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Mattias - Endocrine > Deck 3 - Thyroid > Flashcards

Deck 3 - Thyroid Flashcards

1
Q

What does the Thyroid secrete

A

Thyroxine (T4)
Triiodithyroxine (T3)
Calcitonin

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2
Q

What does the parathyroid gland secreete

A

Parathyroid hormone

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3
Q

What are the functional units of the thyroid called

A

Follicle

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4
Q

What is the core of the functional units of the thyroid called

A

Colloid

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5
Q

What line the follicle in the thyroid gland

A

Follicular cells

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6
Q

What cells secrete Calcitonin

A

Parafollicular C cells

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7
Q

What is the colloid of the thyroid gland

A

Tyrosine-containing thyroglobulin filled spaced

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8
Q

What does Carbimazole and Propylthiouracil (PTU) inhibit

A

Attachement of iodine to tyrosine residues which then forms T3 and T4

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9
Q

Which thyroid hormone is secreted the most, which is most active

A

Most secreted - Thyroxine, T4

Most active - Triiodothyroxine T3

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10
Q

Where is Thyroxine converted to Triiodothyroxine

A

Liver and Kidney

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11
Q

How is T3 and T4 transported in blood

A

Bound to plasma protein
Thyroxine binding globulin (TBG) ~70%
Thyroxine binding prealbumin (TBPA) ~20%

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12
Q

What are the three levels of medical ethics

A

Laws
Guidelines and recommendations
Ethics

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13
Q

What is Battery in terms of consent

A

Unlawful touching, no harm is required for battery to be effective

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14
Q

What is neglience in terms of consent

A

If relevant, or the right amount of, information is not provided

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15
Q

What types of thyroid cancers are there

A 
Papillary
Follicular
Medullary
Anaplastic
Others (2%)
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16
Q

What type of thyroid cancers are referred to as Differentiated Thyroid cancers

A

Papillary

Follicular

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17
Q

Most Differentiated thyroid cancers take up iodine and secrete Thyroglobulin.
True or False?

A

True

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18
Q

Differentiated thyroid cancers are not TSH driven.

True or False

A

False, they are TSH driven

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19
Q

Differentiated thyroid cancers have a strong association with

A

Radiation exposure

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20
Q

What is the most common thyroid cancer

A

Papillary thyroid cancer

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21
Q

How does Papillary thyroid cancer tend to spread

A

Via Lymphatics

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22
Q

What is the 10y survival rate for Papillary thyroid cancer

A

> 95%

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23
Q

What is the second most common thyroid cancer

A

Follicular carcinoma

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24
Q

How does Follicular carcinoma tend to spread

A

Hematogenously

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25
Q

If lymphadenopathy is found, is it likely due to follicular cancer

A

No, Follicular cancer rarely spread through Lymphatics

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26
Q

Prognosis of follicular cancer

A

Good, 10y survival rate is >95%

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27
Q

What inverstigations should be done if thyroid cancer is suspected

A

Utrasound guided Fine-needle aspiration
TSH, T3 and T4 blood levels
No need for isotope thyroid scan

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28
Q

What is the AMES system

A 
Post op risk stratification
Age
Metastases
Extent of primary tumor
Size of primary tumor
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29
Q

Important post op care with thyroidectomy

A

Check Calcium levels within 24h
Ca2+ replacement if below 2mmol/L
IV Ca2+ replacement if below 1.8mmol/L

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30
Q

What is performed 3-6 months post-op sub-total or total thyroidectomy

A

Whole body iodine scanning

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31
Q

How early to the patient need to stop T3 and T4 medication prior to Whole body iodine scan

A

T3 - 2 weeks prior

T4 - 4 weeks prior

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32
Q

What is Thyroid Remnant Ablation

A

Procedure to kill off last thyroid cells. Done by taking highly radioactive Iodine tablet

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33
Q

What is the C-peptide

A

A byproduct of insulin production.

Used to test for disease stage in Diabetes

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34
Q

Classical symptoms of T1DM in non-emergency

A

Poolyuria
Polydipsia
Weight loss
General malaise

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35
Q

Classical presentation of Diabetic Ketoacidosis

A

Vomiting, abdominal pain, altered consciousness, acidotic breathing (kaufsmall?) Dehydrated

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36
Q

Blood results in DKA

A

pH <7.3
ketones +++
Blood glucose high

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37
Q

Key difference in DKA treatment for under 16years old

A

Based on weight. Careful fluid resuscitation. Risk of cerebral odema highlighted
Insulin commenced 1h after IV fluids started

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38
Q

What is Cheirarhropathy

A

Cutaneous condition characterized by thickened skin and limited joint mobility of the hand and fingers leading to flexion contractures. associated with Diabetes Mellitus

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39
Q

What are the clinical signs of congenital Thyroid disease

A

Exessive sleeping, hypofonia, umbilical hernia, Jaundice, Skin and hair changes

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40
Q

What is Guthrie’s test

A

Neonatal heel prick capillary blood test to test for congenital Thyroid disease

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41
Q

What is the window of treatment of Congenital Thyroid disease and why

A

2/3 months. Up to that point, baby is protected by placental thyroid hormones

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42
Q

Untreated Congenital Thyroid disease leads to

A

Growth failure

Intellectual disability

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43
Q

What are the signs of Acquired hypothyroidism of the young

A

Growth failure, delayed puberty, education difficulties, Goitre, TSH up and T3&T4 down

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44
Q

Initial therapy of hyperthyroidism

A

Beta blockers for cardiovascular symptoms (Tachycardia and arrythmias)

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45
Q

What is most common in young, hypo or hyperthyroid

A

Hypothyroidism

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46
Q

What is Addison Crisis, treatment

A

Emergency with absent cortisol and Aldosterone leading to hypotension, hyponatremia and hyperkalemia.
Treat with salt and cortisol but watch for hypoglycemia

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47
Q

What does Congenital Adrenal Hyperplasia lead to in females

A

Ambigous genitalia due to overproduction of testosterone

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48
Q

Most common cause of Hyper and Hypo thyroid disease

A

Autoimmune

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49
Q

What is pretibial mycodema and when is it seen

A

Accumulation of hydrophilic mucopolysaccharides in the dermis causing doguhy induration of the skin, especially shins.
Seen in Grave’s disease

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50
Q

What is Hashimoto’s thyroiditis

A

Chronic thyroiditis, autoimmune disease causing goitrus hypothyroidism

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51
Q

What are some drugs causing primary hypothyroidism

A 
Amiodarone
Lithium
IL-2
IFN-alpha
Aminosalisylic acid
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52
Q

What is a dietary cause of goitrus hypothyroidism

A

Iodine deficiency

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53
Q

Categories of causes of panhypopituitarism

A 
TIIN
Trauma
Infection
Infiltration
Neoplasm
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54
Q

Investigation findings in Hashimoto’s thyroiditis

A

TSH up, T3 and T4 down
Thyroid peroxidase Antibodies
T-cell infiltrate and inflammation on histology

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55
Q

Signs of hypothyroidism of hair/skin

A 
Coarse, sparse hari
Dull face
Periorbital puffiness
Vitilago
Cool dought skin
Hypercarotenemia
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56
Q

Cardiac signs of hypothyroidism

A

Low Heart rate
Cardiac dilation
Pericardial effusion
Worsening of Heart failure

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57
Q

Metabolic signs of hypothyroidism

A

Hyperlipidemia
Weight gain
Decreased appetite
Constipation (mega colon, ascities)

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58
Q

What does Macrocytosis mean

A

Enlarged red blood cell but still functional

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59
Q

Why does hypothyroidism present with hyperprolactinemia, when does it not

A

Because raised Thyrotropin-releasing hormone (TRH) causes raised prolactin.
It does not occur when hypothyroidism is due to hypothalmic dysfunction

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60
Q

Blood findings in hypothyroidism

A 
TSH up, T4 and T3 down
Macrocystosis
Creatine kinase up
LDL cholesterol up
Hyperprolacinemia
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61
Q

What antibodies are involved in auto-immune thyroid disease

A

Anti-TPO Ab
Anti-thyroglobulin Ab
TSH receptor Ab

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62
Q

Treatment of hypothyroidism

A

Levothyroxine
In young 50-100 ug/day
Ischemic heart disease start at 25-50 ug/day and titrate up every four weeks

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63
Q

Hypothyroidism treatment follow up

A

Check TSH levels 2 months after dose change, with even levels, check yearly

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64
Q

When might levothyroxine levels have to be increased and why

A

In pregnancy

Because thyroxine binding globulin levels are increased

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65
Q

Who typically suffers from Myxoedema coma

A

Elderly women with longstanding but unrecognized or untreated hypothyroidism

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66
Q

Findings in Myxoedema coma

A

Bradycardia
ECG - low voltage, heart block, T wave inversion, prolongation of QT interval
Type 2 respiratory failure - hypoxia, hypercapnia, respiratory acidosis

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67
Q

Treatment of Myxoedema coma

A

Intensive care, ABC
T3 replacement - watch out for IHD.
Hydrocortisone
Antibiotics if suspected infection

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68
Q

What drug cause thyroid dysfunction in 50% of its patients. When does it cause hypo/hyper

A

Amoidarone
Hypo if the iodine intake is high
Hyper if the iodine intake is low

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69
Q

Symptoms of hyperthyroidism, all types of hyperthyroidism

A

Palpatations, Atrial fibrillation
Tremor, sweating, Anxiety, Nervousness, Irratibility, Sleep disturbance, Frequent and loose bowel.
Double vision, Lid retraction, Rapid nail growth, thinning of hair.
Muscel weakness (big muscles) weight loss, increased appetitie, heat intolerance, less periods

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70
Q

What is an auto-immune hyperthyroidism condtion

A

Grave’s disease

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71
Q

What is a dstinguished feature of Grave’s disease

A

Eye protrusion

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72
Q

What are some causes of hyperthyroidism that are common

A

Multi-nodular goitre
Toxic nodule (adenoma)
Thyroiditis
Grave’s disease

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73
Q

What medication might cause hyperthyroidism

A

Lithium
Amiodarone
Thyroxine

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74
Q

What antibody is often present in hyperthyroidism

A

TSH receptor Antibody

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75
Q

What is the goitre like in Grave’s disease? What’s the results of a Scintigraphy

A

Smooth symmetrical goitre

High uptake on Scintigraphy

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76
Q

What are the ophthamology features of Grave’s disease

A

Lid retraction, Lid Lag, Chemosis, Proptosis, Visual loss and Diplopia

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77
Q

What severely worsen Grave’s disease

A

Smoking

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78
Q

What type of onset in Nodular hyperthyroid

A

insidious onset

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79
Q

Blood results of Nodular hyperthyroid

Antibodies present

A

T3 and T4 up
TSH down
TSH receptor Antibody NEGATIVE

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80
Q

Features of goitre in Nodular hyperthyroidism

A

Nodular feeling, asymmetrical

Scintigraphy is asymmetrical with uneven uptake

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81
Q

What is De Quervains

A

Sub-acute Thyroiditis

82
Q

Features of De Quervains thyroiditis

A

Triggered by viral
Painful gland
Associated with soar throat and fever
Younger, age 20-50

83
Q

Treatment of De Quervains thyroiditis

A

Usually self limiting over a few months

NSAIDs for pain

84
Q

What is Thyroid storm

A 
Medical emergency
Severe hyperthyroidism, Hyperthermia
Tachycardia, Cardiac collapse
Altrial fibrillation
Heart failure
85
Q

Thyroid storm treatment

A

Propanolol for cardiac complications
ABC
Carbamizole and PTU to limit thyroid activity
Fluids and monitoring

86
Q

Treatment of Grave’s disease, drug

A

Carbimazole and Propythiouracul (PTU)
High dose for 12-18 months then stop
Beta blocker if symptomatic

87
Q

What is the relapse risk once drug treatment is stopped in Grave’s disease

A

50%

88
Q

Drug treatment of hyperthyroidism

A

Carbimazole, Propylthiouracil (PTU)

Beta blocker if symptomatic

89
Q

Which is the preffered drug treatment of hyperthyroidism in pregnancy

A

Propylthiouracil (PTU)

90
Q

Non-drug treatment of hyperthyroidism

A

Radio-iodine or Thyroidectomy

91
Q

Precautions of Radio iodine treatment

A

Ensure not pregnant
Avoid pregnancy for 6 months after
Contact restrictions post treatment
Risk for hypo, monitor

92
Q

Risk of Thyroid surgery

A

Reccurent laryngeal nerve palsy
Hypothyroidism
hypo-parathyroidism

93
Q

Blood result in subclinical hyper and hypo thyroidism

A

Hyper - TSH low, T3 and T4 normal

Hypo - TSH high, T3 and T4 normal

94
Q

What is the thyroid axis, simplified from top to bottom

A

Hypothalmus –(TRH)–> Anterior pituitary –(TSH)–> Thyroid –(T3 and T4)–> Target organs

95
Q

Where does TSH bind

A

TSH receptor on surface of thyroid epithelial cells

96
Q

What type of receptor is the TSH receptor

A

G protein coupled receptor

97
Q

How does T3 and T4 act on target cells

A

Change the gene transcription by binding to Thyroid response element

98
Q

What is a cause of ectopic hyperthyroidism

A

Struma ovarii

Rare ovarian tumor

99
Q

Triad of features in Grave’s disease

A

Hyperthyroidism with diffuse goitre
Eye changes
Pretibial myxoedema

100
Q

What is eye protruding called

A

Exophthalmos

101
Q

What HLA is Hashimoto’s thyroiditis associated with

A

HLA DR3

HLA DR5

102
Q

Most common cause of hypothyroidism

A

Hashimoto’s thyroiditis

103
Q

What genes are associated with Hashimoto’s thyroiditis.

A

CTLA-4 and PTPN-22
Both involved in T cell inhibition
Hashimoto’s thyroiditis patients have polymorphism of these genes

104
Q

What type of thyroid carcinoma is mostly associated with radiation

A

Papillary carcinoma

105
Q

What genes are mutated in Papillary carcinoma

A

RET
NTKR1
BRAF

106
Q

What genes are mutated in Follicular carcinoma

A

PI3K/AKT pathway genes

107
Q

Which thyroid carcinoma is most often presented with lymph node metastasis

A

Papillary carcinoma

108
Q

What cells are involved in Medullary Thyroid carcinoma

A

Parafollicular C cells

109
Q

Which thyroid carcinoma is associated with Multiple Endocrine Neoplasia

A

Medullary Thyroid Carcinoma

MEN 2A and 2B

110
Q

What types of cells are there in the Parathyroid gland

A 
Cheif cells (Produce PTH)
Oxyphil cells
111
Q

What is Parathyroid hyperplasia associated with

A

MEN 1 and MEN 2A

112
Q

What is the function of Parathyroid hormone

A

Increase blood calcium levels by stimulating osteolasts to break down bone and release Calcium. PTH also increases GI absorption of Calcium by activating Vitamin D. Also act on kidney to increase Ca reabsorption

113
Q

What are the three stages of the ovarian cycle

A

Follicular growth
Ovulation
Luteal phase

114
Q

In regards to the ovarian cycle, what hormone does the hypothalmus release

A

Gonadotropin Releasing hormone (GnRH)

115
Q

In regards to the ovarian cycle, which hormones does the pituitary release

A

Luteinizing hormone (LH)
Follicle stimulating hormone (FSH)
Prolactin

116
Q

What hormones are released by the placenta

A

Human Placental Lactogen
Placental Progesterone
Placental Oestrogen

117
Q

What is the function of Human Placental Lactogen

A

Decrease maternal insulin sensitivity which increases maternal blood glucose
Decrease maternal glucose utilization which increase glucose to fetus
Increase Maternal lipolysis which increase energy for mother and increase glucose availability for fetus

118
Q

What two hormones are involved in causing Gestational Diabetes

A

Human Placental Lactogen

Progesterone

119
Q

In what trimester does Gestational Diabetes occur

A

Thrid Trimester

120
Q

What is pre-eclampsia

A

Disorder of pregnancy with high blood pressure and proteinuria.
Occurs in third trimester

121
Q

Untreated Gestational Diabetes may lead to what complications in pregnancy

A 
Congential malformation
Prematurity
Macrosomia (>90th percentile) 
Still birth
Jauncice of baby
122
Q

Untreated Gestational Diabetes may lead to what complications in neonates

A 
Respiratory Distress (immature lungs)
Fits due to Hypoglycemia or hypocalcemia
123
Q

What is the major growth factor in the third trimester

A

Fetus starts its own insulin production

124
Q

Treatment of Gestational Diabets

A

Life style

Some may need Metformin or even insulin

125
Q

Drug treatment of T1DM and T2DM in pregnancy

A

T1DM - Insulin

T2DM - Metformin, most likely need insulin later

126
Q

What are safe blood pressure drugs in pregnancy

A

Labetalol
Nifedipine
Methyldopa

127
Q

Are statins safe in pregnancy

A

No

128
Q

What supplement is important for Diabetic pregnancies, dosage

A

Folic acid

5mg/daily

129
Q

Maternal complications of Gestational Diabetes post birth

A

50% 10-15y risk of T2DM (80% in obese)

<5% risk of T1DM

130
Q

What hormone is detected in pregnancy test, produced by

A

Hyman Chorionic Gonadotropin (HCG)

Produced by placenta

131
Q

What is corpus luteum

A

The remnant of an ovarian follicle after ovulation

132
Q

What is the function of corpus luteum

A

Produce Progesterone, Estradiol, inhibin A and Estrogen

133
Q

What are the effects of hyper- and hypo thyroidism on mentruational cycle

A

Cause anovulatory cycles (uneven)

134
Q

What is the effect of HCG on thyroid levels

A

HCG act as TRH, Stimulating TSH and T3 and T4 release

135
Q

What happens to Thyroxine binding globulin levels in pregnancy

A

Whey increase, because normally thyroid levels increase, fT4 stay constant

136
Q

What hormone causes the increase of TBG in pregnancy

A

Estrogen

137
Q

Levothyroxine treatment in pregnancy

A

Drug levels has to compensatefor increase in TBG. Increase dose by 25ug as soon as pregnancy is suspected. TBG levels plateau at 20 weeks, check monthly until then and then twice a month. Average dose increase with 50% of initial dosage by week 20.
Aim of treatment is TSH levels <3 mU/L

138
Q

Risks of untreated hypothyroidism of pregnancy

A

Increased abortion, Pre-eclampsia, Postpartum hemorrhage, preterm labor, Lower IQ of fetus

139
Q

Causes of hyperthyroidism in pregnancy

A

Graves, Toxic multinodular goitre, Thyroiditis, Toxic adenoma Gestational HCG associated Thyrotoxicosis

140
Q

What is Hyperemesis gravidarum

A

Complication of pregnancy causing nausea, vomitting and dehydration. Different from morning sickness, as hyperemesis gravidarum is thyroid related

141
Q

Hyperthyroidism in pregnancy may lead to

A

Infertility, Miscarriage, Still birth, Thyroid crisis in labor, Transient neonatal thyrotoxicosis

142
Q

Management of hyperthyroid in pregnancy

A 
Wait and see.
Beta blockers in early stage 
Low dose antithyroid 
Propulthiouracil (PTU) in first trimester
Carbimazole in 2nd and 3rd trimester
143
Q

What hormones are release by the posterior pituitary

A

ADH and Oxytocin

144
Q

What hormones are released by the anterior pituitary

A 
ACTH
TSH
FSH
LH
Prolacting
GH (Somatotropin)
145
Q

What hormone stimulate Testosterone production

A

Luteinizing hormone(LH)

146
Q

What hormone plays a role in spermatogenesis

A

Follicular stimulating hormone

147
Q

What is the upstream regulation of cortisol

A

Hypothalmus –(Corticotropin releasing hormone [CRH])–> Pituitary gland –(Adrenocorticotropic hormone [ACTH])–> Adrenal gland –(Cortisol)–>Target cells

148
Q

What is the effect of cortisol

A

Regulates glucose levels
Increase fat storage
Immune effect
Stress response

149
Q

What hypothalamus hormone has a negative effect on prolacting release from the pituitary

A

Dopamine, also called Prolactin-inhibiting hromone

150
Q

What hormones are part of Baseline tests

A 
TSH, free T4
LH, FSH, Testosterone
GH
Prolactin
Insulin-like Growth factor-1 (IGF-1)
151
Q

What is the principle of dynamic tests

A

Too much hormone - suppression test

Too little hormone - Stimulation test

152
Q

What is the stimulatory test for cortisol levles

A

Synacthen test

Give synthetic ACTH, measure cortisol at -, 30 min, 60min

153
Q

What is the insulin stress test

A

Patient is given insulin to induce hypoglycemia. GH and Cortisol should increase as a response to counteract the insulin. Normal resonse is Cortisol >500 nmol/L and GH >7ug/L after

154
Q

What does the insulin stress test assess

A

Integrity of the hypothalmo-pituitary-adrenal axis

155
Q

What is the water deprevation test

A

Tests for Diabetes insipidus
Patient is not allowed to drink for 8h while serum and urine osmolality is measured. normal, Urine should become more concentrated. In Diabetes insipidous, urine stay dilute. To distinguish between cranial and nephrogenic DI patient is given Desmopressin (which should concentrate and reduce urine output). In cranial DI, Desmopressin causes raised urine osmolality. In nephrogenic DI, there is no change

156
Q

What are the size of Miroadenoma and Macroadenoma of the pituitary

A

Micro - Less or equal to 1cm

Macro >1cm

157
Q

What may a non functioning pituitary adenoma cause

A 
Compression of optic chiasm
Compression of CN 3,4 and 6
Hypoadrenalism
Hypothyroidism
Hypogonadism
Diabetes Insipidous
GH deficiency
158
Q

What visual field defect does a pituitary adenoma cause

A

Bitemporal hemianopia
(XXGG) (GGXX) <–Vision distribution
X-loss
G-Good vision

159
Q

What are physiological causes of raised prolactin

A

Breast feeding, pregnancy, stress, sleep

160
Q

What drugs cause raised prolactin

A 
Dopamine antagonists
Antipsychotics
antidepressants
Estrogen
Coccaine
161
Q

What are pathological causes of raised prolactin

A

Hypothyroidism
Stalk lesions (iatrogenic, RTA)
Prolacinoma

162
Q

Clinical symptoms and signs of raised prolactin in females

A

Early signs
Galactorrea (30-80%)
Ammenorrhea
Infertility

163
Q

Clinical symptoms and signs of raised prolactin in males

A 
Late presentation
Galactorrhea <30%
Visual field abnormality
Headache
Impotence
164
Q

Investigations of Prolactinoma

A

Blood prolacti
MRI
Visual field
Pituitary function test - other hormones affected

165
Q

Treatment of Prolactinoma, drugs

A

Dopamin agonists

  • Bromocriptin (3/day)
  • Quinagolid (1/day)
  • Cabergoline (2/week) less side effects
166
Q

What is Acromegaly

A

Syndrome characterized by excess Growth hormone (GH)

167
Q

Features of Acromegaly

A 
Thickened soft tissue
Hypertension
Cardiac failure
Vascular headache
Sleep apnea
Diabetes mellitus
Early cardiovascular death
Giantism
168
Q

What are the results of Glucose tolerance test in Acromegaly

A

GH shold be supressed but is unchanged in Acromegaly. >1ug/L

Paradoxical increase in GH is sometimes seen

169
Q

What hormone is used in Acromegaly diagnosis

A

Insuline-like Growth factor-1 (IGF-1)

Raised in Acromegaly

170
Q

Treatment for Acromegaly

A

Pituitary syrgery or radiotherapy of pituitary fossa

171
Q

Post-op Acromegaly treatment

A

Redo Glucose tolerance test. GH <0.4 ug/L is satisfactory

172
Q

Drug treatment of Acromegaly

A

Somatostatin Analogue - Octreotide (S/C 3/day)
Domapine Agonist - Cabergoline (PO 2/week)
Growth hormone receptor Antagonist - Pegvisomant (SC 1/day)

173
Q

Side effects of Octreotide

A

Flatulence, Diarrhea, Abdominal pains
Gastritis <60%
Gallstones 60%

174
Q

Examples of Somatostatin analogues used in Acromegaly

A 
Octreotide (SC 3/day)
Sandostatin LAR (IM 1/4 weeks)
Lanreotide autogel (IM 1/4 weeks)
175
Q

What is the effect on tumor size by Pegvisomat in Acromegaly

A

Does not decrease, occasional increase in size

176
Q

What is the effect on IFG-1 and GH levels byy Pegvisomant in Acromegaly

A

IFG-1 decrease

GH may increase

177
Q

What kind of drug is Pegvisomant and what line of treatment is it for what condition

A

Growth hormone receptro antagonist

Last line treatment for Acromegaly

178
Q

Aim for Acromegaly treatment

A

Grow hormone levles <1 ug/L and normalized IGF-1

179
Q

What is Cushing’s syndrome

A

Excess cortisol

180
Q

Symptoms and signs of Cushing’s syndrome

A

Myopathy, Osteoporosis, Thin skin, bruising, striae, Diabetes Mellitus, Obesity, psychosis, depression, hypertension, edema, virilism, hirsutism, acne, oligo/omenorrhea

181
Q

Typical Cushin sundrome patient features

A

Abdominal fat with striae skin
Think arms/legs
Moon face
Buffalo hump

182
Q

Investigation for Cushing’s disease

A

Give high dose of oral Dexamethasone
Normally decreased cortisol levels are seen
In Cushing’s disease, cortisol levels stay high

183
Q

What are the two types of Dexamethasone suppression test

A

Overnight - 1mg given in the evening and cortisol levels are measured next morning
48h test - 2mg/day, cortisol is measured 6h after last dose
100nmol/L is abnormal.

184
Q

Causes of Cushing syndrome

A

Pituitary (80%)
Adrenal adenoma
Extopic cortisol production
Pseudo-cushings

185
Q

Location of ectopic cortisol production

A

Thymus, Lung, pancreas

186
Q

Causes of Pseudo-Cushing’s

A

Alcohol and Depression

Steroid medication

187
Q

Treatment of Cushing syndrome

A

Surgery. Depending on cause
Pituitary - hypophysectomy or radiotherapy
Adrenal - Adrenalextomy
Extopic - remove source OR bilateral adrenalectomy

188
Q

Drug treatment of Cushing’s syndrome

A

Metyrapone (Blocks cortisol synthesis)
Ketoconazole (Blocks glucocorticoid synthesis, antifungal drug)
Pasireotide (Somatostatin analogue)

189
Q

Function of Growth hormone in adults

A 
Improves well being
Decrease Abdominal fat
Increase muscle mass and stamina
Increase cardiac function
Increase Bone density
190
Q

Treatment of Cranial Diabetes Insipidous

A

Desmopressin

191
Q

What is the main mineralocortcoid

A

Aldosterone

192
Q

What is the effect on [Na+] if mineralocorticoid is raised

A

Increase [Na+]

193
Q

What is the effect on urine Osmolality if ADH increase

A

The osmolality goes up

194
Q

What is countercurrent multiplication

A

The concentrating mechanism of the loop of Henle

195
Q

What is SIAD and what happens to [Na+]

A

Syndrome of Inappropriate Antidiuretic hormone secretion

[Na+] down

196
Q

Where is the anterior pituitary derived from

A

Rathke’s pouch

197
Q

Whar are the other names of the anterior and posterior pituitary

A

Anterior - Adenohypophysis

Posterior - Neurohypophysis

198
Q

Difference between tropic and non-tropic hormones

A

Non-tropic act on target cells

Tropic act on other endocrine glands

199
Q

What are the tropic hormones of the Anterior pituitary

A

TSH
ACTH
FSH
LH

200
Q

What are the non-tropic hormones of the anterior pituitary

A

GH and Prolactin

201
Q

What hormones does the posterior pituitary secrete

A

ADH (Vasopresin)

Oxytocin

Mattias - Endocrine (4 decks)

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