Flashcards in Endocrinology in the Clinical Setting Deck (55)
What is clinical endocrinology?3
- the diagnosis and treatment of conditions resulting form alterations of normal hormone physiology.
How does an evaluation of a patient with an endocrine disorder differ?
- history differs by asking about cold and heat intolerance.
- physical must be focused around the thyroid gland and nail beds.
- labs focused around hormones. If a certain level is high, we attempt to suppress it. If it does not go down, we know there is an issue.
What are the common endocrine disorders?
- T1DM and T2DM
- thyroid nodule
- metabolic syndrome
- gestational diabetes
- osteoporosis (osteopenia)
- growth hormone deficiency
What are the UNcommon endocrine disorders?
- Addison's disease
- adrenal carcinoma
- Klinefelter's syndrome
- Cushing's disease
- osteomalacia (soft bones)
- diabetes insipidus
What are the symptoms of endocrine disorders?
- cold intolerance
- warm intolerance
- blurred vision
- inability to concentrate
- frequent bowel movements.
Does treatment of endocrine conditions require interaction with other specialties?
- YES often
** What are the 5 concerns in endocrinology?
1. laboratory selection
2. know the limitations of your test.
3. utilize screening tests when appropriate.
4. If the hormone level is elevated, try to suppress it. If the hormone level is low, try to stimulate it.
5. Recall the influence of medications and nutritional state when interpreting laboratory results (thyroid, adrenal).
What is the most common pituitary tumor?
- non-functioning pituitary adenoma
*found incidentally on imaging stuidies.
What is the most common pituitary secreting tumor?
What are the types of malignant pituitary tumors?
- functional and non-functional pituitary carcinomas
From where can metastases to the pituitary occur?
- breast, lung, stomach, kidney
What are some pituitary cysts?
- Rathke's cleft cyst, mucocoeles, others
What is empty sella syndrome?
- congenital defect of the sella due to herniation of the arachnoid and CSF into the sella, compressing and destroying the pituitary gland.
What are some developmental abnormalities of the pituitary?
- cransiopharyngioma= can suppress ADH (vasporessin) and develop diabetes insipidus.
What vascular tumor can disrupt the pituitary-hypothalamic axis?
What are some other diseases that can disrupt the pituitary-hypothalamic axis?
- malignant systemic diseases (hodgkin's, non-hodgkin lymphoma, histiocytosis...)
- granulmoatous diseases (sarcoidosis, wegner's, TB...)
- vascular aneurysms (intrasellar location)
What size is considered to be an enlarged pituitary gland?
- 10mm or more
**** What visual disturbance can an enlarged pituitary cause?
- bitemporal hemianopsia= loss of peripheral vision
36 y/o female with bilateral galactorrhea and amenorrhea for the last few months, and previously had children. She has BMI of 31 and is on psychotropic medications (can elevate prolactin). Imaging is done, and finds a pituitary adenoma. How should we treat her?
- start her on BROMOCRIPTINE= dopamine agonist (inhibits prolactin release) that will help to shrink the tumor.
What are the clinical features of hyperprolactinemia/ prolactinoma?
- women may present with oligomenorrhea, amenorrhea, galactorrhea, or infertility.
- men often have less symptoms.
- both sexes may experience visual defects or headache due to mass effect.
What can increase levels of prolactin?
- pituitary and hypothalamic disqease.
How are prolactinomas treated?
- 1st line= medically (BROMOCRIPTINE and CABERGOLINE). Take with food (bread) to help with side effects before bed.
*major side effect is nausea and vomiting.
- 2nd line= surgically
- 3rd line= radiotherapy
What is acromegaly?
- enlarged bones of hands, feet, and jaw, enlarged tongue, widely spaced teeth, and growth of visceral organs leading to dysfunction (ex. cardiac failure) due to a rare pituitary adenoma in adults causing excessive secretion of GH and thus IGF-1.
What is the greatest contributor to mortality in acromegaly?
- cardiovascular disease
How do you diagnose acromegaly?
- elevated GH and insulin growth factor-1 (IGF-1) levels
- lack of GH suppression by oral glucose.
Is IGF-1 or GH, better when evaluating for acromegaly?
- IGF-1 bc it has a longer half-life
How do you treat acromegaly?
- bromocryptine (dosage may be higher than for prolactinomas)
- relieve signs and symptoms
- surgical (transphenoidal or transfrontal approach)
What are some causes of HYPOpituitarism?
- pituitary adenomas (adults) or craniopharyngioma (children)
- Sheehan syndrome= pregnancy-related infarction of the pituitary gland.
- empty sella syndrome= congenital defect of the sella. Herniation of the arachnoid and CSF into the sella compresses and destroys the pituitary gland.
What labs will you look for if you suspect hypopituitarism?
- hyposmolality of serum with elevated urine osmolality (SIADH-llike syndrome)