Term
| difference between cushiness syndrome and disease? |
|
Definition
syndrome: chronic gluccorcorticoid xs
disease: ACTH producing tumour in pituitary |
|
|
Term
|
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
|
Definition
fat redistribution: central obesity, moon face, supraclavicular fat pads
skin bruising
proximal myopathy
mood changes
HTN
pigmentation in acth dependent causes
Hypokalemia |
|
|
Term
|
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
|
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
|
Definition
Graves
multinonodular
physiological: pregnancy
others: iodine deficiency |
|
|
Term
|
Definition
TFT
imaging: US. if retrosternal then CT
Needle aspiration
Biopsy |
|
|
Term
|
Definition
cosmetically displeasing
compress surrounding structures trachea: SOB
compress recurrent laryngeal nerve: dysphonia
gullet compression: dysphagia
SVC compression: facial swelling, blurred vision |
|
|
Term
|
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
|
Definition
pregnancy/breast feeding
young children at home
incontinence (eliminated in urine) |
|
|
Term
|
Definition
headache
bitemporalhemianopia
hypopituitarism
increase hand/feet size
corsening facial features
macroglossia
hoarse voice
carpal tunnel
HTN
osteoarthritis
xs sweating |
|
|
Term
|
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
|
Definition
medical: octreotide
surgical: Transphenoidal resection
Radiotherapy if needed |
|
|
