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Path - Chem Path > Pituitary, Thyroid, Adrenals > Flashcards

Pituitary, Thyroid, Adrenals Flashcards

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1
Q

Hypothalamic Hormone - GHRH has action on which pituitary hormone(s)?

A

Stimulates GH

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2
Q

Hypothalamic Hormone GnRH has action on which hormone?

A

LH/FSH

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3
Q

Hypothalamic Hormone - TRH has action on which pituitary hormone(s)?

A

Stimulates TSH, Prolactin

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4
Q

Hypothalamic Hormone - Dopamine has action on which pituitary hormone(s)?

A

Inhibits Prolactin

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5
Q

Hypothalamic Hormone - CRH has action on which pituitary hormone(s)?

A

Stimulates ACTH

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6
Q

Combined Pituitary Function Test (CPFT) - Indications

A

Assessment of all components of anterior pituitary function used particularly in pituitary tumours or following tumour treatment

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7
Q

Combined Pituitary Function Test (CPFT) - Contraindications

A

Ischaemic heart disease Epilepsy Untreated hypothyroidism (impairs the GH and cortisol response)

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8
Q

Combined Pituitary Function Test (CPFT) - Side Effects

A

-Sweating, palpitations, loss of consciousness -Rarely - convulsions with hypoglycaemia -Patients should be warned that the TRH injection they may experience transient symptoms of - metallic taste in mouth, flushing and nausea

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9
Q

Combined Pituitary Function Test (CPFT) - Interpretation

A

Involves interpreting three aspects 1) Insulin tolerance test 2) Thyrotrophin Releasing Hormone Test 3) Gonadotrophin Releasing Hormone Test

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10
Q

Combined Pituitary Function Test (CPFT) - Interpretation -Insulin tolerance test

A

-Adequate cortisol response = Increase greater than 170 nmol/l to above 500nmol/l

> below 170 = Cushings

-Adequate GH response = Increase greater than 6mcg/L

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11
Q

Combined Pituitary Function Test (CPFT) - Interpretation -Thyrotrophin Releasing Hormone Test

A
  • The normal result is a TSH rise to >5mU/l (30min value >60min value -If the 60min sample > 30min value - indicated primary hypothalamic disease)
  • Hyperthyroidism = TSH remains suppressed
  • Hypothyroidism = exaggerated response
  • With the current sensitive TSH assays basal levels are now adequate and dynamic testing is not usually needed to diagnose hyperthyroidism
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12
Q

Combined Pituitary Function Test (CPFT) - Interpretation -Gonadotrophin Releasing Hormone Test

A
  • Normal peaks can occur at either 30 or 60 minutes
  • LH should >10U/l and FSH should >2U/l
  • An inadequate response = possible early indication of hypopituitarism
  • Gonadotrophin deficiency is diagnosed on the basal levels rather than the dynamic response
  • Males = Low testosterone in the absence of raised basal gonadotrophins
  • Females = low oestradiol without elevated basal gonadotrophins and no response to clomiphene -Pre-pubertal children should have no response of LH or FSH to LHRH
  • IF sex steroids are present (i.e. precocious puberty), the pituitary will be ‘primed’ and will therefore respond to LHRH. Priming with steroids MUST NOT occur before this test
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13
Q

Pituitary Tumours - size and effects

A

Can produce any combination of pituitary hormones

  • Microadenoma less than 10mm, benign
  • Macroadenoma greater than 10mm, aggressive

Can compress optic chiasm = bitemporal hemianopia

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14
Q

Posterior pituitary hormones

A

ADH

Oxytocin

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15
Q

causes of Excess ADH

A

Lungs - Lung paraneoplasias - SCC and Small Cell pneumonia

Brain - Traumatic Brain injury, meningitis

Iatrogenic - SSRIs, Amitryptiline

Effect - Euvolaemic Hyponatraemia

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16
Q

Neurogenic/ Cranial ADH failure

A

Failure of ADH production - 50% idiopathic

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17
Q

Nephrogenic ADH failure - causes

A

Commonly iatrogenic - Lithium, also hypercalcaemia, renal failure

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18
Q

Dipsogenic ADH failure

A

failure/ damage to hypothalamus and thirst drive, hypernatraemia without increased thirst response

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19
Q

Oxytocin -effects? -if pathologically low, what can you give? -antagonist?

A

Acts to increase uterine contractions and expulsion of milk. Not commonly pathological- if in failure of production syntocinon can be given to help stimulate breast feeding. Oxytocin antagonist Atosiban used in tocolysis

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20
Q

Normal values of

  • TSH
  • Free T4
  • Free T3
A

TSH - 0.33-4.5 mu/L

Free T4 - 10.2-22.0 pmol/L

Free T3 - 3.2-6.5 pmol/L

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21
Q

Thyroid Function Tests -High TSH and Low T4

A

Hypothyroidism

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22
Q

Thyroid Function Tests -High TSH normal T4

A

Treated hypothyroidism or subclinical hypothyroidism (look for associated hypercholesterolaemia)

23
Q

Thyroid Function Tests -High TSH and High T4

A

TSH secreting tumour or thyroid hormone resistance

24
Q

Thyroid Function Tests -Low TSH and High T4/T3

A

Hyperthyroidism

25
Q

Thyroid Function Tests -Low TSH and normal T4/T3

A

Subclinical Hyperthyroidism

26
Q

Thyroid Function Tests -Low TSH and Low T4

A

Central hypothyroidism (hypothalamic/pituitary disorder

27
Q

Thyroid Function Tests - High (later Low) TSH and Low T4/T3

A

Sick euthyroidism (with any severe illness)

28
Q

Thyroid Function Tests -Normal TSH, abnormal T4

A

? Assay interference, changes in TBG, amiodarone

29
Q

Causes of High Uptake Hyperthyroidism

A
  • Graves disease - 40-60%, F>M (9:1), autoantibodies ++, high uptake on isotope scan
  • Toxic multinodular goitre- 30-50%, high uptake
  • Toxic adenoma - 5%, hot nodule on isotope scan
30
Q

Causes of Low Uptake Hyperthyroidism

A
  • Subacute DeQuervains Thyroiditis - self limiting post viral painful goitre
  • Postpartum thyroiditis
31
Q

Causes of Autoimmune Hypothyroidism

A
  • Primary atrophic hypothyroidism - diffuse lymphocytic infiltration and atrophy. No goitre
  • Hashimotos thyroiditis - Plasma cell infiltration and goitre. Elderly females. May be initial Hashitoxicosis. ++ autoantibody titres
32
Q

Other causes of Hypothyroidism

A
  • Iodine deficiency (common worldwide)
  • Post thyroidectomy/radioiodine
  • Drug induced - antithyroid drugs, lithium, amiodarone
33
Q

Hyperthyroid - treatment

A

Depends on aetiology

  • Low uptake - symptomatic - beta blockers, NSAIDs for dequervains
  • High uptake - BB and antithroid therapy - carbimazole/propylthiouracil (prop is rarely used now due to risks of aplastic anaemia)

Can be used to block and replace or titrate TSH. Can also use radio iodine or surgery

34
Q

Hypothyroid - treatment

A

Thyroid replacement therapy

35
Q

Thyroid Neoplasia - Papillary -frequency, average age of onset, treatment

A

>60% of cases 30-40y surgery +/- radioiodine, Thyroxine to lower TSH

36
Q

Thyroid Neoplasia - Follicular -frequency, average age of onset, appearance, treatment

A

25% Middle age Well differentiated but spreads early Surgery + RI + Thyroxine

37
Q

Thyroid Neoplasia - Lymphoma -Risk factor

A

5% MALT origin (mucosa-associated lymphoid tissue) Risk factor - Chronic Hashimotos, good prognosis

38
Q

Thyroid Neoplasia - Anaplastic –frequency, average age of onset, treatment

A

Rare Elderly Poor response to any treatment

39
Q

Cushing’s syndrome -cause

A

Pituitary Tumour - “Cushing’s Disease” (85%)

Adrenal Tumour (10%)

Ectopic ACTH producing tumour (5%)

Iatrogenic - steroid use

40
Q

Cushing’s Disease -Symptoms & Signs

A

Moon face Buffalo Hump Striae Acne Hypertension Diabetes Muscle weakness proximal myopathy Hirsuitism

41
Q

Cushing’s Disease -Investigations

A

Low dose dexamethasone (0.5mg) High dose dexamethasone (2mg)

42
Q

Cushing’s Disease -Treatment

A

Treat underlying disease - surgical removal of lesion

43
Q

Addison’s Disease -Causes

A

Autoimmune TB Tumour deposits Adrenal haemorrhage Amyloidosis

44
Q

Addison’s Disease -Symptoms & signs

A

High K+, low Na+ and low glucose Postural hypotension Skin pigmentation Lethargy Depression

45
Q

Addison’s Disease -Investigations

A

SynACTHen Test

46
Q

Addison’s Disease -Treatment

A

Hormone repalcement - Hydrocortisone/fludrocortisone if primary adrenal lesion

47
Q

Conn’s Disease -Causes

A

Adrenal tumour

48
Q

Conn’s Disease -Symptoms & Signs

A

Uncontrollable Hypertension, High Na+, Low K+

49
Q

Conn’s Disease -Investigations

A

Aldosterone:Renin Ratio

50
Q

Conn’s Disease -Treatment

A

Aldosterone antagonists/ potassium sparing diuretics - Spironolactone, eplerenone, amiloride

51
Q

Pheochromocytoma -Causes

A

Adrenal medulla Tumour = high Adrenaline

52
Q

Pheochromocytoma -Symptoms & Signs

A

Episodic hypertension

Arrhythmias

Death if untreated

53
Q

Pheochromocytoma -Investigations

A

Plasma and 24h urinary metadrenaline measurement/ catecholamines & VMA

54
Q

Pheochromocytoma -Treatment

A

Alpha blockade, beta blockade then surgery when blood pressure well controlled

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