Endocrine

Front 1

What are the signs and sx of hypercalcaemia?

Back 1

1. Renal stones

2. Osteopenia, pseudogout

3. Constipation, peptic ulcer and pancreatitis

4. Confusion

Hint 1

Stones, Bones, Abdominal Groans, and psychological Moans

Front 2

What are the 2 signs associated with hypocalcaemia?

Back 2

1. Chvostek sign (/ˈkvɒstɨk/) is a clinical sign of existing nerve hyperexcitability (tetany) seen in hypocalcemia.[1] It refers to an abnormal reaction to the stimulation of the facial nerve. When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips)

2. Trousseau's sign:

This sign may be positive before other manifestations of hypocalcemia such as hyperreflexia and tetany, as such it is generally believed to be more sensitive (94%) than the Chvostek sign (29%) for hypocalcemia.[2][3]To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct. The sign is also known as main d'accoucheur (French for "hand of the obstetrician") because it supposedly resembles the position of an obstetrician's hand in delivering a baby.

Front 3

what is the causes of Diabetic Ketoacidosis in Type I Diabetes mellitus?

Back 3

fat metabolism is increased to compensate for the lack of availability of glucose; XS acetyle coA is produced which is converted in the liver to ketone bodies and two of these are organic acids.

Front 4

What are the hormones produced by the Anterior Pituitary and Posterior Pituitary respectively?

Back 4

Prolactin

ACTH (adrenocorticotropic hormone)

FSH/LH (follicle-stimulating hormone)/ luteinising hormone

TSH (thyroid stimulating hormone)

GH (growth hormone)

Posterior:

- ADH (aka arginine vasopressin)

- Oxytocin

Front 5

What are the causes of hypopituitarism?

Back 5

1. Tumours

2. Lymphocytic hypophysitis

3. Pituitary apoplexy (e.g. Sheehan's syndrome)

4. Empty sella syndrome

5. Infiltrative disorders (e.g. sarcoidosis)

6. Infectious diseases (e.g. TB)

7. Head trauma

8. Cranial irradiation

9. Congenital and hereditary disorders.

Front 6

Which pituitary tumours are the most common? List them in order.

Back 6

1. Prolactinomas (prolectin-secreting) - 40%

2. GH-secreting - 15%

3. ACTH - secreting 10%

4. TSH -secereting Rare

Front 7

What are the recognised familial syndromes associated with the development of pituitary tumours?

Back 7

MEN1 (multiple endrocine neoplasia 1)

Carney syndrome

McCune-Albright syndrome

Familial isolated pituitary adenomas

Front 8

What is MEN1? (MEN2A, MEN2B)

Back 8

Autosomal dominant

MEN gene mutation

3Ps: Pituitary, Parathyroid, Pancreas

Neoplasms in the endocrine organs, different classifications affect different organs.

MEN1:

- hyperparathyroidism (90%); MC manifestation is asymptomatic hypercalcaemia

-Pituitary tumours (60-70%), prolactin or GH

- Pancreatic endocrine tumours (B cells; insulin, alpha cells; glucagon, Zollinger ellison syndrome; gastrin, increase acid, gastric ulcers.

General CP:

Kidney stones + stomach ulcers

Front 9

What are is Carney syndrome?

Back 9

Carney complex and its subsets LAMB syndrome[1] and NAME syndrome[1] are autosomal dominant conditions comprising myxomas of the heart and skin, hyperpigmentation of the skin (lentiginosis), and endocrine overactivity.[2][3] It is distinct from Carney's triad. Approximately 7% of all cardiac myxomas are associated with Carney complex

Front 10

What is McCune-Albright syndrome?

Back 10

McCune–Albright syndrome is suspected when two of the three following features are present:

Autonomous endocrine hormone excess, such as in precocious puberty

Polyostotic fibrous dysplasia

Unilateral café au lait spots

Front 11

What is lymphocytic hypophysitis?

Back 11

MC in postpartum women and classically presents with one or more pituitary hormone deficiencies and mass-effect Sx caused by the inflammatory infiltration.

Autoimmune.

Indistinguishable from piituitary adenoma on MRI

Hint 11

Autoimmune disorder

Front 12

Which cancer can cause SIADH?

Back 12

Small cell lung carcinoma

Hint 12

Syndrome of Inappropriate ADH

Ectopic ADH production

Front 13

What are the hallmarks of prolactin excess in women (pituitary hypersecretion/tumours)

Back 13

Galactorrhoea

Mentrual dysfunction

Infertility

*Prolactin inhibits FSH/LH secretion, causing hypogonadism.

Front 14

Cushing's syndrome signs?

Back 14

Non-specific/common in community:

Central obesity

Hypertension

Glucose intolerance

Specific signs:

Easy bruising

thick purple abdominal striae

proximal muscle weakness

Untreated cushing patients often have osteoporosis,

increased risk of death from CVS + infection.

ACTHObesity (predominantly central)Excessive bruisingProximal muscle weaknessFacial plethoraPurple skin striaeAcne, hirsutismMenstrual dysfunctionImpotenceHypertensionGlucose intoleranceOsteoporosisMental changesPeripheral oedemaExcess pigmentation (unusual)

Front 15

Local mass effect: Visual field loss is common, what are the 2 classical abnormalities? Can you name some other possibilities>

Back 15

1. superior quadrantanopia

2. bitemporal hemianopia (compresion of optic chiasm from a lesion with suprasella extension).

3. Loss of red perception is a subtle abnormality that can cusggest a compressive lesion.

4. direct invasion of optic nerve

5. Lesions that exten laterally in to the cavernous sinuses can cause palsies of CN III, IV, VI as well as damage branches of CN V (typically present with ophthalmoplegia (weakness/paresis or paralysis/plegia of one ormore extraoscular muscles), diplopia, ptosis and decreased facial sensation.)

Front 16

What are the initial assessment of pituitary function? Labs

Back 16

• Prolactin

• LH, FSH and testosteroneor oestradiol

• TSH and T4

• ACTH and cortisol

• Insulin-like growth factor 1

• Serum sodium

Morning sample is required as cortisol and test are highest in the morning.

Front 17

What is the specialised test for hypopituitarism?

Back 17

Short synacthen test:

Confirms cortisol deficiency

Insulin-induced hypoglycaemia (using an insulin tolerance test) is used to demonstrate GH deficiency and/or cortisol deficiency.

Front 18

What specialised tests are used to diagnose diabetes insipidus?

Back 18

Hypernatraemia and/or elevated osmolality is present in association with hypotonic (inappropriately dilute) urine.

Water deprivation test (done in hospital under specialist care) may be required to make diagnosis.

Front 19

What are the screening tests for Cushing/s syndrome?

Back 19

24hrs urinary free cortisol measurement or

overnight low-dose (1mg) dexamethasone suppression test.

False positives in patients with alcohol dependence, obesity or depression.

Front 20

What is the most sensitive method for imaging pituitary gland?

Back 20

MRI with gadolinium constrast.

CT unlikely to detect small lesions.

Front 21

What is the Mx for prolactinoma?

Back 21

1st line: DA-agonist therapy (bromocriptine or cabergoline).

Long Term treatment.

Front 22

What is the Mx for acromegaly?

Back 22

1st line = surgery

Somatostatin is a hypothalamic peptide (aka GH-inhibiting hormone). Somatostatin analogues (e.g. octreotide or lanreotide autogel) are options for patients who are not suitable for surgery. (IGH1 controlled via medical treatment in 50-60% of patients)