Revision Tutorial Flashcards
why does hand and foot size increase in acromegaly
due to soft tissue expansion
what is the gold standard test for acrogmegaly
GTT (GH should decrease with glucose but in acromegaly it increases)
what tests can you do for acromegaly
GTT, IGF- 1
what happens if a pituitary tumour grows into the sphenoid sinus
CFS leak- clear drops coming from node
what happens if a pituitary tumour grows laterally into cavernous sinus
squint due to compression on cranial nerve 6
why is cranial nerve 6 the most prone to injury
is the longest
what additional tests should you do in acromegaly
Visual fields, TSH (hypothyroid from pituitary tumour), T4, prolactin, sodium (hypoadrenal), BG for diabetes, U and Es
(helps tell if there is a tumour)
what is the clinical sign name for excessive or inappropriate milk production
galactorrhoea
what are 5 causes of galacctorhoea
prolactinoma, pregnancy, drugs: antipsychotics/dopamine antagonists/metaclopramide, pituitary tumour, RTA
what is the round dark object on either side of the pituitary
carotid artery
what nerves are in the cavernous sinus
oculomotor trochlear opthalmic branch of trigeminal maxillary branch of trigeminal abducens nerve trocheal nerve
damage to what nerve causes the eye to be pulled inwards
abducents
damage to what nerve will cause a squint when the eye can only move outwards
oculomotor
what is the venous system of the cavernous sinus
superior and inferior petrosal sinuses- ultimately into the internal jugular vein via the sigmoid sinus
what is metabolic syndrome
obesity, hypertension, increased blood glucose and cholesterol- puts you at risk of diabetes and CVD disease
why do you get thin skin in cushings
mobilisation of protein, protein degradation
what screening test for cushings
overnight DT
what eye signs in cushings
conjunctival oedema (chemosis)
how does high cortisol weaken bones
increases osteoclasts activity, reduces osteoblasts, collagen formation and calcium absorbtion
what should dexomethasone do
decrease ACTH and cortisol levels
what can causes a glucocorticoid deficiency
addisons disease
what can cause addison
CAH, haemorrhage of the adrenal glands (acute hypoadrenalism), menigococcal septicaemia, exogenous steroid use, adrenal TB, hypopituitarism
what can be see in the mouth in addisons disease
buccal pigmentation
what could cause a man to havel short stature, high pitch voice, infantile genitalia, no pubic or axillary hair
hypogonadism (happened pre puberty)
name 3 things that can cause hypogonadism
hypopituitarism, anabolic steroid (long term), tumour
what investigations should you do in hypogonadism
testosterone and LG/FSH, GH, IGF-1, prolactin, ACTH and cortisol
what can cause amenorrhoea
pregnancy, hyper and hypothyroidism
what likely caused this: 24 y/o women, amenorrhoea, hirustism
PCOS
what drugs can you give in PCOS
metformin, combined contraceptive pill, anti andorgens (cyclotyrone, spironolactone, elphloathine)
what caused this: boy with marfanism, mum had thyroid cancer, tongue has small neuromata, larger neuromata on gums, slightly raised calcium
MEN 2 (thyroid cancer and neuroma)
what causes this: middle aged women, hypertensive- intermittent attacks, cafe-au-late, lumps below skin
MEN 2 causing a phaeochomocytoma (too much adrenaline causing the paradoxical HPX attacks)
A 24 year old female notices a lump in her neck. Her GP thinks it might be a thyroid swelling and send her to the clinic for assessment. What tests should be done to confirm the diagnosis?
blood tests for T3, T4, TSH, thyroid antibodies
ultrasound (U1-5)- above 3 needs FNA
thyroid uptake scan
what is the prognosis for thyroid cancer
80-85% follicular or papillary, good prognosis, dont metastasise, present early, thyroidectomy to remove it
who need FNA always for thyroid lump
under 30s, esp teens
what usually accompanies medullary thyroid cancers
MEN 2 (a and b) or family history
what can cause hyperthyroidism
toxic nodule/ goitre, graves or autoimmune, thyroiditis (autoimmune/ viral),
how do you use blood tests to distinguish toxic goitre from graves
toxic goitre increased conversion to T3, graves all thyroid hormones raised
what is the treatment for graves
antithyroid drugs, surgery, radioactive iodine
what is the treatment for a toxic nodule
beta blockers, radioiodine
what is the risk in carbimazole
agranulocytosis- check white blood count if sore throat or dry cough
what should you do in patients needing levothyroxine with CVD
might exacerbate symptoms so start with low dose and titrate up
what can cause cushings syndrome
Pituitary adenoma (cushings disease), exogenous steroid use, ectopic tumour secreting ACTH, small cell carcinoma, pseudo cushings (appearances of cushings without biochemical markers- commonest cause alcohol)
what test to diagnose cushings
1mg overnight DTT suppression test (at 10 oclock, check cortisol at 9am- can get false positive in chronic stress and depression), 48 hr low dose DTT suppression test, if this negative do a high dose DTT suppression. In cushings lose diurnal variation, have high cortisol production so have raised 24 hr cortisol urinary secretion. If from pituitary CT pituitary, if not CT chest.
when not fit for surgery what drug can help with cushings syndrome
metyraprone
what can cause amenorrhoea
hypothyroidism, hyperthyroidism, pregnancy, low body weight/ excessive exercise (hypothalamic dysfunction), hyperprolactinaemia (iatrogens (dopamine antagonists, stressed, prolactinoma)), premature ovarian failure.
what drugs can cause galactprrhoea
metoclopramide, anti convulsants, dopamine antagonists, anti depressants. Anti pyschotics, thenofiazine, oestrogens, opiates (all cause lack of dopamine).
what are the signs of panhypopituitarism
tiredness, weight gain, thirst, amenorrhoea, slowness of thought, reduced exercise tolerance, pale skin, hairlessness, diarrhoea, vomiting, postural hypotension, pigmentation increased- in Addisons
how can you confirm a diagnosis of panhypopituitarism
IGF-1, thyroid function test (TSH), ACTH and cortisol, GTT, water deprivation for ADH, PRL. Need to do stimulation tests
name causes of pituitary failure
pituitary adenoma, carcinoma, haemorrhage (pituitary apoplexy), hyperplasia, trauma (RTA/surgery), sheenans syndrome, radiotherapy/ chemotherapy, infective (post meningitis), auto immune, sarcoidosis
name 4 endocrine conditions that can cause hypertension
cushings, diabetes, phaeochromocytoma, conns (primary hyperaldosterism), acromegaly
what can be diagnosed with an MIBG scan
phaeochromocytoma
what receptor for:
insulin
tyrosine kinase receptor
what receptor for:
growth hormone
cytokine receptor
what receptor for:
caclium
GPCR
what is the main role of insulin
increases hepatic glycogen synthesis
what nerves pass through the right cavernous sinous
III, IV, V1, V2, VI
what structure is most at risk during a total thyroidectomy
recurrent laryngeal nerve
how often should people with insulin who drive check their insulin
every time they drive
what is the target of the drug dapagliflozin
sodium glucose co transporter
what is insulitis
inflammatory infiltrate around a pancreatic islet
what is this thyroid uptake scan appearance:
uptake reduced
thyroiditis
what is this thyroid uptake scan appearance:
increase uptake of whole thyroid
graves
what is this thyroid uptake scan appearance:
patchy uptake
multinodule
what is a colloid nodule
benign thyroid lumps which can be solitary or found in a multinodular goitre
what is the treatment for a microprolactinoma
cabergoline (dopamine agonists)
why might you have raised prolactin in a NON functioning pituitary adenoma
as tumour might block dopamine getting through the stalk
what is the FIRST thing you should treat in hypopituitarism
hydrocortisone
what will prolactin levels be like in a macroprolactinoma
> 5000
what is the treatment for a phaeochromocytoma
alpha then beta blocker (a before b)
how do you diagnose conns
paired renin and aldosterone measurement
what syndrome is hyperaldosteronism
conns
what do you loose in conns
potassium
what is the treatment for an addisons crisis
IV saline and hydrocortisone
what is the gold standard for acromegaly diagnosis
glucose tolerance test
what are the 6 p’s of acute limb ischaemia
pale painless pulseless paralysed paraesthesia perishing cold
