T5-L1: Disorders of the Endocrine System Flashcards
How does prolactinoma present?
- Prolactinoma is one of the most functional tumours - results in uncontrollable division of the lactotrophs leading to producing of prolactin. This is due t a mutation in the lactotrophs.
- Can get gynecomastia, infertility, amenorrhea and increased milk production
It can lead to bitemporal hemianopia due to compression of the optic nerves. It can also lead to pain due to stretching of the meninges.
- Can get gynecomastia, infertility, amenorrhea and increased milk production
What is the best way to confirm acromegaly?
Best confirmation of acromegaly is glucose suppression test - glucose is supposed to suppress GH. Failure to suppress hGH is diagnostic of acromegaly when coupled with elevated IGF1 and clinical signs of excess growth hormone.
Give the epidemiology, aetiology and pathogenesis of Hashimoto’s thyroiditis.
Epidemiology; Found in 2% of the pop.; peaks is age 59, found in more women than men
Aetiology: Autoimmune - unsure of the causes
Pathogenesis: Autoimmune degeneration of the follicular cells leading to reduced production of T3 and T4. Involves the formation of antithyroid antibodies that attack the thyroid tissue, causing progressive fibrosis.
Give the epidemiology, aetiology and pathogenesis of Graves’ Disease.
Epidemiology: Responsible for 80% of hyperthyroidism. Females are affected more than men. Peaks in the third or fourth decades of life
Aetiology: Autoimmune, unknown cause
Pathogenesis: Caused by the production of IgG autoantibodies directed against the thyrotropin receptor - LTAS (long acting thyroid stimulator). These antibodies bind to and activate the receptor, causing the autonomous production of thyroid hormones.
Give some signs and symptoms of hypothyroidism.
Signs:
- Hypothermia
- Bradycardia
- Delayed relaxation of deep tendon reflex
- Periorbital oedema
- Enlargement of tongue
- Diastolic hypertension
- Hair loss
Symptoms:
- Constipation
- Weakenss/fatigue
- Feeling cold
- Weight gain
- Dry skin
- Hoarse voce
- Oedema
- Depression
- Paraesthesia
- Menorrhagia
Give some signs and symptoms of hyperthyroidism.
- Nervousness, anxiety and irritability
- Mood swings
difficulty sleeping
persistent tiredness and weakness - Sensitivity to heat
swelling in your neck from an enlarged thyroid gland (goitre) - An irregular and/or unusually fast heart rate (palpitations)
- Twitching or trembling
- Weight loss
- Diarrhoea
How do multi nodular goitres typically present?
Most patients have a euthyroid presentation - no thyroid symptoms.
Dominant nodules may be mistaken clinically for a thyroid carcinoma. Enlargement can lead to tracheal compression/dysphagia.
What is a common cause of solitary thyroid nodule? It has a solid mass with a fibres capsule which is usually cold on radio-isotopic scanning.
Thyroid follicular adenoma
Give the likely cause of the following cancer:
- Well differentiated carcinoma with excellent prognosis
- Younger (<45 years old) and mostly female patients
- 60 to 70% of thyroid carcinomas
- Invades lymphatics and spreads to local lymph nodes
Papillary thyroid cancer
What are causes of hyperparathyroidism?
Primary:
- Parathyroid Adenoma, Hyperplasia, Carcinoma
Secondary:
- Renal failure (impaired calciferol production)
- Hyperphosphatemia
- Decreased calcium levels
- Inhibition of bone reabsorption
Tertiary:
- Autonomous hyper secretion of the parathyroid hormone
- Chronic secondary hyperparathyroidism (after renal transplantation)
What is the function of the different parts of the adrenal gland?
Zona glomerulosa - mineralocorticoids
Zona fasciculata - glucocorticoids
Zona reticularis - androgens
Medullar - catecholamines stress hormones
What are the symptoms of Cushing’s syndrome?
- Upper body obesity with thin arms and legs
- Buffalo hump
- Red, round face
- High blood sugar
- High blood pressure
- Vertigo
- Blurry vision
- Acne
- Female balding
- Water retention
- Menstrural irregularities
- Thin skin and bruising
- Poor wound healing
- Hirsutism
- Purple striate
- Severe depression
Give the aetiology and pathogenesis of Cushing’s disease?
Rare endocrine disorder due to excessive cortisol - important for glucose metabolism and modulate response to stress.
- Endogenous - ACTH secreting pituitary adenomas, tumours of the pituitary etc. and exogenous causes (steroid therapy) - Paraneoplastic syndromes can also cause it
What is Conn’s syndrome?
Hyperaldosteronism. It can be primary and secondary.
Epidemiology:
- Women more than men 30-50 years
Aetiology:
- Can be bilateral due to hyperplasia, adenoma, carcinoma and familial hyperaldosteronism - Secondary aldosteronism is more common then primary - secondary is due to renal failure and increased production of aldosterone.
Signs and symptoms: Renal retention of sodium and water leading to high BP, headache. We also get a loss of potassium, leading to muscle weakness, paraesthesia, muscle spasms, excessive urination and cardiac arrythmias .
What is Addison’s disease?
Chronic primary adrenal cortical insufficiency
Epidemiology:
- Seen in 5.3 per million - Can be secondary to a non-functional adenoma or compressing prolactinoma - Most commonly seen in its autoimmune form
Signs and symptoms:
- Trial of hyperpigmentation, postural hypertension and hyponatraemia (causes a host so symptoms)
- Treatment is with long term steroid replacement
- If undiagnosed it can be fatal
Acute adrenal crisis can be triggers by trauma, dehydration etc, this leads to profound diseases - electrolyte disturbances, renal shutdown and circulatory collapse etc.
