Conditions & Diseases Flashcards
Benign pituitary adenomas summary
Def: tumor of on one of the type of cells in the pituitary gland
MC is prolactinoma
SS: Hormone hypersecretion headache bitemporal hemianopia leads to hyposecretion of other hormones
Eval: MRI w/ contrast - gold CT Visual field testing Serum Hormone level - prolactin - TSH, FT4 - ACTH, AM cortisol - LH, FSH, estradiol, testosterone - Insulin-like growth factor-1
Monitoring: >= 10 mm and no abnormalities - monitor every 6/12 mths and then for next few years 5-9 mm and no abnormalities - MRI bid next 2 years 2-4 mm and no abnormalities - no testing needed
Txt:
- Pharm - dopamine agonists, somatostatin analog, pegvisomant
- transsphenoidal Surgery
- radiotherapy
- gamma knife radiosurgery
Hypersecretion of Growth Hormone summary
Def: Excessive release of GH due to GH-secreting pituitary adenoma
SS: Kids - Gigantism Adults acromegaly - feet - hands - facial features
Eval:
Serum IGF-I (most sensitive)
Oral Glucose Tolerance Test (specific)
Txt:
Surgery
Somatostatin analogs
GH receptor antagonist
Growth Hormone Deficiency summary
SS:
Kids
• Growth retardation
• Short stature (> 3 SD) • Fasting hypoglycemia
Adulthood: • Increased abdominal adiposity • Reduced muscle strength and exercise capacity • Reduced muscle mass • Glucose interolerance and insulin resistance • Lipid profile abnormalities • Other sxs of panhypopituitarism
Eval:
Low Serum IGF-I screen
Insulin tolerance test
- if normal will increase GH
Hyperprolactinemia summary
Def: overproduction of actin
SS: Women - MC - Amenorrhea - galactorrhea - infertility - estrogen deficiency * osteopenia * vaginal dryness * hot flushes.
Men:
• Loss of libido and erectile dysfunction
Cause: Prolactinomas and Medications blocking dopamine
Eval: Preg test TSH (hypo) medication effects MRI
Hypoprolactinemia summary
Def: inability to lactate after delivery
Cushing’s syndrome summary
Def: Constellation of clinical features from excess glucocorticoids of any etiology
Cause:
- Pituitary tumor secreting ACTH
- Secretion of ACTH by non-pituitary tumor
- ACTH independent tumor of the adrenal gland
- Iatrogenic
SS: • Moon facies * Obesity • Diabetes mellitus • Diastolic hypertension • Hirsutism • Striae • Buffalo hump • Central adiposity • Hyperpigmentation with ectopic ACTH production
Eval:
• Initial tests
- 24 hour urinary free cortisol excretion increased 3 times
above normal
- Dexamethasone overnight test (Plasma cortisol >50 nmol/L at 8-9 AM after 1 mg dexamethasone at 11 PM
- Midnight plasma cortisol >130mnol/L
• Imaging Studies
- MRI pituitary to look for pituitary adenoma
- CT adrenal glands to look for adrenal tumor
Txt:
Adrenal Insufficiency summary
Cause:
- MC autoimmune
- autoimmune polyglandular syndrome (APS)
- infection
- hemorrhage
- infiltration
SS: • weakness/Fatigue * pigmentation of skin • Weight loss * Ab pain • Anorexia • Myalgias and arthralgias • Fever • Anemia, lymphocytosis, eosinophilia • Hypoglycemia • Hypotension (postural) • Hyponatremia
Eval:
- Short ACTH stimulation test
- ECG
- Antiadrenal antibodies
- Evaluate for infections, e.g. adrenal TB
- 24 hour urine
- MRI of pituitary to rule out pituitary adenoma
- Screen for Autoimmune Polyglandular Syndrome
Txt:
IV hydrocortisone
oral hydrocortisone
Diabetes insipidus summary
Def: deficiency of ADH
SS:
- Polyuria
- polydipsia
- nocturia
- Central: posterior pituitary fails to secrete ADH
- Nephrogenic: kidney fails to respond to ADH
Eval: • Water deprivation test - Normal: * decrease in urine output * increase in urine concentration - DI: * Continue high urine output * Continue low urine osmolarity * Administration of vasopressin
Syndrome of Inappropriate ADH summary
Def: excess ADH
SS:
water retention
concentrated urine
Eval
- Hyponatremia
- Serum hypoosmolality
- High urine osmolality (above 100 mosmol/kg)
Txt:
Graves Disease
Def: most common hyperthyroid diagnosis; autoimmune disorder; multisystem syndrome
Etiology: women > men; peak age 20-40 yo
Assoc with other AI diseases (type 1 DM, vitiligo, pernicious anemia, collagen vascular diseases)
Patho: Thyroid antibodies (IgG) override regulation which causes overstimulation of thyroid»_space;>increase in thyroid hormone secretion (*this suppresses TRH and TSH)
S/s: diplopia, lacrimation, photphobia, heat intolerance, tachycardia; pretibial myexedema, exopthalmos, lid lag, EOM paralysis, periorbital edema, papilledema, goiter (3x normal, may hear bruit, NON TENDER), ocular manifestations
- Sympathetic hyperactivity:most pts affected by lid lag which resolves with tx
- infiltrative changes: immune-mediated orbital edema, protrusion, retinal damage that does not resolve with tx
Tx: antithyroid drug therapy - Propylthiouracil - Methimazole radioactive iodine I131 subtotal thyroidectomy adjuvent sx tx (many will block conversion of T4 to T3)
Multinodular Goiter
Def: enlargement of the gland d/t follicular cell numbers increasing; if these cells are functioning they produce thyroid hormone leading to hyperthyroidism
Etiology: hypothyroid/increased thyroid hormone needs (body is trying to make more so it gets larger and then overproduces); hyperthyroidism; infectious or genetic disorders
Patho: hormone levels vary (euthyroid/hypoerthyroid/hypothyroid)
Tx: antithyroid drug therapy; radioactive iodine I131; subtotal thyroidectomy; adjuvent sx tx (many will block conversion of T4 to T3)
Thyroid Nodules
Def: less numerous or solitary (adenoma: nodule made of follicular cells that overgrow the area) can lead to toxic/hyperfunctioning if hyperthyroidism follows nodule
Eval: Refer to endocrinology; US; RAIU with I123 to determine hot (area of activity) vs. cold (area of no activity most likely malignant); biopsy; consistent f/u
Subacute thyroiditis (can be both hypo or hyperthyroidism)
Def: inflamm of thyroid gland; follicular cell damage so it releases stored thyroid hormone unnecessarily
S/s:*often following a viral infection; *TENDER gland is a hallmark sign; sore neck with fever
elevated thyroid hormone levels, suppression of TSH and TRH
Tx: antithyroid drug therapy; radioactive iodine I131; subtotal thyroidectomy; adjuvent sx tx (many will block conversion of T4 to T3)
Hashimoto’s thyroiditis
Def: most common adult cause of hypothyroidism; autoimmune disorder
Etiology: women > men; mean age of dg xis 60
Patho: IgG affects the thyroid and prevents the release thyroid hormone
S/s: often assoc with firm goiter, myexedema, puffy face, extra weight, thickened skin
Tx:
d/c or lower dose of offending medication
Levothyroxine
annual TSH monitoring
Myxedema coma
life threatening complication of hypthyroidism long standing disease extreme hypothermia areflexia seizures CO2 retention bradycardia widespread edema respiratory depression coma almost always in elderly
Tx: URGENT
d/c or lower dose of offending medication
thyroid hormone preparations-synthetic T4 preferred
annual TSH monitoring
