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Ch 9: Endocrine Disorders (ii) - Coggle Diagram
Ch 9: Endocrine Disorders (ii)
Hyperparathyroidism
primary
causes
usually solitary adenoma
enlargement of multiple glands (e.g. in MEN syndromes)
ca (rare)
ectopic adenomas (rare)
high ca + high PTH
do 24hr urinary ca collection to excl familial hypocalciuric hypercalcaemia
imaging: US, Sestamibi
Tx
correct ca using IV fluids + furosemide
parathyroidectomy
Presentation
often asymp (incidental finding)
urinary STONES
BONE pain
Abdominal GROANS
Psychiatric MOANS (depression, psychosis)
Fatigue OVERTONES
CV comps: short QT, arrythmias
secondary
hyperplasia of all 4 glands due to chronic hypocalc (CKD)
low ca, high PTH
phosphate can be high (tx with phosphate binder)
tertiary
prolonged secondary
high PTH, high calc, normal phosphate
tx: parathyroidectomy of 3.5 glands
malignant hyperparathyroidism
PTHrP secreted by tumour (e.g. SCLC)
Phaeochromocytoma
catecholamine producing tumours of chromaffin cells of adrenal medulla
ddx = paraganglioma (tumour of sympathetic ganglia)
a/w MEN + VHL
headaches, sweating, tachycardia, paroxysmal HTN, palpitations, tremor, panic attacks
investigations
24hr urine collection of catechols + metanephrines
plasma metanephrines
CT/MRI adrenals
Tx = total adrenalectomy
a blockade 10-14d before
b blockade 2-3d before
laparoscopic usually
can't tell if its malignant until it mets, hence long term followup needed
Cushing's syndrome
causes
iatrogenic
primary adrenal adenoma/carc/hyperplasia
secondary pit adenoma (Cushing's disease)
Ectopic ACTH secreting tumour
investigations
plasma cortisol
24hr urinary cortisol
overnight 1mg dexamethasone suppression test
high dose (2mg) dexamethasone suppression test to distinguish between pit vs ectopic tumour
pit tumour: cortisol will suppress a bit
ectopic tumour: no suppression
CT/MRI
tx options
adrenalectomy
lifelong cortisol + mineralocorticoid replacement
transsphenoidal resection
ectopic tumour excision
Conn's syndrome (primary hyperaldosteronism)
usually due to single benign adenoma
HTN, high Na, low K, fluid retention, cardiac comps
investigations
fludrocortisone suppression test
CT/MRI
adrenal vein sampling for measuring levels of aldosterone + renin
tx = adrenalectomy (can be partial for small lesions)