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from science to clinical practice > human development - endocrinology clinical > Flashcards

human development - endocrinology clinical Flashcards

1
Q

what is hypothyroidism?

A

when the thyroid gland does not produce enough thyroid hormone (thyroxine or triiodothyronine)

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2
Q

what is the difference between primary and secondary hypothyroidism?

A

primary - thyroid gland abnormality; not able to produce TS4 and TS3. most common form of hypothyroidism

secondary - pituitary gland abnormality; not able to produce TSH to stimulate the thyroid gland to produce TS4 and TS3

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3
Q

what is the difference between tertiary and resistance hypothyroidism?

A

tertiary - hypothalamus abnormality, perhaps due to radiation. unable to produce TRH to stimulate thyrotrophs in the pituitary that produce TSH.

resistance - thyroid hormone receptors aren’t functioning so tissues are resistant to thyroid hormone effects

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4
Q

what is a suprasellar mass?

A

situated or rising above the sella turcica (saddle shaped depression in the body of the sphenoid bone)

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5
Q

what is the optic chiasm?

A
  • essential for visual pathway
  • part of the brain where optic nerves from each eye cross
  • located inferior to the hypothalamus but superior to the pituitary
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6
Q

what is hypopituitarism?

A

when there isn’t enough of one or more of the pituitary hormones (TSH, FSH, LH, GH, PRL, ACTH)

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7
Q

what are the clinical signs for hypopituitarism?

A
  • gaining of weight
  • loss of sexual drive (libido)
  • loss of menses (periods in women, erections in men)
  • fatigue
  • loss of hair in the face, skin becomes soft
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8
Q

what causes hypopituitarism?

A
  • tumour compressing optic chiasm and pituitary gland
  • this causes interference between the hypothalamus and pituitary gland
  • so trophic hormones produced by the hypothalamus can no longer reach the anterior pituitary cells
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9
Q

what are the types of pituitary tumours in terms of size?

A
  • micro adenoma: <10mm
  • macro adenoma: >10mm
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10
Q

what are the types of pituitary tumours in terms of function?

A
  • functioning: over secrete hormones; gives rise to endocrine syndromes
  • non functioning
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11
Q

what are the functioning macro-adenomas?

A
  • prolactinoma
  • Cushing’s (ACTH)
  • acromegaly (GH)
    (about half of the tumours are non functioning)
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12
Q

what are the different ways pituitary tumours can be treated?

A
  • conservative/surveillance (watch and do nothing) as they can be slow growing tumours
  • majority of macro-adenomas are treated surgically (trans-sphenoidal surgery)
  • majority of micro-adenomas are treated conservatively or medically
  • prolactin secreting tumours are treated medically
  • radiotherapy if there is a high likelihood of regrowth after removal
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13
Q

what are the clinical signs for hypothyroidism?

A
  • slowing of metabolic processes
  • weight gain
  • cold
  • tired
  • constipation
  • bradycardia
  • low mood
  • thin hair
  • dry skin
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14
Q

what causes hypothyroidism?

A
  • iatrogenic: surgery or radio iodine treatment
  • chronic autoimmune thyroiditis (most common): atrophic or Hashimoto’s
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15
Q

how can be hypothyroidism be treated?

A
  • levothyroxine
    75 - 125 mcg/day
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16
Q

what are the clinical signs for hyperthyroidism/thyrotoxicosis?

A
  • breathlessness
  • shaking
  • sweating
  • palpitations
  • restlessness
  • diarrhoea
  • muscle stiffness and weakness
  • lid retraction (eyelid is higher than expected)
  • lid lag (eyelid movement lags behind the movement of the eyes)
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17
Q

what are the causes of hyperthyroidism/thyrotoxicosis?

A
  • grave’s disease: thyroid gland is overactive
  • toxic thyroid nodule: nodule in the thyroid gland which autonomously produces excessive thyroid hormone
18
Q

how can hyperthyroidism/thyrotoxicosis be treated?

A
  • 6-12 month course of treatment
    . carbimazole (better)
    . propylthiouracil
  • radio iodine (avoid in thyroid eye disease)
  • surgery
19
Q

how can thyroiditis be classed?

A
  • painless (lymphocytic and Hashimoto’s)
  • painful (granulomatous and radiation induced)
20
Q

are thyroid nodules mostly malignant or benign?

A

benign

21
Q

what is the main type of thyroid cancer?

A

papillary thyroid cancer

22
Q

what is Addison’s disease in terms of the functioning of the adrenal gland?

A

hypofunction

23
Q

what are examples of diseases where the adrenal gland is hyper functioning?

A
  • Cushing’s
  • Conn’s / hyperaldosteronism
  • pheochromocytoma
24
Q

what is the name of an autoimmune primary hypoadrenalism disease?

A

Addison’s disease

25
Q

what are the causes of primary hypoadrenalism?

A
  • abrupt discontinuation of steroids
  • autoimmune (addison’s)
  • tuberculosis
  • haemmorhage / infarction
  • surgery
26
Q

what are the symptoms for primary hypoadrenalism?

A
  • weight loss
  • malaise (general feeling of discomfort, illness or fatigue)
  • diarrhoea
  • nausea / vomiting
  • syncope (fainting or passing out due to low BP)
  • myalgia (muscle pain)
27
Q

what are the signs for primary hypoadrenalism?

A
  • pigmentation (new scars, buccal, palmar creases)
  • wasting (gradual deterioration)
  • dehydration
  • loss of body hair
28
Q

what are the investigations used to detect primary hypoadrenalism?

A
  • random cortisol test
  • short synacthen test (synacthen; a synthesised ACTH, is injected into the patient to see whether the adrenal gland responds to it and produces cortisol)
  • plasma ACTH test
  • urea and electrolytes
  • adrenal antibodies
29
Q

how is adrenal failure treated?

A
  • emergency, life-threatening cases:
    ICU care, IV hydrocortisone at high doses, fluids, sodium
  • maintenance treatment:
    glucocorticoids (hydrocortisone, prednisolone)
    mineralocorticoids (fludrocortisone)
30
Q

what is Cushing’s syndrome?

A
  • excess cortisol
  • either ACTH dependent or independent
  • ACTH dependent: due to pituitary
  • ACTH independent: due to adrenal glands
31
Q

what are the signs for Cushing’s syndrome?

A
  • moon face
  • plethora (excess of blood)
  • acne
  • hirsutism (where women have thick black hair in their face, thighs, tummy, back etc.)
  • frontal balding
  • thin skin/bruising
  • poor wound healing
  • pigmentation
  • buffalo hump
  • striae
32
Q

what are the dynamic investigations to confirm Cushing’s syndrome diagnosis?

A
  • low does dexamethasone suppression test (normally, after patients take dexamethasone, cortisol will be suppressed to undetectable levels. with Cushing’s syndrome, cortisol can still be detected)
  • 24hr urinary cortisol
  • loss of diurnal rhythm
33
Q

how can Cushing’s syndrome be treated?

A
  • laparoscopic adrenalectomy (removal of an adrenal gland)
  • replacement hydrocortisone treatment with periodic withdrawal to check if the counteractive adrenal gland is functioning
34
Q

what is a phaeochromocytoma?

A
  • tumour of the adrenal medulla
  • secreting NA or A
35
Q

what are the clinical features of phaeochromocytoma?

A
  • headaches
  • palpitations
  • weight loss
  • sense of doom
  • chest pain
  • sweating
36
Q

what tests can phaeochromocytoma be diagnosed with?

A
  • 24hr urine catecholamines
  • 24hr urine or plasma metanephrines (better option)
37
Q

how is phaeochromocytoma treated?

A
  • pretreated with alpha and beta blockade:
    phenoxybenzamine and doxazosin
  • then surgery
38
Q

what would a screening blood test show for a patient with primary hyperaldosteronism?

A
  • low renin
  • elevated aldosterone
39
Q

what is conn’s syndrome?

A
  • primary hyperaldosteronism
  • independant of RAAS
  • hypertension, hypokalaemia, alkalosis
40
Q

how do you confirm primary hyperaldosteronism diagnosis?

A
  • measurement of renin (suppressed) and aldosterone (elevated) in salt-replete individuals (amount of salt in patient’s body’s is at normal levels)
  • selective venous sampling (to determine which adrenal gland is secreting abnormal levels of aldosterone)
41
Q

how can conn’s syndrome / primary hyperaldosteronism be treated?

A
  • remove the adenoma (laparoscopic)
  • drug treatment (spironolactone, eplerenone)
  • eplerenone is the preferred drug for men as spironolactone may have negative effects on men

from science to clinical practice (5 decks)

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