ENDOCRINOLOGY-Acromegaly: symptoms

Acromegaly: symptoms

ABCDEF:

Arthralgia/ Arthritis
Blood pressure raised
Carpal tunnel syndrome
Diabetes
Enlargemed organs
Field defect

Addison's disease: features

ADDISON:

Autoimmune
DIC (meningcoccus)
Destruction by cancer, infection, vascular insufficiency
Iatrogenic
Sarcoidosis, granulomatous such as TB histiomycosis
hypOtension/ hypOnatermia
Nelson's syndrome [post adrelectomy, increased ACTH]

Adrenal disorders: Cushing's vs Addison's

Cushing: is Gushing cortisol.
In Addison's: patient's cortisol doesn't Add up.

Adrenal gland: functions

ACTH:

Adrenergic functions
Catabolism of proteins/ Carbohydrate metabolism
T cell immunomodulation
Hyper/ Hypotension (blood pressure control)

Adrenal cortex: layers and products

"Get your Facts Right, Men are Glued to their Gonads":

Glomerulosa
Fasciculata
Reticularis
Mineralocorticoids
Glucocorticoids
Gonadocorticoids [androgens]

Carcinomas having tendency to metastasize to bone

"Particular Tumours Love Killing Bone":

Prostate
Thyroid
Lung
Kidney
Breast

Corticosteroids: adverse side effects

CUSHINGS BAD MD:

Cataracts
Up all night (sleep disturbances)
Suppression of HPA axis
Hypertension/ buffalo Hump
Infections
Necrosis (avascular)
Gain weight
Striae
Bone loss (osteoporosis)
Acne
Diabetes
Myopathy, moon faces
Depression and emotional changes

Cushing syndrome

CUSHING:

Central obesity/ Cervical fat pads/ Collagen fiber weakness/ Comedones (acne)
Urinary free corisol and glucose increase
Striae/ Suppressed immunity
Hypercortisolism/ Hypertension/ Hyperglycemia/ Hirsutism
Iatrogenic (Increased administration of corticosteroids)
Noniatrogenic (Neoplasms)
Glucose intolerance/ Growth retardation

Diabetic ketoacidosis: I vs. II

ketONE bodies are seen in type ONE diabetes.

Diabetic ketoacidosis: management

FUCKING:

Fluids (crytalloids)
Urea (check it)
Creatinine (check it)/ Catheterize
K+ (potassium)
Insulin (5u/hour. Note: sliding scale no longer recommended in the UK)
Nasogastic tube (if patient comatose)
Glucose (once serum levels drop to 12)

Goitre: differential

GOITRE:

Goitrogens
Onset of puberty
Iodine deficiency
Thyrotoxicosis/ Tumor/ Thyroiditis [Hashimoto's]
Reproduction [pregnancy]
Enzyme deficiencies

Gynecomastia: causes

DaLAS:

Digitalis
Leydig cell tumors
Alcohol
Sertoli cell tumors

Gynaecomastia: causing drugs

DISCOS:

Digoxin
Isoniazid
Spironolactone
Cimetidine
Oestrogens
Stilboestrol

Gynecomastia: common causes

GYNECOMASTIA:

Genetic Gender disorder (Klinefelter)
Young boy (pubertal)*
Neonate*
Estrogen
Cirrhosis/ Cimetidine/ Ca Channel blockers
Old age*
Marijuana
Alcoholism
Spironolactone
Tumors (Testicular & adrenal)
Isoniazid/ Inhibition of testosterone
Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)

*Asterisk indicates physiologic cause.

Hirsutism vs. virilism

Hirsutism: Hair on body like a male.
Virilism: Voice and rest of secondary sexual characteristics like a male.

Hirsutism

virilism

Hypercalcemia: causes

MD PIMPS ME:

Malignancy
Diuretics (thiazide the main culprit)
Parathyroid (hyperparathyroidism)
Immobilization/ Idiopathic
Megadoses of vitamins A,D
Paget's disease
Sarcoidosis
Milk alkali syndrome
Endocrine (Addison's disease, thyrotoxicosis)

Hypercalcemia: causes

GRIM FED:

Granulomas (sarcoid, TB),
Renal faliure
Immobility (esp. long term)
Malignancy
Familial (eg familial hypocalciuric hypercalcemia)
Endocrine (see below for subtypes)
Drugs (esp. thiazide diuretics, lithium)

*Endocrine causes are PATH:

Phaeochromocytoma
Addison's disease
Thyrotoxicosis
Hyperparathyroidism

Hypercalcemia: differential

VITAMIN TRAPS:

Vitamin A and D intoxication
Immobilization
Thyrotoxicosis
Addison's disease/ Acidosis
Milk-alkali syndrome
Inflammatory disorders
Neoplastic disease
Thiazides, other drugs
Rhabdomyolysis
AIDS
Paget's disease/ Parenteral nutrition/ Parathyroid disease
Sarcoidosis

Hypercalcemia: symptoms of elevated serum levels

"Bones, Stones, Groans, Moans":

Bones: pain in bones
Stones: renal
Groans: pain
Psychic moans/ Psychological overtones: confused state

Hyperthyroidism: signs and symptoms

THYROIDISM:

Tremor
Heart rate up
Yawning [fatigability]
Restlessness
Oligomenorrhea & amenorrhea
Intolerance to heat
Diarrhea
Irritability
Sweating
Musle wasting & weight loss

Hypothyroidism/thyroiditis: maifestations and morphology

"A SCHISM among the Axis during WWII":

Addison disease
Subacute thyroiditis
Cretinism/ Cold intolerance/ Constipation
Hashimoto's disease
Infectious-subacute thyroiditis
Silent thyroiditis
Myxedema coma

*The Axis: Schimidt syndrome (when other endocrinology disorders accompany Hashimoto's disease) and "Hitler cells" (Hurthle cells, which are follicular epithelial cells with basophilic inculsions)

LH vs FSH: function in male

LH: Leydig cells stimulated to produce testosterone.
FSH: Spermatogenesis stimulated.

MEN I (Multiple Endocrine Neoplasia) syndrome: components

"Please Please Pay Attention To peptic ulceration, you worms":

*Adenomas of:

Pituatary
Pancreatic islets
Parathyroid
Adrenal cortex
Thyroid, associated with peptic ulceration

*Syndrome is called "Wermer's syndrome".

Multiple Endocrine Neoplasia (MEN) subtype classification

Each subtype has 2 or 3 causes, plus something 1 or 2 more items.
MEN I is disease of 3 P's: [Pituitary, Parathyroid, Pancreas] plus one more: adrenal cortex.
MEN II is disease of 2 C's: [Carcinoma of thyroid, Catacholamines (pheochromocytoma)] plus two more: parathyroid for MEN IIa or

mucocutaneous neuromas for MEN IIB (also called MEN III).

Multiple endocrine neoplasia III: components

MEN III is a disease of 3 M's: