Endocrinology 3 Flashcards
(37 cards)
Prolactin over secretion (prolactinoma)
- Common condition
- Usually due to a pituitary tumour secreting prolactin
Clinical presentation of prolactin over secretion
- Galactorrhoea (breast milk production)
- Amenorrhoea in women and sexual dysfunction in men
- Headaches and visual field problems with large tumours
How is prolactinoma diagnosed?
- Static test is enough to diagnose
- Pituitary MRI
What can mildly raised prolactin be due to?
- Sexual intercourse
- Nipple stimulation
- Stress
- Large number of drugs
- Non functioning pituitary tumour
Growth hormone over secretion
Rare affecting 1/25000
In childhood or adolescence growth hormone excess results in:
- Excessive growth spurt and increased size of feet and hands
- If left untreated growth hormone excess leads to gigantism, the most serious consequences of the disease
Clinical presentations of growth hormone oversecretion
In adults growth hormone excess affects skin, soft tissue and skeleton
- Acromegalic face
- Wide and large hands/ feet
- Increased sweating
Diagnosis of growth hormone over secretion
- Suppression tests= necessary
- Glucose is given, followed by GH measurements at diff time points
- Imaging is necessary to confirm the presence of pituitary tumour
What is Cushing’s syndrome?
- Rare affecting 1-2/100,000
- Abnormal cortisol levels
May be due to: - Pituitary secreting ACTH tumour
- Adrenal tumours secreting cortisol
- Cancers producing ACTH
Cushing’s clinical presentation
- Growth arrest in children
- Typical facial appearance
- Fat redistribution
- Skin abnormalities
- Complications
Tests for Cushings
- Suppression tests required
- Dexamethasone suppression test is used to confirm the failure to suppress endogenous cortisol production
What can thyroid overproduction be due to?
-Primary hyperthyroidism
- Secondary hyperthyroidism (pituitary TSH secretion)
Prevalence of hyperthyroidism
- prevalence around 2% in the female population
- 10 times more common in women
5 causes of hyperthyroidism
- Graves’ disease (80%)- autoimmune condition
- Toxic nodule or toxic MNG (15%)
- Thyroiditis (1%)
- Drug induced
- Rarities
Clinical presentation of hyperthyroidism
- Hyperactivity, irritability, insomnia
- Heat intolerance and increased sweating
- Palpitations
- Weight loss despite overeating
- Menstrual problems
Signs of thyrotoxicosis
- hand tremor
- increased sweating
- fast pulse
Inspection of the thyroid
Enlarged
- smooth= Graves’ disease
- nodular= toxic nodules
- tender= thyroid inflammation
Extrathyroidal signs- thyroid eye disease
- swelling around the eyes
- protrusion of the eyeball (proptosis)
- paralysis of eye muscles
Investigations of hyperthyroidism
- static test
- thyroid blood test
Raised thyroid hormone
Suppressed TSH - antibody testing to confirm the autoimmune nature of the condition
Hormonal under- secretion
Growth hormone deficiency
Children= failure to grow
Adults
- nothing
- tiredness
- depression
Tests for growth hormone under secretion
Stimulation test
- Glucagon stimulation test
- insulin stress test
Treatment of growth hormone deficiency
Growth hormone replacement
- injections
- Expensive
What may steroid under secretion be due to?
Adrenal failure
Pituitary failure
Clinical presentation of steroid under secretion
- failure to grow in children
- severe tiredness
- dizziness due to low BP
- abdominal pain, vomiting & diarrhoea
Tests for steroid under secretion
Stimulation test
- synacthen test if primary adrenal failure is suspected
- GST or IST if secondary adrenal insufficiency is suspected
Failure to diagnose= death
