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79 Cards in this Set

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What causes exophthalmos?
infiltration of fatty tissues around the eye
What is Myxoedema?
hypothyroidism
What type of hypothyroidism accounts for over 90% of hypothyroid cases?
Hashimoto's
What is the mechanism that causes goiters in Hashimoto's?
• Hashimoto's is a primary hypothyroidism • With low levels of T3 & T4, the pituitary releases excess TSH which causes the thyroid gland to enlarge
What are the dominant features of hypothyroidism in children?
• reduction in growth velocity • arrest of pubertal development
What are clinical findings in an adult with hypothyroidism?
• bradycardia • dryness of the skin • hypothermia • non-pitting edema (most obvious on the eyelids and hands) • reduced body hair • pericardial & pleural effusions
What is used as a basis for the diagnosis of hypothyroidism?
• biochemical estimation of T4 & TSH • clinical suspicion • decreased DTRs • low voltage EKG • thyroid antibodies assays
What are causes of hypothyroidism?
• autoimmune (most common is Hashimoto's) • drug-induced (Lithium Carbonate) • secondary to treatment of hyperthyroidism • nutrition deficiency in iodine
How does Lithium Carbonate cause hypothyroidism?
• Lithium Carbonate, like iodine, inhibits the release of thyroid hormones • leads to goiter & hypothyroidism
What is the treatment of hypothyroidism?
• thyroxine (start at a low dose 25µg) • increase very slowly (every 4 - 6 weeks)
What is a known complication of patient given a sudden increase in T4 with a history of ischemic heart disease?
myocardial infarction
What are the 4 types of thyroid cancer?
• Papillary & Papillary/follicular (75%) • Follicular and Hurthle cell (15%) • Medullary (7%) • Anaplastic (3%)
What is the usual treatment of thyroid cancer?
removal of the thyroid
What is the most common cause of hypoparathyroidism?
thyroid removal
True/False: Radioactive iodine treatment will only target a cancerous thyroid
Thyroid cells have the unique ability to absorb iodine, which no other organ or cell can do. The correct answer is: True
What is the function of the parathyroid glands?
• to regulate the calcium level in our bodies so that the nervous and muscular systems can function properly
What is the calcium range that the parathyroid tries to maintain?
8.5 - 10.5
How does the parathyroid regulate calcium?
• by stimulating the breakdown of bone • stimulating the intestines to absorb more calcium
What would be expected EKG changes in a patient with hyperparathyroidism?
• shortened QT interval & tachycardia • hypercalcemia causing increased contraction
What are the effects of parathyroid hormone?
• activates osteoclasts, which breakdown bone, to release calcium into the blood • increases calcium absorption from the intestine • stimulates activation of Vitamin D in the kidneys
What is the most common cause of excess parathyroid hormone (PTH) production?
a benign tumor in one of the parathyroid glands
What is a parathyroid adenoma?
• an enlargement of one parathyroid gland • accounts for 96% of all patients with primary hyperparathyroidism
A patient with hypercalcemia and an elevated PTH level indicates what?
primary hyperparathyroidism
A patient with hypercalcemia and a normal (or low) PTH level indicates what?
secondary hyperparathyroidism
What diagnostic studies can be used to help diagnose hyperparathyroidism?
• ultrasound of the neck can reveal enlarged glands • Scintigraphy with MIBI can identify adenomas or hyperplastic parathyroids
What is the definitive treatment of hyperparathyroidism?
Surgery
If hypercalcemia is severe, what treatment is used to maintain bone?
Bisphosphonates
What can be used to treat hyperparathyroidism medically?
Cinacalcet (a calcimimetic) which activate calcium receptors on parathyroid glands causing a decreased secretion of PTH
What is the best test to perform to determine the severity of hyper/hypocalcemia?
EKG
What is Addison's Disease?
• adrenal insufficiency caused by destruction of the adrenal cortex (outer layer) • causes a decrease in glucocorticoid (cortisol) and mineralcorticoid (aldosterone) hormones
What is the most common cause of Addison's disease?
autoimmune destruction of the adrenals
Explain the mechanism by which Addison's disease will cause hypertension
• renin-angiotensin-aldosterone system will be unable to stimulate secretion of aldosterone by the adrenal cortex • this will stimulate an increased production in angiotensin II which will cause vasoconstriction and hypertension
What is Polyendocrine Deficiency Syndrome?
Addison's disease occuring with a deficiency in other glands
What are the two types of Polyendocrine Deficiency Syndrome?
• Type I - occurs in children • Type II (aka Schmidt's syndrome)- occurs in adults
What are some characteristics of Polyendocrine Deficiency Syndrome (Type I)?
occurs in childen and adrenal insufficiency with: • underactive parathyroid glands • slow sexual development • pernicious anemia • chronic candida infections • chronic active hepatitis • hairloss
What are features of Polyendocrine Deficiency Syndrome (Type II)?
• underactive thyroid gland • slow sexual development • diabetes • vitiligo • loss of pigment on areas of the skin
What are causes of Addison's Disease (other the autoimmune)?
• Acute adrenal failure following withdrawl of steroids • Ganulomatous disease • Infiltration by metastases • Tuberculosis infection of adrenal gland
What are clinical features of Addison's Disease?
• Depression • GI disturbances • Hypoglycemia • Increased pigmentation (from elevated ACTH production) • Tiredness • Weight loss
What is the most specific test for diagnosing Addison's disease?
ACTH stimulation test
What is the ACTH Stimulation Test?
• blood and urine cortisol are measured before & after a synthetic form of ACTH is injected • normal response is a rise in blood and urine cortisol levels • patients with Addison's disease respond poorly or have no response
What is the treatment for Addison's disease?
• Hydrocoritsone IV and 0.9% saline (acute crisis) • usually combination Hydrocortisone (corticosteroid) and Fludrocortisone (mineralcorticoid)
What is Conn's syndrome?
primary hyperaldosteronism (excess aldosterone secretion)
What are the 2 types of abnormalities of the adrenal gland seen in Conn's Syndrome?
• a benign adenoma • enlargement of both adrenals (hyperplasia) * both abnormalities can be seen by CT/MRI
What are symptoms of Conn's Sydrome?
• HTN (main, and often the only, symptom) • Muscle weakness • Polyuria & Nocturia • Tiredness
What blood levels should be measured for diagnosing Conn's Syndrome?
• aldosterone • renin
If a patient with hypertension has elevated renin and aldosterone levels, where is the problem located where?
in the kidney
What are the relative levels of renin and aldosterone in patients with Conn's Syndrome?
Aldosterone is high; Renin is low
Blood tests for aldosterone and renin for diagnosing Conn's syndrome must be taken under certain controlled conditions. What are these controlled conditions?
blood is usually drawn in the morning after the patient is lying supine for 30 minutes
What is the treatment for an aldosterone-producing adenoma?
Surgical removal (unilateral adrenalectomy) via laparoscopic procedure
What is the treatment of primary hyperaldosteronism due to bilateral hyperplasia?
spironolactone (which is similar to the female sex hormone Estradiol) *can cause gynecomastia
What is the difference between Cushing's Syndrome and Cushing's Disease?
• Cushing's Syndrome is a combination of symptoms caused by excess production of cortisol by the adrenal glands • Cushing's Disease is a diagnosis of excess cortisol due to pituitary tumor
What are the symptoms of Cushing's syndrome?
• Central obesity and moonface (hallmark symptoms) • emotional liability • excess hair growth • glucose intolerance • hypertension • kidney stones • menstrual irregularity • osteoporosis
What is the most common cause of excess steroids in the blood?
long-term use of steroids medications for other disorders
What are the relative levels of cortisol and ACTH in Cushing's Disease?
• Cortisol and ACTH levels are elevated • Problem is in the pituitary (MCC is a pituitary adenoma)
How can you determine if excess cortisol is due to an adrenal or pituitary tumor?
• A pituitary tumor will have elevated ACTH and cortisol levels • An adrenal tumor will have elevated cortisol levels but the normal pituitary will sense the excess cortisol and will stop making ACTH
What other type of tumor can cause an increase in ACTH?
small cell lung carcinoma
True/False: The majority of the causes of Cushing's Syndrome is ACTH independant
• Most of the causes of Cushing's Syndrome is ACTH dependant (80%), either pituitary tumors or lung cancers • ACTH independent causes account for 20% of cases, either benign or malignant adrenal tumors The correct answer is: False
What is most sensitive test to check for Cushing's Syndrome?
measure the amount of cortisol excreted in a 24 hour time period
What is the specific test for diagnosing Cushing's Syndrome?
• Dexamethasone Suppresion test • Dexamethasone is a powerful synthetic steroid that will shut down steroid production in people with a normal adrenal gland
What is the treatment of Cushing's Syndrome?
Depends on the cause • pituitary tumors are removed surgically & often treated w/ radiation • if the cause is within a single adrenal gland, treatment by surgical removal
What are the 5 surgical techniques of adrenalectomy?
• Standard Trans-Abdominal • Thoraco-Abdominal (used for the largest & most malignant tumors • Posterior (good for small tumors; well-tolerated by patients) • Retroperiotoneal (well tolerated and provides good exposure) • Laparoscopic (used for small to moderate-sized tumors)
What are factors that determine which adrenal operation that will be performed?
• size of the tumor • type of adrenal tumor (benign or malignant) • appearnace of the tumor on CT or MRI scans • history of previous abdominal operations • surgeon's experience
What are the 4 x-ray tests used to visualize the adrenal gland?
• Ultrasound • CT • MRI • MIBG scan (usually used for pheochromocytomas)
What is the definition of Pheochromocytoma?
• a tumor of the adrenal gland that causes excess release of epinephrine and norepinephrine • usually develops in the medulla of one or both adrenal glands
If the patient has symptoms of a pheochromocytomoa and there is no tumor of the adrenal gland, what type of scan should be done?
abdominal CT becuase the tumor can be in the abdomen
What are symptoms of a pheochromocytoma?
• severe headache • abdominal pain • chest pain • difficulty sleeping • flushing • hand tremor • HTN • increased appetite • irritability • loss of weight • nervousness • palpitation • sweating • tachycardia
What tests should be done to help diagnose a pheochromocytoma?
• Abdominal CT/MRI • Adrenal biopsy • MIBG Scintiscan
What imaging test is used to confirm a pheochromocytoma?
MIBG scintiscan
What lab tests would be abnormal with a pheochromocytoma?
• elevated urine VMA (byproduct of catecholamines) • elevated urine & blood catecholamines • elevated glucose
What is the definitive treatment for a pheochromocytoma?
• surgical removal • medical management if the tumor is inoperable
What is Multiple Endocrine Neoplasia II?
a hereditary disorder in which patients develop a type of thyroid cancer accompanied by recurring cancer of the adrenal glands
What is MEN IIa?
a multiple endocrine neoplasia associated with hyperplasia of the parathyroid gland
What is the cause of MEN II?
a genetic mutation in a gene called RET
What are the types of tumors that occur in MEN II?
• the adrenal tumor is a pheochromocytoma • the thyroid tumor is a medullary carcinoma of the thuroid
What is the main risk factor for MEN II?
a family history of MEN II
What are general symptoms of MEN II?
symptoms may vary but are consistent with those of pheochromocytoma, medullary carcinoma of the thyroid, and sometimes hyperparathyroidism *look up symptoms
What are physical findings of a patient with MEN II?
• enlarged cervical lymph nodes • single or multiple thyroid nodules • HTN, tachycardia, & elevated temperature
What is MEN IIb?
mucosal neuroma (benign tumors of the mucosa)
What is the treatment of MEN II?
surgical removal of the medullary carcinoma of the thyroid and the pheochromocytoma