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LCA endocrinology
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16
Medical
Undergraduate 4
06/19/2017

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Term
difference between cushiness syndrome and disease?
Definition
syndrome: chronic gluccorcorticoid xs
disease: ACTH producing tumour in pituitary
Term
nelsons syndrome?
Definition
rapidly increasing pituitary tumour after bilateral adrenelectomy
Term
Cushings can be ACTH dependent and independent. name some examples
Definition
dependent
Cushings disease
ectopic acth PRODUCING TUMOUR

INDEPENDENT
glucocorticoid rx
adrenal adenoma
adrenal hyperplasia
Term
features of cushings
Definition
fat redistribution: central obesity, moon face, supraclavicular fat pads
skin bruising
proximal myopathy
mood changes
HTN
pigmentation in acth dependent causes
Hypokalemia
Term
ix in Cushnings?
Definition
dexamethasone suppression test overnight
24 hour urine cortisol

2nd line test
48 hour dexamethasone suppression
midnight cortisol
Term
localising the lesion in Cushings. you have looked for plasma acth. what do you do if it is low and why?

what if it is high?
Definition
low? means not from pituitary. image adrenals looking for a tumour there or hyperplasia

high? means ACTH from pituitary or ectopic source. do the high dexamethasone suppression test. this suppresses pituitary tumour but not ectopic source (e.g. small cell lung ca)

in high dexamethasone suppression test:
if cortisol is not suppressed do CT thorax looking for ectopic source
if cortisol is suppressed then do pituitary MRI to confirm pituitary tumour
Term
mx of Cushings
Definition
MEDICAL: metyrapone and ketoconzaole
surgical: rx cause: transsphenoidal resection
surgical: bilateral adrenelectomy if cause unknown. NB: if cause was Cushings disease then be aware of nelsons syndrome
Term
Goitre causes
Definition
Graves
multinonodular
physiological: pregnancy
others: iodine deficiency
Term
ix in goitre?
Definition
TFT
imaging: US. if retrosternal then CT
Needle aspiration
Biopsy
Term
complications of goitre?
Definition
cosmetically displeasing
compress surrounding structures trachea: SOB
compress recurrent laryngeal nerve: dysphonia
gullet compression: dysphagia
SVC compression: facial swelling, blurred vision
Term
mx of goitre?
Definition
conservative if euthyroid
medical for hyperthyroid: beta blocker, carbimazole or in pregnancy: propylthiouracil
surgical: radio iodine 131

reasons for surrey: malignant, compression, cosmetics, reoccurs

hypothyroid: levothyroxine
Term
cI to radioiodine?
Definition
pregnancy/breast feeding
young children at home
incontinence (eliminated in urine)
Term
features of acromegaly
Definition
headache
bitemporalhemianopia
hypopituitarism
increase hand/feet size
corsening facial features
macroglossia
hoarse voice
carpal tunnel
HTN
osteoarthritis
xs sweating
Term
ix in acromegaly
Definition
failure to suppress GH with oral glucose tolerance test
pituitary fx test and serum prolactin to detect hypopituitarism
MRI pituitary to visualise tumour
Term
complications of acromegaly?
Definition
impaired Glucose tolerance and DM
cardiomyopathy
Colon cancer (colonoscopy at 50 years)
Term
mx of acromegaly?
Definition
medical: octreotide
surgical: Transphenoidal resection
Radiotherapy if needed
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