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Endocrinology > pathophysiology > Flashcards

pathophysiology Flashcards

1
Q

what is acromegaly a result of?

A

excess growth hormone

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2
Q

how common is acromegaly?

A
  • Rare – approx. 3-4 people in every million
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3
Q

what is the aetiology of acromegaly?

A
  • Most often caused by a benign pituitary tumour – can also be caused by non-endocrine tumour secreting GH
  • Further divided into micro and macroadenomas (macro is most common)
  • Some genetic link
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4
Q

are men and women affected the same with acromegaly?

A

yes - even split

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5
Q

when is acromegaly onset?

A

often slow and diagnosed in middle age

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6
Q

what are signs of acromegaly?

A
  • Change in facial features – widening of bridge of nose, thick lips, protruding jaw and bone, macroglossia (enlarged tongue), teeth separation
  • Headaches and visual disturbance – tumour
  • Deeper voice
  • Skin tag, excessive sweating and mild hirsutism in women (excessive growth of hair – male like patterns – usually dark and coarse)n
  • Joint pain and carpal tunnel syndrome (pressure on nerve on wrist causing numbness and tingling)
  • Hypertension and diabetes – extra strain
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7
Q

what investigations are done for acromegaly?

A
  • Routine bloods – glucose, lipids, bone profile
  • IGF-1 to exclude acromegaly if normal
  • Check thyroid, prolactin, gondal and adrenal hormones – if one is abnormal you are at increased risk of others being abnormal)
  • MRI to assess tumour
  • CT is non endocrine tumour is suspected
  • Cardiac workup – ECG, echo
  • Thyroid ultrasound
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8
Q

what treatment is used in acromegaly?

A

Treatment: usually in combination
- Endoscopic trans-spinodal surgery first line with radiotherapy as an adjuvant
- Somastatin analogues eg octreside – decrease tumour size and manage symptoms
- Dopamine agonists such as bromocriptine – suppress GH hypersecretion

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9
Q

what is first presentation of prolactinomas?

A
  • Usual presentation is raised prolactin – it is raised in lots of other states too ( drugs – spironolactone, NSAIDs, anti-psychotics, stress)
  • Women more commonly present with irregular/ absent menstruation, galactorrhoea (milky nipple discharge unrelated to normal milk production of breast feeding), reduced libido, hirsutism
  • Men have more subtle associated symptoms: erectile dysfunction, galactorrhoea, reduced beard growth, reduced libido – often presents late with osteoporosis
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10
Q

what symptoms do large prolactinomas tumour present as?

A

headaches and visual disturbances

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11
Q

what treatment is used in prolactinomas?

A

cabergoline (dopamine agonist)

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12
Q

what are the side effects of cabergoline?

A

can cause severe issues with impulse control and sleepiness

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13
Q

what size is a micro prolactinoma?

A

<1cm

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14
Q

what size is a macro prolactinoma?

A

1-4cm

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15
Q

what is a giant prolactinoma?

A

> 4cm

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16
Q

what condition is common following prolactinoma?

A
  • Osteoporosis is common – around 30% lose bone density – hypogonadism and oestrogen and testosterone is required for bone mass
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17
Q

what does luteinising hormone do?

A

acts on ovaries and testes
- Adrenal gland maturation

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18
Q

what does LH deficiency cause in childhood?

A

delayed/ no puberty

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19
Q

what does LH deficiency do in women?

A

menopausal, hirsutism

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20
Q

what does LH deficiency do to men?

A

regression of sex, loss of muscle, erectile dysfunction

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21
Q

what does hyper LH do to a child?

A

early puberty, early secondary sexual characteristics

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22
Q

what are the complications of acromegaly?

A

cardiomegaly, hypotensive, T2DM – increased insulin resistance, bitemporal hemianopia (each vision field is missing outer sections on both sides), impaired glucose tolerance, colo-rectal cancer, osteoarthritis

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23
Q

what has an inhib effect on prolactin?

A

dopamine

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24
Q

what inhibits LH and FSH secretion?

A

prolactin

25
Q

what is galactorrhea?

A

too high levels of prolactin

26
Q

what can cause increase in prolactin?

A
  • Can be caused by drugs, stress, a score over 3000 is indicative of endocrine pathology
  • Common endocrine cause: pituitary adenoma
27
Q

why does excess prolactin present earlier in women?

A
  • Presents earlier in women – will stop periods, men tend to get more general symptoms – presentation comes with osteoporosis
28
Q

what can hyperprolactinemia cause?

A

: galactorrhoea, amenorrhoea, erectile dysfunction – inhibits gonadotrophin release – infertility, hypogonadism, osteoporosis

29
Q

what does adrenocorticosteroid hormone do?

A

ACTH: - Responsible for sex steroid production or to form cortisol

30
Q

when is cortisol stimulated?

A

stress or during hyperglycaemia

31
Q

what does cortisol do?

A
  • Causing insulin resistance, central adiposity, raised cholesterol, muscle catabolism, reduced bone density, Na retention, K+ loss, emotional changes, growth – important but also inhibs excessive growth, anti-inflam effects
32
Q

what are features of Cushing’s?

A
  • Features: moon face, fat pad on back of neck, central adiposity, thinning of skin, distal limb wasting, stretch marks, acne, T2DM, vertigo, bruising
  • Women: hirsutism
33
Q

what is the aetiology of cushings syndrome?

A

ectopic ACTH, adrenal adenomas

34
Q

what is the aetiology of cushings disease?

A

iatrogenic (long term steroids)

35
Q

what can cause pseudo cushings?

A

obesity, alcohol, depression

36
Q

how do you confirm cushings?

A
  • Confirm diagnosis – 24hr urinary cortisol and overnight dex suppression test
37
Q

how do you manage cushings?

A

depends on cause – trans-sphenoidal surgery B/L adrenalectomy

38
Q

what is addison’s?

A

Too low cortisol: addisons – adrenal deficiency

39
Q

what are features of addisons?

A
  • Features: weight loss, hypotension, skin change, hypoglycaemia, loss in sex hormones – loss of body and pubic hair, loss in libido/ amenorrhoea, muscle wasting and limbs
40
Q

what signs indicate addison’s?

A

: hypotension, hypokalaemia, hyponatremia – not reabsorbed, hypoglycaemia, weight loss and high plasma – renin

41
Q

why is there an increase in skin pigmentation in addisons?

A

more Melatonin secreting hormone

42
Q

what is an addisonian crisis? - what symptoms

A

adrenal crisis
- Profound fatigue
- Dehydration

43
Q

what signs are seen in addisonian crisis?

A
  • Vascular collapse (hypotensive)
  • Renal shut down
  • Decrease in serum Na
  • Increase in serum K
44
Q

what might be the first presentation of addisons?

A

addisonian crisis

45
Q

what can be the aetiology of addisons - adrenal insufficiency?

A
  • Addisons: autoimmune, TB, HIV, metastasis (anything that stretches adrenal system), lymphoma, haemorrhage
46
Q

why can chronic steroid use cause adrenal insufficiency?

A

: chronic steroid use (body switches off cortisol production – needs to be stepped down or it will cause an Addisonian crisis),

47
Q

what investigations are needed within adrenal insufficiencies?

A
  • Hyponatraemia and hyperkalaemia
  • Hypoglycaemia
  • ACTH level, renin- aldosterone levels
  • 21 hydroxylase adrenal autoantibodies
48
Q

how do you manage adrenal insufficiencies?

A
  • Hydrocortisone (IV STAT in crisis), oral glucocorticoid
  • Fludocortisone (mineralcorticoid)
49
Q

what is pheochromocytoma?

A

tumour of adrenal glands that secretes unregulated excessive amounts of catecholamines – adrenaline

50
Q

why does the symptoms of pheochromocytoma in episodes?

A

adrenaline secreted in bursts

51
Q

is phaechromacytoma a genetic disorder?

A
  • Phaeochromocytoma – more common in certain genetic disorders – MEN2, neurofibromatosis type 1, von hippel-lindau disease
52
Q

how does phaeochromocytoma present?

A
  • Presentation: tachycardia, palpitations, SVT, sweaty, tremor, flushed, GI disturbances, HTN – signs of fight response
53
Q

what is the 10% pattern to phaeochromocytoma?

A
  • 10% pattern to tumours – 10% bilateral, 10% cancerous, 10% outside adrenal gland
54
Q

what is vitiligo?

A

Vitiligo – skin condition
- Large patches (nearly whole hand of hyper pigmentation)

55
Q

what is hypopituitarism?

A

reduced production of all pituitary hormones

56
Q

what is - Panhypopituitarism

A

reduction in all anterior pituitary hormones

57
Q

what causes hypopituitism?

A

disease of hypothalamus-stalk and pituitary

58
Q

name some causes of disease of hypothalamus-stalk and pituitary

A
  • Irradiation, surgery, pituitary tumour, ischaemia or bleed, infiltration (amyloidosis, haemochromatosis) infection – TB, meningitis
  • Specific causes: kallman syndrome, craniopharyngioma, apoplexy (pituitary haemorrhage or infarct). Sheehans syndrome – apoplexy (unconscious from haemorrhage) due to ischaemia from maternal haemorrhage
59
Q

what clinical signs would indicate hypopituitism?

A

reduced LH, FSH, testosterone, TSH, T4/T3, prolactin may be raised

Endocrinology (6 decks)

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