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Path - Chem Path > Pituitary, Thyroid, Adrenals > Flashcards

Pituitary, Thyroid, Adrenals Flashcards

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1
Q

Hypothalamic Hormone - GHRH has action on which pituitary hormone(s)?

A

Stimulates GH

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2
Q

Hypothalamic Hormone GnRH has action on which hormone?

A

LH/FSH

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3
Q

Hypothalamic Hormone - TRH has action on which pituitary hormone(s)?

A

Stimulates TSH, Prolactin

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4
Q

Hypothalamic Hormone - Dopamine has action on which pituitary hormone(s)?

A

Inhibits Prolactin

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5
Q

Hypothalamic Hormone - CRH has action on which pituitary hormone(s)?

A

Stimulates ACTH

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6
Q

Combined Pituitary Function Test (CPFT) - Indications

A

Assessment of all components of anterior pituitary function used particularly in pituitary tumours or following tumour treatment

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7
Q

Combined Pituitary Function Test (CPFT) - Contraindications

A

Ischaemic heart disease Epilepsy Untreated hypothyroidism (impairs the GH and cortisol response)

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8
Q

Combined Pituitary Function Test (CPFT) - Side Effects

A

-Sweating, palpitations, loss of consciousness -Rarely - convulsions with hypoglycaemia -Patients should be warned that the TRH injection they may experience transient symptoms of - metallic taste in mouth, flushing and nausea

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9
Q

Combined Pituitary Function Test (CPFT) - Interpretation

A

Involves interpreting three aspects 1) Insulin tolerance test 2) Thyrotrophin Releasing Hormone Test 3) Gonadotrophin Releasing Hormone Test

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10
Q

Combined Pituitary Function Test (CPFT) - Interpretation -Insulin tolerance test

A

-Adequate cortisol response = Increase greater than 170 nmol/l to above 500nmol/l

> below 170 = Cushings

-Adequate GH response = Increase greater than 6mcg/L

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11
Q

Combined Pituitary Function Test (CPFT) - Interpretation -Thyrotrophin Releasing Hormone Test

A
  • The normal result is a TSH rise to >5mU/l (30min value >60min value -If the 60min sample > 30min value - indicated primary hypothalamic disease)
  • Hyperthyroidism = TSH remains suppressed
  • Hypothyroidism = exaggerated response
  • With the current sensitive TSH assays basal levels are now adequate and dynamic testing is not usually needed to diagnose hyperthyroidism
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12
Q

Combined Pituitary Function Test (CPFT) - Interpretation -Gonadotrophin Releasing Hormone Test

A
  • Normal peaks can occur at either 30 or 60 minutes
  • LH should >10U/l and FSH should >2U/l
  • An inadequate response = possible early indication of hypopituitarism
  • Gonadotrophin deficiency is diagnosed on the basal levels rather than the dynamic response
  • Males = Low testosterone in the absence of raised basal gonadotrophins
  • Females = low oestradiol without elevated basal gonadotrophins and no response to clomiphene -Pre-pubertal children should have no response of LH or FSH to LHRH
  • IF sex steroids are present (i.e. precocious puberty), the pituitary will be ‘primed’ and will therefore respond to LHRH. Priming with steroids MUST NOT occur before this test
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13
Q

Pituitary Tumours - size and effects

A

Can produce any combination of pituitary hormones

  • Microadenoma less than 10mm, benign
  • Macroadenoma greater than 10mm, aggressive

Can compress optic chiasm = bitemporal hemianopia

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14
Q

Posterior pituitary hormones

A

ADH

Oxytocin

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15
Q

causes of Excess ADH

A

Lungs - Lung paraneoplasias - SCC and Small Cell pneumonia

Brain - Traumatic Brain injury, meningitis

Iatrogenic - SSRIs, Amitryptiline

Effect - Euvolaemic Hyponatraemia

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16
Q

Neurogenic/ Cranial ADH failure

A

Failure of ADH production - 50% idiopathic

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17
Q

Nephrogenic ADH failure - causes

A

Commonly iatrogenic - Lithium, also hypercalcaemia, renal failure

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18
Q

Dipsogenic ADH failure

A

failure/ damage to hypothalamus and thirst drive, hypernatraemia without increased thirst response

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19
Q

Oxytocin -effects? -if pathologically low, what can you give? -antagonist?

A

Acts to increase uterine contractions and expulsion of milk. Not commonly pathological- if in failure of production syntocinon can be given to help stimulate breast feeding. Oxytocin antagonist Atosiban used in tocolysis

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20
Q

Normal values of

  • TSH
  • Free T4
  • Free T3
A

TSH - 0.33-4.5 mu/L

Free T4 - 10.2-22.0 pmol/L

Free T3 - 3.2-6.5 pmol/L

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21
Q

Thyroid Function Tests -High TSH and Low T4

A

Hypothyroidism

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22
Q

Thyroid Function Tests -High TSH normal T4

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A

Treated hypothyroidism or subclinical hypothyroidism (look for associated hypercholesterolaemia)

23
Q

Thyroid Function Tests -High TSH and High T4

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A

TSH secreting tumour or thyroid hormone resistance

24
Q

Thyroid Function Tests -Low TSH and High T4/T3

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A

Hyperthyroidism

25
Thyroid Function Tests -Low TSH and normal T4/T3
Subclinical Hyperthyroidism
26
Thyroid Function Tests -Low TSH and Low T4
Central hypothyroidism (hypothalamic/pituitary disorder
27
Thyroid Function Tests - High (later Low) TSH and Low T4/T3
Sick euthyroidism (with any severe illness)
28
Thyroid Function Tests -Normal TSH, abnormal T4
? Assay interference, changes in TBG, amiodarone
29
Causes of High Uptake Hyperthyroidism
- Graves disease - 40-60%, F\>M (9:1), autoantibodies ++, high uptake on isotope scan - Toxic multinodular goitre- 30-50%, high uptake - Toxic adenoma - 5%, hot nodule on isotope scan
30
Causes of Low Uptake Hyperthyroidism
- Subacute DeQuervains Thyroiditis - self limiting post viral painful goitre - Postpartum thyroiditis
31
Causes of Autoimmune Hypothyroidism
- Primary atrophic hypothyroidism - diffuse lymphocytic infiltration and atrophy. No goitre - Hashimotos thyroiditis - Plasma cell infiltration and goitre. Elderly females. May be initial Hashitoxicosis. ++ autoantibody titres
32
Other causes of Hypothyroidism
- Iodine deficiency (common worldwide) - Post thyroidectomy/radioiodine - Drug induced - antithyroid drugs, lithium, amiodarone
33
Hyperthyroid - treatment
Depends on aetiology - Low uptake - symptomatic - beta blockers, NSAIDs for dequervains - High uptake - BB and antithroid therapy - carbimazole/propylthiouracil (prop is rarely used now due to risks of aplastic anaemia) Can be used to block and replace or titrate TSH. Can also use radio iodine or surgery
34
Hypothyroid - treatment
Thyroid replacement therapy
35
Thyroid Neoplasia - Papillary -frequency, average age of onset, treatment
\>60% of cases 30-40y surgery +/- radioiodine, Thyroxine to lower TSH
36
Thyroid Neoplasia - Follicular -frequency, average age of onset, appearance, treatment
25% Middle age Well differentiated but spreads early Surgery + RI + Thyroxine
37
Thyroid Neoplasia - Lymphoma -Risk factor
5% MALT origin (mucosa-associated lymphoid tissue) Risk factor - Chronic Hashimotos, good prognosis
38
Thyroid Neoplasia - Anaplastic --frequency, average age of onset, treatment
Rare Elderly Poor response to any treatment
39
Cushing's syndrome -cause
Pituitary Tumour - "Cushing's Disease" (85%) Adrenal Tumour (10%) Ectopic ACTH producing tumour (5%) Iatrogenic - steroid use
40
Cushing's Disease -Symptoms & Signs
Moon face Buffalo Hump Striae Acne Hypertension Diabetes Muscle weakness proximal myopathy Hirsuitism
41
Cushing's Disease -Investigations
Low dose dexamethasone (0.5mg) High dose dexamethasone (2mg)
42
Cushing's Disease -Treatment
Treat underlying disease - surgical removal of lesion
43
Addison's Disease -Causes
Autoimmune TB Tumour deposits Adrenal haemorrhage Amyloidosis
44
Addison's Disease -Symptoms & signs
High K+, low Na+ and low glucose Postural hypotension Skin pigmentation Lethargy Depression
45
Addison's Disease -Investigations
SynACTHen Test
46
Addison's Disease -Treatment
Hormone repalcement - Hydrocortisone/fludrocortisone if primary adrenal lesion
47
Conn's Disease -Causes
Adrenal tumour
48
Conn's Disease -Symptoms & Signs
Uncontrollable Hypertension, High Na+, Low K+
49
Conn's Disease -Investigations
Aldosterone:Renin Ratio
50
Conn's Disease -Treatment
Aldosterone antagonists/ potassium sparing diuretics - Spironolactone, eplerenone, amiloride
51
Pheochromocytoma -Causes
Adrenal medulla Tumour = high Adrenaline
52
Pheochromocytoma -Symptoms & Signs
Episodic hypertension Arrhythmias Death if untreated
53
Pheochromocytoma -Investigations
Plasma and 24h urinary metadrenaline measurement/ catecholamines & VMA
54
Pheochromocytoma -Treatment
Alpha blockade, beta blockade then surgery when blood pressure well controlled

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