Extra endocrinology Flashcards
Hypercalcaemia
A: Hyperparathyroid, malignancy, vitamin D toxicity, iatrogenic, sarcoidosis, immobility.
S: Bones (pain/fractures), stones (renal), moans (depression) and groans (abdo pain).
Polyuria, polydypsia, constipation, confusion, fatigue.
D: Serum calcoum.
T: Rehydration, IV biphosphonates.
Hypocalcaemia
A: Hypoparathyroid, osteomalacia (vitamin D deficiency), hypomagnesaemia, drugs (cisplatin), metastases, acute pancreatitis.
S: Tingling, cramps, hyperreflexia, seizures. Twitching in corner of mouth (Chvostek’s sign), carpo-pedal spasm when BP cough is inflated (Trosseau’s sign).
D: Serum calcium
T: IV or oral calcium supplementation.
Hyperparathyroidism
A: Adenoma, hyperplasia or cancer.
Secondary to renal disease
Tertiary to autonomous hyperplasa.
S: Usually asymptomatc, features of hypercalcaemia. May cause renal stones, HTN, osteoperosis, arrythmias or renal failure.
D: Sermu HPT and calcium.
T: Cinacalcet to reduce calcium levels. Surgery.
Hypoparathyroidism
A: DiGeorge syndrome, hypomagnesaemia, calcium receptor mutation, autoimmune, radiation, surgery, infiltration, pseudoparathyroidism (failure to secrete)
S: Features of hypocalcaemia.
D: Serum PTH, sermu calcium.
T: Activated vitamin D and calcium supplements.
Phaeochromacytoma
A: Cathecolamine producing tumours of the adrenal medulla.
Can be sporadic or autosomal dominant.
S: HTN, postural hypotension, cardiac failure
Sweating, flushing, pallor, pyrexia, headache, palpitations.
D: Elevated 24 hour cathecolamines.
T: Alpha blockade with phenoxybenzamine followed by beta blockade for reflex tachycardia. May need adrenolectomy.
Congenital adrenal hyperplasia
A: Point mutation in CYP21 gene. Causing 21 hydroxylase deficiency. Also adrenocortical insufficiency.
S: Hirsutism, acne, oligomenorrhea, subfertility. Asymptomatic in males.
D: Increased serum 17-OH progesterone and testosterone.
T: Prednisolone 2.5mg or dexamethasone (0.5mg). Fludrocortisone,
Acromegaly
A: Excess GH.
Somatotroph adenoma in most cases. GHRH secretion.
S: Prognathism, frontal bossing, enlarged nose, deep voice, large hands and feet, nerve and entrapment, coarse skin.
Excess swelling, headaches joint pains, diabetic symptoms.
D: Fasting GH level and IGF-1 levels.
T: Trans-sphenoidal surgery followed by somatostatin and radiotherapy.
Hyperprolactinaemia
A: Prolactinoma, compressing stalk, radiation, drugs (DA therapy, neuroleptics, anti-depressants).
Remember the P’s: pregnancy, prolactinoma, physiological, POS, primary hypothyroidism, phenothiazides, metclopramide, domperidone.
S: Absent/reduced menstruation, galactorrhoea, breast tenderness, headaches, visual defects, loss of libido, sub-fertility.
D: Sermum prolactin, MRI pituitary.
T: Dopamine agonist therapy with bromocriptine or cabergoline.
Diabetes Insipidus
A: Deficiency of ADH causing free water loss.
S: Dehydration, polyuria, excessive thirst, weight loss.
D: Paired serum (increased) and urine osmolality (dilute) and overnight water deprivation.
T: Mild cases usually with free fluid intake, or desmopressin.
Symptom of Inappropriate ADH
A: Idiopathic, respiratory, CNS, drugs, malignancy.
S: Low sodium. Fatigue, confusion, falls, seizures, thirst.
T: Paired osmolalities, urine sodium.
T: Fluid restriction, demeclocyline.
Carcinoid tumour
A: Tumour of enterochromaffin cells of neural crest releasing excess 5-hydroxytriptamine. Usually in appendix or ileum (or other GI)
S: Flushing, abdo pain, diarrhoea, wheeze, right sided heart valve disease, peripheral oedema.
D: 24 hour urinary collection for 5-HIAA
T: Ocreotide, 5HT antagonists.
