Flashcards in Other endo 1 Deck (23):
What are the symptoms of high calcium?
psychic moans - depression
Groans - abdo pain, pancreatitis, Peptic ulcer disease
thrones - polyuria, polydipsia ( nephronic DI) and constipation
OTHER - high BP
What are the causes of primary hyperparathyroidism ?
80% solitary adenoma
0.5 parathyroid less than 0.5 %
what investigations would do and what results would you see in a patient with primary hyperparathyroidism?
high or inappropriately normal PTH
ECG: short QT, bradycardia, 1st degree heart block
x-ray: Osteitis fibrosa cystica, phalangeal erosion
DEXA : osteoporosis
What is Osteitis fibrosa cystica?
It is a skeletal disorder resulting in a loss of bone mass, a weakening of the bones as their calcified supporting structures are replaced with fibrous tissue (peritrabecular fibrosis), and the formation of cyst-like brown tumors in and around the bone
What is the treatment for Primary hyperparathyroidism
avoid dietary CA and thiazides
The definitive management is total parathyroidectomy
conservative management may be offered if the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage
calcimimetic agents such as cinacalcet are sometimes used in patients who are unsuitable for surgery
What are the causes of secondary hyperparathyroidism ?
vitamin D deficiency
chonric renal disease
What is the treatment for secondary hyperparathyroidism?
give phosphate binder
VIT D calicitriol ( active)
What is pseudohypoparathyroidism ?
Failure of target organ response to PTH
symptoms of hypocalciumia
short 4th and 5th metacarpals, short stature
Ix low ca and high PTH
What is pseudoppseudohypoparathyroidism
Normal receptor in kidney and normal biochem
abnormal paternal receptors in the body
What are the symptoms of Cushing's
acne and hirsutism
Interscapular nad supraclavicular fat pads
What medical conditions are associated with Cushing's
hypokalaemia ( NA can be normal or low )
What are the ATCH independent causes of Cushing's syndrome?
STERIODS: commonest cause
adrenal noduar hyperplasia
(ACTH will be low due to feedback)
What are the ATCH-dependent cause of
Cushing disease - pityitary tumour
( corisol supression on high-dose dex)
causes: SCLC, carninoid tumour
No suppression by any dose of dex
what investigations would you do for a ptx with crushing's?
1st 24 hour unrinary free cortisol
lat night serum or salivary corisol
dexamethasone suprression test
ACTH ( acth degrades very qucikly after venepunture
imaging: CT. MRI, chest x-ray
What is the treatment for patients with Cushing's?
cushing disease -trans-sphenoidale excision
adrenal adenoma/ca: adrenelectomy - hydrocortisone and fludrocortisone
What is Nelson's syndrome
rapid enlargement of pituitary adenoma following bilateral adrenalectomy for Cushing syndrome
mass effects: bitemporal heminaopia
what are the features Primary hyperaldosteronism
Hypokalemia: weakness, hypotonia, hyporeflexia, cramps
what are the causes of primary hyperaldosteronism?
bilateral adrenal hyperplasia (70%)
adrenocortical adenoma ( 30%): Conn's syndrome
What is the treatment for Conn's ?
What is the treatment for adrenal hyperplasia?
Spironolactone, plerenone and amiloride
What are the investigations and results would you see in a patient with primary hyperaldosteronism?
U&Es normal or high NA, low K
aldosterone: renin ratio increased
ECG flat/ inverted T waves, U waves, depressed ST segments, pronged PR and Qt intervals
what is the cause of secondary hyperaldosteronism?
due to increased renin from decreased renal perfusion
normal aldosterone:renin ratio