreads via blood (haematogenically)
- Metastasises to BLL (bone, liver, lung)

Question 12

What is the 2nd most common type of thyroid cancer?

Answer 12

Follicular carcinoma

Question 13

Anaplastic carcinoma of the thyroid typically affects what population of people?

Answer 13

Older people (60+)

Question 14

Risk factors of thyroid cancer

Answer 14

Exposure to ionising radiation (i.e. neck radiotherapy)

Family history of thyroid disease

Female

Previous thyroiditis

MEN2 syndrome

Question 15

Serum _____ is typically elevated in medullary carcinoma of the thyroid

Answer 15

Calcitonin

Question 16

Indications of 2-week referral for thyroid cancer

Answer 16

Unexplained thyroid lump/ nodule

Thyroid mass with unexplained voice hoarseness/ voice changes

Thyroid mass with supraclavicular/ cervical lymphadenopathy

Unexplained painless thyroid mass increasing rapidly in size

Thyroid nodule with compression signs

Question 17

Presentation of a thyroid cancer

Answer 17

Hard, non tender thyroid nodule

Cervical lymphadenopathy (especially in papillary)

Voice hoarseness/ stridor

Question 18

What thyroid cancer typically grows rapidly?

Answer 18

Anaplastic carcinoma

Question 19

What are the three phases of de Quervain thyroiditis?

Answer 19

1. Transient thyrotoxicosis (4-6 weeks)
2. Transient hypothyroidism (2-6 months)
3. Euthyroidism

Question 20

What are the biochemical findings in de Quervain thyroiditis

Answer 20

Thyrotoxicosis phase
- Raised T3 and T4
- Raised ESR, CRP
- Reduced thyroid radioiodine uptake

Hypothyroid phase
- Low T3, T4
- May show thyroid peroxidase antibodies

Question 21

What are the histological findings of de Quervain thyroditis

Answer 21

Giant cell granulomatous inflammation

Question 22

de Quervain thyroiditis is typically triggered by…

Answer 22

Viral upper respiratory tract infection

Question 23

What are the conditions included in Multiple endocrine neoplasia, Type 1 (MEN1 syndrome)

Answer 23

3Ps

Pituitary adenoma

Parathyroid hyperplasia

Pancreatic tumours

Question 24

What are the conditions included in Multiple endocrine neoplasia, Type 2A (MEN2A syndrome)

Answer 24

Ps over M (2Ps and 1M)

Medullary carcinoma of the thyroid

Phaeochromocytoma

Parathyroid hyperplasia

Question 25

What are the conditions included in Multiple endocrine neoplasia, Type 2B (MEN2B syndrome)

Answer 25

Ms over P (3Ms, P M)

Mucosal neuromas

Marfanoid habitus

Medullary thyroid cancer

Phaemochromocytoma