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from science to clinical practice > human development - endocrinology clinical > Flashcards

human development - endocrinology clinical Flashcards

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1
Q

what is hypothyroidism?

A

when the thyroid gland does not produce enough thyroid hormone (thyroxine or triiodothyronine)

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2
Q

what is the difference between primary and secondary hypothyroidism?

A

primary - thyroid gland abnormality; not able to produce TS4 and TS3. most common form of hypothyroidism

secondary - pituitary gland abnormality; not able to produce TSH to stimulate the thyroid gland to produce TS4 and TS3

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3
Q

what is the difference between tertiary and resistance hypothyroidism?

A

tertiary - hypothalamus abnormality, perhaps due to radiation. unable to produce TRH to stimulate thyrotrophs in the pituitary that produce TSH.

resistance - thyroid hormone receptors aren’t functioning so tissues are resistant to thyroid hormone effects

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4
Q

what is a suprasellar mass?

A

situated or rising above the sella turcica (saddle shaped depression in the body of the sphenoid bone)

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5
Q

what is the optic chiasm?

A
  • essential for visual pathway
  • part of the brain where optic nerves from each eye cross
  • located inferior to the hypothalamus but superior to the pituitary
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6
Q

what is hypopituitarism?

A

when there isn’t enough of one or more of the pituitary hormones (TSH, FSH, LH, GH, PRL, ACTH)

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7
Q

what are the clinical signs for hypopituitarism?

A
  • gaining of weight
  • loss of sexual drive (libido)
  • loss of menses (periods in women, erections in men)
  • fatigue
  • loss of hair in the face, skin becomes soft
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8
Q

what causes hypopituitarism?

A
  • tumour compressing optic chiasm and pituitary gland
  • this causes interference between the hypothalamus and pituitary gland
  • so trophic hormones produced by the hypothalamus can no longer reach the anterior pituitary cells
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9
Q

what are the types of pituitary tumours in terms of size?

A
  • micro adenoma: <10mm
  • macro adenoma: >10mm
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10
Q

what are the types of pituitary tumours in terms of function?

A
  • functioning: over secrete hormones; gives rise to endocrine syndromes
  • non functioning
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11
Q

what are the functioning macro-adenomas?

A
  • prolactinoma
  • Cushing’s (ACTH)
  • acromegaly (GH)
    (about half of the tumours are non functioning)
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12
Q

what are the different ways pituitary tumours can be treated?

A
  • conservative/surveillance (watch and do nothing) as they can be slow growing tumours
  • majority of macro-adenomas are treated surgically (trans-sphenoidal surgery)
  • majority of micro-adenomas are treated conservatively or medically
  • prolactin secreting tumours are treated medically
  • radiotherapy if there is a high likelihood of regrowth after removal
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13
Q

what are the clinical signs for hypothyroidism?

A
  • slowing of metabolic processes
  • weight gain
  • cold
  • tired
  • constipation
  • bradycardia
  • low mood
  • thin hair
  • dry skin
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14
Q

what causes hypothyroidism?

A
  • iatrogenic: surgery or radio iodine treatment
  • chronic autoimmune thyroiditis (most common): atrophic or Hashimoto’s
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15
Q

how can be hypothyroidism be treated?

A
  • levothyroxine
    75 - 125 mcg/day
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16
Q

what are the clinical signs for hyperthyroidism/thyrotoxicosis?

A
  • breathlessness
  • shaking
  • sweating
  • palpitations
  • restlessness
  • diarrhoea
  • muscle stiffness and weakness
  • lid retraction (eyelid is higher than expected)
  • lid lag (eyelid movement lags behind the movement of the eyes)
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17
Q

what are the causes of hyperthyroidism/thyrotoxicosis?

Study These Flashcards
A
  • grave’s disease: thyroid gland is overactive
  • toxic thyroid nodule: nodule in the thyroid gland which autonomously produces excessive thyroid hormone
18
Q

how can hyperthyroidism/thyrotoxicosis be treated?

Study These Flashcards
A
  • 6-12 month course of treatment
    . carbimazole (better)
    . propylthiouracil
  • radio iodine (avoid in thyroid eye disease)
  • surgery
19
Q

how can thyroiditis be classed?

Study These Flashcards
A
  • painless (lymphocytic and Hashimoto’s)
  • painful (granulomatous and radiation induced)
20
Q

are thyroid nodules mostly malignant or benign?

21
Q

what is the main type of thyroid cancer?

Study These Flashcards
A

papillary thyroid cancer

22
Q

what is Addison’s disease in terms of the functioning of the adrenal gland?

23
Q

what are examples of diseases where the adrenal gland is hyper functioning?

Study These Flashcards
A
  • Cushing’s
  • Conn’s / hyperaldosteronism
  • pheochromocytoma
24
Q

what is the name of an autoimmune primary hypoadrenalism disease?

Study These Flashcards
A

Addison’s disease

25
what are the causes of primary hypoadrenalism?
- abrupt discontinuation of steroids - autoimmune (addison's) - tuberculosis - haemmorhage / infarction - surgery
26
what are the symptoms for primary hypoadrenalism?
- weight loss - malaise (general feeling of discomfort, illness or fatigue) - diarrhoea - nausea / vomiting - syncope (fainting or passing out due to low BP) - myalgia (muscle pain)
27
what are the signs for primary hypoadrenalism?
- pigmentation (new scars, buccal, palmar creases) - wasting (gradual deterioration) - dehydration - loss of body hair
28
what are the investigations used to detect primary hypoadrenalism?
- random cortisol test - short synacthen test (synacthen; a synthesised ACTH, is injected into the patient to see whether the adrenal gland responds to it and produces cortisol) - plasma ACTH test - urea and electrolytes - adrenal antibodies
29
how is adrenal failure treated?
- emergency, life-threatening cases: ICU care, IV hydrocortisone at high doses, fluids, sodium - maintenance treatment: glucocorticoids (hydrocortisone, prednisolone) mineralocorticoids (fludrocortisone)
30
what is Cushing's syndrome?
- excess cortisol - either ACTH dependent or independent - ACTH dependent: due to pituitary - ACTH independent: due to adrenal glands
31
what are the signs for Cushing's syndrome?
- moon face - plethora (excess of blood) - acne - hirsutism (where women have thick black hair in their face, thighs, tummy, back etc.) - frontal balding - thin skin/bruising - poor wound healing - pigmentation - buffalo hump - striae
32
what are the dynamic investigations to confirm Cushing's syndrome diagnosis?
- low does dexamethasone suppression test (normally, after patients take dexamethasone, cortisol will be suppressed to undetectable levels. with Cushing's syndrome, cortisol can still be detected) - 24hr urinary cortisol - loss of diurnal rhythm
33
how can Cushing's syndrome be treated?
- laparoscopic adrenalectomy (removal of an adrenal gland) - replacement hydrocortisone treatment with periodic withdrawal to check if the counteractive adrenal gland is functioning
34
what is a phaeochromocytoma?
- tumour of the adrenal medulla - secreting NA or A
35
what are the clinical features of phaeochromocytoma?
- headaches - palpitations - weight loss - sense of doom - chest pain - sweating
36
what tests can phaeochromocytoma be diagnosed with?
- 24hr urine catecholamines - 24hr urine or plasma metanephrines (better option)
37
how is phaeochromocytoma treated?
- pretreated with alpha and beta blockade: phenoxybenzamine and doxazosin - then surgery
38
what would a screening blood test show for a patient with primary hyperaldosteronism?
- low renin - elevated aldosterone
39
what is conn's syndrome?
- primary hyperaldosteronism - independant of RAAS - hypertension, hypokalaemia, alkalosis
40
how do you confirm primary hyperaldosteronism diagnosis?
- measurement of renin (suppressed) and aldosterone (elevated) in salt-replete individuals (amount of salt in patient's body's is at normal levels) - selective venous sampling (to determine which adrenal gland is secreting abnormal levels of aldosterone)
41
how can conn's syndrome / primary hyperaldosteronism be treated?
- remove the adenoma (laparoscopic) - drug treatment (spironolactone, eplerenone) - eplerenone is the preferred drug for men as spironolactone may have negative effects on men

from science to clinical practice (5 decks)

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