Revision Tutorial Flashcards by Louise Emerson

why does hand and foot size increase in acromegaly

due to soft tissue expansion

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what is the gold standard test for acrogmegaly

GTT (GH should decrease with glucose but in acromegaly it increases)

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what tests can you do for acromegaly

GTT, IGF- 1

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what happens if a pituitary tumour grows into the sphenoid sinus

CFS leak- clear drops coming from node

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what happens if a pituitary tumour grows laterally into cavernous sinus

squint due to compression on cranial nerve 6

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why is cranial nerve 6 the most prone to injury

is the longest

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what additional tests should you do in acromegaly

Visual fields, TSH (hypothyroid from pituitary tumour), T4, prolactin, sodium (hypoadrenal), BG for diabetes, U and Es

(helps tell if there is a tumour)

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what is the clinical sign name for excessive or inappropriate milk production

galactorrhoea

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what are 5 causes of galacctorhoea

prolactinoma, pregnancy, drugs: antipsychotics/dopamine antagonists/metaclopramide, pituitary tumour, RTA

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what is the round dark object on either side of the pituitary

carotid artery

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what nerves are in the cavernous sinus

oculomotor 
trochlear 
opthalmic branch of trigeminal 
maxillary branch of trigeminal 
abducens nerve 
trocheal nerve

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damage to what nerve causes the eye to be pulled inwards

abducents

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damage to what nerve will cause a squint when the eye can only move outwards

oculomotor

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what is the venous system of the cavernous sinus

superior and inferior petrosal sinuses- ultimately into the internal jugular vein via the sigmoid sinus

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what is metabolic syndrome

obesity, hypertension, increased blood glucose and cholesterol- puts you at risk of diabetes and CVD disease

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why do you get thin skin in cushings

mobilisation of protein, protein degradation

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what screening test for cushings

overnight DT

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what eye signs in cushings

conjunctival oedema (chemosis)

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how does high cortisol weaken bones

increases osteoclasts activity, reduces osteoblasts, collagen formation and calcium absorbtion

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what should dexomethasone do

decrease ACTH and cortisol levels

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what can causes a glucocorticoid deficiency

addisons disease

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what can cause addison

CAH, haemorrhage of the adrenal glands (acute hypoadrenalism), menigococcal septicaemia, exogenous steroid use, adrenal TB, hypopituitarism

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what can be see in the mouth in addisons disease

buccal pigmentation

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what could cause a man to havel short stature, high pitch voice, infantile genitalia, no pubic or axillary hair

hypogonadism (happened pre puberty)

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name 3 things that can cause hypogonadism

hypopituitarism, anabolic steroid (long term), tumour

what investigations should you do in hypogonadism

testosterone and LG/FSH, GH, IGF-1, prolactin, ACTH and cortisol

what can cause amenorrhoea

pregnancy, hyper and hypothyroidism

what likely caused this: 24 y/o women, amenorrhoea, hirustism

PCOS

what drugs can you give in PCOS

metformin, combined contraceptive pill, anti andorgens (cyclotyrone, spironolactone, elphloathine)

what caused this: boy with marfanism, mum had thyroid cancer, tongue has small neuromata, larger neuromata on gums, slightly raised calcium

MEN 2 (thyroid cancer and neuroma)

what causes this: middle aged women, hypertensive- intermittent attacks, cafe-au-late, lumps below skin

MEN 2 causing a phaeochomocytoma (too much adrenaline causing the paradoxical HPX attacks)

A 24 year old female notices a lump in her neck. Her GP thinks it might be a thyroid swelling and send her to the clinic for assessment. What tests should be done to confirm the diagnosis?

blood tests for T3, T4, TSH, thyroid antibodies ultrasound (U1-5)- above 3 needs FNA thyroid uptake scan

what is the prognosis for thyroid cancer

80-85% follicular or papillary, good prognosis, dont metastasise, present early, thyroidectomy to remove it

who need FNA always for thyroid lump

under 30s, esp teens

what usually accompanies medullary thyroid cancers

MEN 2 (a and b) or family history

what can cause hyperthyroidism

toxic nodule/ goitre, graves or autoimmune, thyroiditis (autoimmune/ viral),

how do you use blood tests to distinguish toxic goitre from graves

toxic goitre increased conversion to T3, graves all thyroid hormones raised

what is the treatment for graves

antithyroid drugs, surgery, radioactive iodine

what is the treatment for a toxic nodule

beta blockers, radioiodine

what is the risk in carbimazole

agranulocytosis- check white blood count if sore throat or dry cough

what should you do in patients needing levothyroxine with CVD

might exacerbate symptoms so start with low dose and titrate up

what can cause cushings syndrome

Pituitary adenoma (cushings disease), exogenous steroid use, ectopic tumour secreting ACTH, small cell carcinoma, pseudo cushings (appearances of cushings without biochemical markers- commonest cause alcohol)

what test to diagnose cushings

1mg overnight DTT suppression test (at 10 oclock, check cortisol at 9am- can get false positive in chronic stress and depression), 48 hr low dose DTT suppression test, if this negative do a high dose DTT suppression. In cushings lose diurnal variation, have high cortisol production so have raised 24 hr cortisol urinary secretion. If from pituitary CT pituitary, if not CT chest.

when not fit for surgery what drug can help with cushings syndrome

metyraprone

what can cause amenorrhoea

hypothyroidism, hyperthyroidism, pregnancy, low body weight/ excessive exercise (hypothalamic dysfunction), hyperprolactinaemia (iatrogens (dopamine antagonists, stressed, prolactinoma)), premature ovarian failure.

what drugs can cause galactprrhoea

metoclopramide, anti convulsants, dopamine antagonists, anti depressants. Anti pyschotics, thenofiazine, oestrogens, opiates (all cause lack of dopamine).

what are the signs of panhypopituitarism

tiredness, weight gain, thirst, amenorrhoea, slowness of thought, reduced exercise tolerance, pale skin, hairlessness, diarrhoea, vomiting, postural hypotension, pigmentation increased- in Addisons

how can you confirm a diagnosis of panhypopituitarism

IGF-1, thyroid function test (TSH), ACTH and cortisol, GTT, water deprivation for ADH, PRL. Need to do stimulation tests

name causes of pituitary failure

pituitary adenoma, carcinoma, haemorrhage (pituitary apoplexy), hyperplasia, trauma (RTA/surgery), sheenans syndrome, radiotherapy/ chemotherapy, infective (post meningitis), auto immune, sarcoidosis

name 4 endocrine conditions that can cause hypertension

cushings, diabetes, phaeochromocytoma, conns (primary hyperaldosterism), acromegaly

what can be diagnosed with an MIBG scan

phaeochromocytoma

what receptor for: | insulin

tyrosine kinase receptor

what receptor for: | growth hormone

cytokine receptor

what receptor for: | caclium

GPCR

what is the main role of insulin

increases hepatic glycogen synthesis

what nerves pass through the right cavernous sinous

III, IV, V1, V2, VI

what structure is most at risk during a total thyroidectomy

recurrent laryngeal nerve

how often should people with insulin who drive check their insulin

every time they drive

what is the target of the drug dapagliflozin

sodium glucose co transporter

what is insulitis

inflammatory infiltrate around a pancreatic islet

what is this thyroid uptake scan appearance: | uptake reduced

thyroiditis

what is this thyroid uptake scan appearance: | increase uptake of whole thyroid

graves

what is this thyroid uptake scan appearance: | patchy uptake

multinodule

what is a colloid nodule

benign thyroid lumps which can be solitary or found in a multinodular goitre

what is the treatment for a microprolactinoma

cabergoline (dopamine agonists)

why might you have raised prolactin in a NON functioning pituitary adenoma

as tumour might block dopamine getting through the stalk

what is the FIRST thing you should treat in hypopituitarism

hydrocortisone

what will prolactin levels be like in a macroprolactinoma

>5000

what is the treatment for a phaeochromocytoma

alpha then beta blocker (a before b)

how do you diagnose conns

paired renin and aldosterone measurement

what syndrome is hyperaldosteronism

conns

what do you loose in conns

potassium

what is the treatment for an addisons crisis

IV saline and hydrocortisone

what is the gold standard for acromegaly diagnosis

glucose tolerance test

what are the 6 p's of acute limb ischaemia

``` pale painless pulseless paralysed paraesthesia perishing cold ```