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Endocrinology > Cushings Syndrome, hypopituitarism, diabetes insipidus > Flashcards

Cushings Syndrome, hypopituitarism, diabetes insipidus Flashcards

1
Q

what is cushings syndrome

A

excess cortisol

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2
Q

what are the effects of too much cortisol

A

protein loss:

  • myopathy: wasting
  • osteoporosis: fractures
  • thin skin: striae, bruising

altered carbohydrate/ lipid metabolism: diabetes mellitus, obesity (central)

altered psyche: psychosis, depression

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3
Q

what results from excess mineralocorticoid

A

hypertension, oedema (due to excess mineralocorticoid activity- aldosterone)

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4
Q

what results from excess androgen

A

virilism, hirsutism, acne, oligo/amenorrhoea

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5
Q

what are the features of cushings

A

thin skin: bruising, striae
proximal myopathy: difficulty in getting out of chair
frontal balding in women
conjunctival oedema (chemosis)
osteoporosis (usually overweight women dont get osteoporosis)
‘moon face’
intrascapular fat pad

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6
Q

what tests can be done to diagnose cushings

A
  1. definitive test= low dose dexamethasone suppression test: 2 day 2mg/ day

cortisol <50 next morning is normal
>130 is definitely cushings

  1. suppression test- overnight (given at midnight) exogenous oral high dose steroid (dexamethasone) such cause lowered serum cortisol

cortisol <50 next morning is normal

  1. urine free cortisol, <250 is normal
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7
Q

why are random cortisols not as helpful

A

due to diurnal cortisol variation

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8
Q

what are the causes of cushings syndrome

A

pituitary (majority)
-cushings disease= pituitary adenoma

adenoma of adrenal- produces too much steroid

ectopic (neuroendocrine that produce ACTH)

  • thymus
  • lung
  • pancreas

pseudo (can present with cushings)

  • alcohol and depression
  • steroid medication
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9
Q

what cause of cushings will have these test results:

ACTH of <300 that is suppressed by 50% with a high DDT

A

pituitary

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10
Q

what cause of cushings will have these test results:

ACTH of <1 that is not suppressed by a high DDT

A

adrenal

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11
Q

what cause of cushings will have these test results:

ACTH of >300 that is not suppressed by a high DDT

A

ectopic (ACTH may even rise)

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12
Q

how do you distinguish pituitary and non pituitary cushings

A

high dose DT - 2mg 6 hourly for 2 days

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13
Q

what would a CRH test show in pituitary disease (not in an adrenal adenoma)

A

50% increase in ACTH

20% increase in cortisol

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14
Q

what is the treatment for a pituitary adenoma

A

hypophysectomy
external radiotherapy if recurs
or bilateral adrenalectomy

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15
Q

what is the treatment for an adrenal adenoma

A

adrenalectomy

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16
Q

what is the treatment for an ectopic cause of cushings

A

surgery to remove source
or
bilateral adrenalectomy

17
Q

what is the most usually ectopic cause of cushings

A

carcinoid tumour

18
Q

what is the drug treatment for cushings

A

metyrapone- dont produce steroid hormone (if other treatment fail/ waiting for radiotherapy to work)

ketoconazole (hepatotoxic)

pasireotide

19
Q

what are the results of pan hypopituitarism

A

anterior pituitary:

  • lack of growth hormone: growth failure
  • lack of TSH: hypothyroidism
  • lack of LH/FSH: hypogonadism
  • lack of prolactin: none known

posterior pituitary
-lack of ADH: diabetes insipidus

20
Q

what can cause hypopituitarism

A

pituitary tumours (non functional or secreting)

secondary metastatic lesions (lung, breast)

local brain tumour (next to pituitary- astrocytoma, meningioma, glioma)

granulomatous diseases (TB, histiocytosis X, sarcoidosis)

vascular diseases (polyarteritis)

trauma (road accidents, skull fractures)

hypothalamic diseases (syphilis, menigitis)

iatrogenic, surgery

autoimmune- sheenan (post pregnancy)

infection (meningitis)

21
Q

what are the symptoms of anterior hypothyroidism

A 
menstrual irregularities 
infertility, impotence 
gynaecomastia (M)
abdominal obesity (lack of thyroid) 
loss of facial hair (M)
loss of axillary and pubic hair 
dry skin and hair 
hypothyroid faces
growth retardation
22
Q

what is the peripheral hormone for TSH

A

thyroxine (T4)

23
Q

what tests are best at measuring the steroid axis

A

synacthen and ITT

24
Q

in post menopausal women what should LH and FSH be like

A

be high - low would suggest pituitary disease

25
Q

what is the replacement for hypopituitarism

A 
thyroxine (100-150mcg/day)
hydrocortisone (10-25mg/day) 
ADH desmopray (nasal) or tables 
GH (nightly)
sex steroids (HRT, oest.prog pill for females, testosterone for males)
26
Q

what are the benefits of growth hormone in adults

A 
improves well being an QOL
decreases abdo fat 
increases muscle mass, strength and stamina 
imporves cardiac function 
decreases cholesterol and increases LDL 
increases bone density 
given daily by SC injections
27
Q

how can testosterone replacement be administered

A 
IM injection every 3-4 weeks 
skin gel (testogel, tostran) 
prolonged IM injection 10-14 weeks 
oral tablets (hard as peptide so destroyed in stomach acid unless in capsule)
28
Q

what are the risks of testosterone replacement

A

prostate enlargement (doesn’t cause prostate cancer) (monitor PR exam and PSA at start)
polycythaemia - increased haemoglobin in the blood
hepatitis (only oral tablets)

29
Q

what are the causes of cranial diabetes insipidus

A

familial (DIDMOAD; DI, DM, optic atrophy, deaf)

acquired (idiopathic, trauma: road accidents, surgery, skull fracture)

rare: tumour, sarcoid, external irradiation, meningitis

30
Q

describe the water deprivation test

A

check serum and urine osmolalities for 8 hours, and then 4h after giving IM DDAVP

if urine/serum osml ratio >2 then normal
(urine more concentrated) if less then DI

if improves after DDAVP then due to cranial DI (deficiency of DDVAP)
if not then nephrogenic

31
Q

what is the treatment for DI

A

desmospray

desmopressin oral tablets

desmopression injection

32
Q

does a baseline urine to serum osmolality >2 usually avoids the need for a water deprivation test

A

yes

33
Q

is a 1mg overnight dexamethasone suppression test is the best screening test for Cushing’s syndrome

A

yes

Endocrinology (46 decks)

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