ENDOCRINOLOGY-Acromegaly: symptoms

Acromegalysymptoms
ABCDEF:
  • Arthralgia/ Arthritis                                                                                                       
  • Blood pressure raised
  • Carpal tunnel syndrome
  • Diabetes
  • Enlargemed organs
  • Field defect

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Addison's diseasefeatures
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]
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Adrenal disordersCushing's vs Addison's

  • Cushing: is Gushing cortisol.
  • In Addison's: patient's cortisol doesn't Add up.
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Adrenal gland: functions
ACTH:
  • Adrenergic functions
  • Catabolism of proteins/ Carbohydrate metabolism
  • cell immunomodulation
  • Hyper/ Hypotension (blood pressure control)
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Adrenal cortexlayers and products
"Get your Facts Right, Men are Glued to their Gonads":
  • Glomerulosa
  • Fasciculata
  • Reticularis
  • Mineralocorticoids
  • Glucocorticoids
  • Gonadocorticoids [androgens]
  Image result for adrenal cortex layers png

Carcinomas having tendency to metastasize to bone
"Particular Tumours Love Killing Bone":
  • Prostate
  • Thyroid
  • Lung
  • Kidney
  • Breast


Corticosteroidsadverse 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
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Diabetic ketoacidosisI vs. II
  • ketONE bodies are seen in type ONE diabetes.
Image result for diabetic ketoacidosis type 1 or 2

Diabetic ketoacidosismanagement
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)


Goitredifferential
GOITRE:
  • Goitrogens
  • Onset of puberty
  • Iodine deficiency
  • Thyrotoxicosis/ Tumor/ Thyroiditis [Hashimoto's]
  • Reproduction [pregnancy]
  • Enzyme deficiencies
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Gynecomastiacauses
DaLAS:
  • Digitalis
  • Leydig cell tumors
  • Alcohol
  • Sertoli cell tumors

Gynaecomastiacausing drugs
DISCOS:
  • Digoxin
  • Isoniazid
  • Spironolactone
  • Cimetidine
  • Oestrogens
  • Stilboestrol

Gynecomastiacommon causes
GYNECOMASTIA:
  • Genetic Gender disorder (Klinefelter)
  • Young boy (pubertal)*
  • Neonate*
  • Estrogen
  • Cirrhosis/ Cimetidine/ CChannel blockers
  • Old age*
  • Marijuana
  • Alcoholism
  • Spironolactone
  • Tumors (Testicular & adrenal)
  • Isoniazid/ Inhibition of testosterone
  • Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)
  *Asterisk indicates physiologic cause.
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Hirsutism vs. virilism
  • Hirsutism: Hair on body like a male.
  • Virilism: Voice and rest of secondary sexual characteristics like a male.
Image result for hirsutism Hirsutism
Image result for virilismvirilism

Hypercalcemiacauses
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)
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Hypercalcemiacauses
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

Hypercalcemiadifferential
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

Hypercalcemiasymptoms of elevated serum levels
"BonesStonesGroansMoans":
  • Bones: pain in bones
  • Stones: renal
  • Groans: pain
  • Psychic moans/ Psychological overtones: confused state
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Hyperthyroidismsigns and symptoms
THYROIDISM:
  • Tremor
  • Heart rate up
  • Yawning [fatigability]
  • Restlessness
  • Oligomenorrhea & amenorrhea
  • Intolerance to heat
  • Diarrhea
  • Irritability
  • Sweating
  • Musle wasting & weight loss

Hypothyroidism/thyroiditismaifestations 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
Image result for hypothyroidism features
*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 FSHfunction in male
  • LH: Leydig cells stimulated to produce testosterone.
  • FSH: Spermatogenesis stimulated.
Image result for LSH AND FSH Function

MEN I (Multiple Endocrine Neoplasiasyndromecomponents
"Please Please Pay Attention Tpeptic ulceration, you worms":
  *Adenomas of:
  • Pituatary
  • Pancreatic islets
  • Parathyroid
  • Adrenal cortex
  • Thyroid, associated with peptic ulceration
  *Syndrome is called "Wermer's syndrome".
Image result for men 1 syndrome

Multiple Endocrine Neoplasia (MENsubtype 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 IIIcomponents
MEN III is a disease of 3 M's:
  • Medullary thyroid carcinoma
  • Medulla of adrenal (pheochromocytoma)
  • Mucosal neuroma

Oestrogenfunctions
OESTROGEN SUX:      
  • Organ development (sex organs)
  • Endocrine: FSH and LH regulation
  • Secondary sex characteristics development
  • Tropic for pregnancy
  • Receptor synthesis (of progesterone, oestrogen, LH)
  • Osteoporosis decrease (inhibits bone reabsorption)
  • Granulosa cell development
  • Endocrine: increases prolactin secretion, but then blocks its effect
  • Nipple development
  • Sex drive increase
  • Uterine contractility increase
  • oXytocin sensitivity increase
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Oxytocin-producing nucleus of hypothalamus
  • Paraventricular nucleus--> Parturition (childbirth is oxytocin's most important role).

Pheochromocytomacommon symptoms
5 P's:
  • Paroxysmal rise in BP
  • Palpitations
  • Perspiration
  • Pain in abdomen
  • PMV in urine

Pheochromocytomadiagnositc rule
 *Rule of 10's:
  • 10% ectopic
  • 10% multiple
  • 10% malignant

Pheochromocytoma3 most common symptoms
"PHEochromocytoma":
  • Palpitations
  • Headache
  • Edisodic sweating (diaphoresis)

Pituitary hormones
FLAG TOP:
  • Follicle stimulating hormone
  • Lutinizing hormone
  • Adrenocorticotropin hormone
  • Growth hormone
  • Thyroid stimulating hormone
  • Oxytocin
  • Prolactin
Alternatively: GOAT FLAP with the second 'A' for Anti-diruetic homone/vasopressin
  *Note: there is also melanocyte secreting homone and Lipotropin, but they are not well understood.

Pituitary: anterior hypophysis hormones
FLAT P wave:
  • FSH
  • LH
  • ACTH
  • TSH
  • Prolactin

Progesteroneactions
PROGESTE:
  • Produce cervical mucous
  • Relax uterine smooth muscle
  • Oxycotin sensitivity down
  • Gonadotropin [FSH, LH] secretions down
  • Endometrial spiral arteries and secretions up
  • Sustain pregnancy
  • Temperature up / Tit development
  • Excitability of myometrium down

Prolactin and oxytocin: functions
  • PROlactin stimulates the mammary glands to PROduce milk.
  • Oxytocin stimulates the mammary glands to Ooze (release) milk.

SIADHcauses
SIADH:
  • Surgery
  • Intracranial: infection, head injury, CVA
  • Alveolar: Ca, pus
  • Drugs: opiates,antiepileptics, cytotoxics, anti-psychotics
  • Hormonal: hypothyroid, low corticosteroid level


SIADHdiagnostic sign
Syndrome of INAPPropriate Anti-Diuretic Hormone:
  • Increased
  • Na (sodium)
  • PP (urine)
  *SIADH is characterized by increased urinary sodium.
Image result for siadh diagnosis criteria

SIADHmajor signs and symptoms
SIADH:
  • Spasms
  • Isn't any pitting edema (key DDx)
  • Anorexia
  • Disorientation (and other psychoses)
  • Hyponatremia
Image result for siadh diagnosis criteria

Sex hormone drugsmale
"Feminine Males Need Testosterone":
  • Fluoxymesterone
  • Methyltestosterone
  • Nandrolone
  • Testosterone
Image result for sex hormone drugs

SIADH-inducing drugs
ABCD:
  • Analgesics: opioids, NSAIDs
  • Barbiturates
  • Cyclophosphamide/ Chlorpromazine/ Carbamazepine
  • Diuretic (thiazide)
Image result for siadh inducing drugs

Steroidside effects
CUSHINGOID:
  • Cataracts
  • Ulcers
  • Skin: striae, thinning, bruising
  • Hypertension/ Hirsutism/ Hyperglycemia
  • Infections
  • Necrosis, avascular necrosis of the femoral head
  • Glycosuria
  • Osteoporosis, obesity
  • Immunosuppression
  • Diabetes

Thyroid carcinomafeatures, prognosis of most popular
Most Popular is Papillary.
  *Clinical features:

  • Papillae (branching)
  • Palpable lymph nodes
  • "Pupil" nuclei (Orphan Annie)
  • Psammoma bodies within lesion (often)
  *Also, has a Positive Prognosis (10 year survival rate: 98%).
Image result for papillary thyroid carcinoma
ENDOCRINOLOGY-Acromegaly: symptoms ENDOCRINOLOGY-Acromegaly: symptoms Reviewed by Bright Zoom on May 05, 2018 Rating: 5

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