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Flashcards in Adrenal Deck (21)
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1
Q

Cushings clinical features

A

Centripetal obesity, limb wasting
Thin skin, easy bruising, livid wide striae
Proximal myopathy
HTN, osteoporosis, glucose intolerance/DM

2
Q

Hyperpigmentation in Cushings

A

Indicates ACTH excess -hence pituitary/ectopic ACTH

3
Q

Causes of ACTH dependent Cushings syndrome

A

Cushings disease, Ectopic ACTH, ectopic CRH

4
Q

Causes of ACTH independent Cushings

A

Adrenal adenoma, carcinoma
Micronodular hyperplasia
Macronodular hyperplasia

5
Q

Causes of pseudo-Cushings

A

Major depressive disorder, alcoholism related

6
Q

Diagnosis of Cushings

A

First demonstrate hypercortisolism -
-24hr urinary free cortisol, retest if less than 3 fold
-Late evening plasma cortisol <50-not CS,>207-CS
-Overnight low dose dexamethasone 1mg Dex, check morning plasma cortisol
N<140nmol/l,<50nmol/L -Excludes Cushings
Check plasma ACTH -ACTH indep if ACTH<5mcg/l
ACTH depen if ACTH>15mcg/l

7
Q

Diagnosis of Cushings disease vs Ectopic ACTH

A

High dose Dex suppression test 2mg 6hrly x 8doses
UFC suppression by>90% -highly spf for Cushings disease
MRI pituitary
Petrosal sinus sampling for ACTH after injecting CRH

8
Q

Management of Cushings

A

Transsphenoidal selective microadenomectomy
Total hypophysectomy if macroadenoma
Pituitary irradiation, radio Sx
Bilateral adrenelectomy in refractory disease

9
Q

Pre op medical Mx of Cushings

A

Metyrapone, ketoconazole, mifepristone

Pasireotide -if failed other Rx-s/e hyperglycemia

10
Q

Rare causes of Cushings

A

Factitious - exogenous intake of steroid
Anomalous R expression on adrenal cells
GIP-dependent (low fasting cortisol,PP rise,low ACTH)
Vasopressin dependent -orthostatic hypo, AVP increases cortisol
Beta adrenergic dependent- postural increases in catechols increases cortisol

11
Q

Clinical presentation of hyperprolactinemia

A

Amenorrhoea, galactorrhoea, hypogonadism/sexual dysfunction

12
Q

Drugs and non pituitary causes of hyperprolactinemia

A

Drugs -phenothiazine, olanzapine, risperidone, metoclopramide
Other causes -post partum, CKD, seizure

13
Q

Pituitary/hypothalamic causes of hyperprolactinemia

A

Pituitary tumour -micro/macro
Macroadenoma with stalk disruption
Stalk trauma

14
Q

Management of hyperprolactinemia

A

Microprolactinoma -Medical- dopamine agonist-bromocriptine/cabergoline
Macroprolactinoma -Medical Rx initially
Sx if needed after medical Rx
Adjunctive RT

15
Q

Etiology of panhypopituitarism

A

Pituitary or hypothalamic tumour(craniopharyngioma)
Trauma
Sheehans syndrome
Autoimmune hypophysitis/empty sella syndrome

16
Q

Clinical presentation of panhypopituitarism

A

Fatigue, pale (ACTH def), poor response to intercurrent illness, postural hypotension, loss of body hair, fine facial wrinkling, cold intolerance, amenorrhoea, infertility, failed lactation, impotence/reduced libido

17
Q

Hypopituitarism investigations

A

Visual assessment
MRI/CT brain for tumour
Basal hormone assay:cortisol, TFT, FSH,LH,E2,T
Dynamic testing: Synacthen test

18
Q

Management of hypopituitarism

A

Treat underlying cause
Steroid replacement first followed by thyroxine
Males -testosterone , females -oestrogen,progesterone
fertility requires gonadotropin therapy

19
Q

Diabetes insipidus

A

Central DI - Vasopressin/ADH insufficiency

Presence suggets hypothalamic damage

20
Q

Investigations for DI

A

Water deprivation test:
DI :Failure to concentrate urine, failure of volume to decrease
Central DI: Responds to DDAVP
Nephrogenic DI: No response to DDAVP

21
Q

Treatment of DI

A

Temporary or mild: Fluids to thirst

Severe/permanent: Desmopressin nasal spray/tabs