MED Endocrine

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Information about MED Endocrine
Health & Medicine

Published on May 31, 2014

Author: ooijianmin

Source: slideshare.net

Endocrine

- Pituitary gland- anterior & posterior - anterior (adenohypophysis), posterior (neurohypophysis) - Anterior produce hormone and secrete into systemic circ. It secretes follicular stimulating & luteinising (gonadotropin), growth (somatotropins), prolactin, thyroid stimulating (tyrotropin), adrenocorticotropic (corticotropin) - Posterior din produce. It release. Hypothalamus produce oxytocin and vassopressin that secreted from nerve axon into capillary bed, store in cells and released by posterior pit gland into circ.

- Vasopressin (antidiuretic hormone) act on V2 R of distal tubules to reabsorp water, thus incr total body water & decr urine vol {if def of antidiuretic hormone, the v2 fail to reabsorp water thus caue polyuria subsequently polydipsia} - Oxytocin cause contraction of uterine muscle (labour) & initiate mechanism of breastfeeding

-hypopituitarism => low trophic hormone (hormone from pituitary gland) > low target hormone > subphysiological stimulate of pituitary hormone (however it is suboptimal, inappropriate or absent) > low target hormone & normal or low trophic hormone

Hypopituitarism • Reduced secretion of ant pituitary hormone, follow the seq growth hormone> gonadotrophins (follicular-stimulating, luteinising hormone)> prolactin> thyroid hormone> adrenocorticotrophic hormone, antidiuretic hormone GGPTAA Causes (according etiology)******** -tumour (pituitary tumour, craniopharyngioma) -trauma -iatrogenic – irridation, surgery -infection –encephalitis -infarction – seehan’s syndrome (according anatomy) -hypothalamus: Kallman’s syndrome, tumour, infection, infarction, inflammation -pituitary stalk: mass lesion (craniopharyngioma), meningioma, trauma, surgery, carotid artery aneurysm - pituitary: infiltration (haemochromatosis, metastases, amyloid), tumour, irridiation, inflammation, autoimmune, ischaemia (Sheehan’s syndromw, pituitary apoplexy)

Signs & symptoms 1. GROWTH HORMONE Sx: -Hypoglycaemia (dizzy, hunger, weakness, trembling, numbness) -dry wrinkly skin -reduced balance strength exercise ability wellbeing -osteoporosis Signs: -short stature -central obesity 2. GONADOTROPHIN Sx: -Impotence/ reduced libido -Irregular menses -Infertility/ dyspareunia/ erectile dysfx -Osteoporosis Signs -Hypogonadism- sparse axillary, pubic and facial hair -Hypogonadism- Small breast, clitoris( female), small penis & testes (male) -High- pitched voice -Thin skin

3. ADRENOCORTICOTROPHIC HORMONE Sx Non specific-nausea, fatigue Hypoglycaemia Signs Pallor (skin, areola) 4. THYROID HORMONE Sx -Cold intolerance -Fatigue -Constipation Signs -bradycardia -hypothermia -slow relaxation of knee jerk

5. PROLACTIN Sx Failure of lactation 6. ANTIDIURETIC HORMONE Sx Polyuria, polydipsia

Ix 1. Basal test -follicular stimulating, luteinising hormone, testosterone, estradiol -insulin-liked growth factor -prolactin -thyroid function test-thyroid stimulating hormone, free t4 -cortisol -U&E (Na+ decr) -Hb (normochromic normocytic)

2. Dynamic test -short Synacthen test -insulin tolerance test -arginine + growth hormone releasing test - Glucagon stimulation test (alternative for insulin tolerance test if failed)

Thyroid gland enlargement • Hyperthyroidism – Graves disease – Multinodular goiter – Malignancy • Hypothyroidm – Iodine deficiency (esp in endemic area) – Hashimoto’s thyroiditis • Others – Familial goiter

Hypothyroidism • Causes – Destruction – Drugs – Enzyme deficiency - dyshormonogenesis – Autoimmune T – H

• History taking – Causes, symptoms, diagnosed (onser sx, test done, medication, complication), family history, other associated autoimmune disease – Cold intolerance, lethargy, weight gain – 手cold intolerance, dry scaly skin, Carpal tunnel syndrome – numbness, pain, tingling (myxoedematous infiltration causing compression on the median nerve), Muscle weakness – 头Alopecia, coarse brittle hair, lethargy, impaired memory and cognition – 脸Facial changes: loss of lateral 1/3 of eyebrow, periorbital puffiness, hoarseness of voice – GI- constipation, decr apetite, weight gain – Sexual – menorrhagia

• PE (refer pg 55) • Q & A • Neurological manifestation and why – Carpal tunnel synd (infiltration of myoedematous causing compression of median n) – Myopathy (segmental demyelination in peripheral nerve> decr nerve conduction velocity> polyneuropathy> weakness) – Slow relaxation of ankle knee jerk – Pseudodementia (impair hippocampal neurogenesis, maturation and differentiation in development of brain> memory and cognition impairment) – Cerebellar syndrome (antithyroid Ab mediated immune response> cerebellar degeneration) – Myoedema coma (ultimate hypothyroidism state before death may preceded by surgery(thyroidectomy/radioiodine/pit surgery), infection, MI, stroke, trauma) • Cvs manifestation and why • Causes of aneamia • Autoimmune disease associated – DM – Pernicious anaemia – Rheumatoid arthritis – Myasthenia gravis – Hypoparathyroidism – Addison’s disease

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