ENDO DDX

Aetiology Pathophys Symptoms Diagnosis Treatment

Prolactin secreted Proliferation of Macroprolactinoma =no Blood Bromocriptine
from the pituitary Lactotroph cell symptoms ↑ prolactin
gland leading to Macroprolactinoma (>10 ↑ TRH (sometimes) Surgery –
increased prolactin mm) = If macro
production compress of the meninges MRI – to determine size If meds didn’t work
→headaches
Compress optic nerve → Radiotherapy
bitemporal hemianopia
Prolactinoma
↓ ovulation/
spermatogenesis
Osteoporosis/ fractures
Galactorrhoea
Vaginal dryness
Gynecomastia
Erectile dysfunction
↓ libido + infertility
Adrenocorticotrophic ↑ACTH production Stimulates the Moon facies Blood Transsphenoidal
hormone- secreting adrenal gland to Buffalo hump ↑ACTH level surgical resection
tumour produce excess Truncal obesity
Cushing’s disease cortisol MRI - size
Pituitary adenoma ↑ GH Growth of bones, hands, ↑ insulin like growth Surgery
hypothalamus feet and lower jaw factor 1
tumour Protrusion of forehead Radiotherapy
Werner’s syndrome ↑ organ size MRI – tumour size
Acromegaly (adult) ↑ sweating Meds
Carpel tunnel Somatostatin analogs
DM- TII
CHF
Gastro cancer – polyps
 1. Pit adenoma ↑ GH Excess growth of long ↑ insulin like growth Surgery
2. Hypothalamic bones (tibia + humerus) factor 1
tumour Weight gain Somatostatin analogs
Gigantism (children)
3. McCune Albright Macrocephaly MRI – tumour size
(congenital) + acromegaly sympt
↑ prolactin sympt
1. Central ↓ADH production Osmolality > 295 Desmopressin
2. (damage to from the Polyuria mmol/L
osmoreceptors, hypothalamus and Polydipsia
supraoptic nucleus, pituitary Dehydration
supraoptico- ↓ BP
hypophyseal tract) Fatigue
Unresponsiveness Nausea
3. Nephrogenic to ADH Poor concentration
→lithium meds Genetic defect to Behavioural therapy
→polycystic kidney vasopressin Water deprivation test
Diabetes Insipidus disease receptor

Placenta releases
4. Gestational vasopressinase

Psychological –
5. Dipsogenic schizophrenia,
compulsive
disorder
Drink too much
water
Endemic Low iodine causes Goiter ↑TSH + ↓T3+T4 Iodine salts
Iodine deficiency low levels of T3 and Hypothyroidism Thyroid hormones
T4 and more TSH Endemic myxoedema Imaging to determine Surgery for goiter
Goiter
and TRH is Decreased fertility the size of the goitre
Sporadic (intrinsic stimulated, leading Spontaneous abortions
endogenous factor) to gland
 enlargements
=Goiter
Hypothyroidism 1. Iodine deficiency ↓ metabolism 1° = ↑TSH + ↓T3+T4 Synthetic T4
2. Hashimoto Myxoedema (hands, feet, supplements
thyroiditis eyes) 2° = normal/↓ TSH
3. Post tx for Enlarged tongue ↓T3 +T4
hyperthyroidism Bradycardia
4. Congenital Constipation
5. Pituitary tumour Weight gain
6. Hypothalamus Memory impairment
damage
(tumour/trauma)

Hashimoto Autoimmune Molecular mimicry Goiter

destruction → autoantibodies Trachea – hoarse voice ↓TSH,T3 +T4 Levothyroxine
cause an immune Compression oesophagus ↑TSH when ↑antiTPO + Surgery for large
response → → dysphagia anti thyroglobulin goiter
destroy follicular ↑prolactin (due to ↑TRH)
cells → Hurthle
cells
Hyperthyroidism 1. Toxic nodular Fatigue 1° = ↓TSH ↑T3+T4 Treat cause
goiter (mutated Weight loss
TSH receptor) Depression Pit tumour = BB +antithyroid drugs
2. Thyroid adenoma Memory problems normal/↑TSH + ↑T3
3. Jod – Basedow Goiter +T4 Radioiodine therapy +
syndrome (I2 Hair loss supplements
induced) Muscle pain Subclinical form = ↓
4. Neonatal Trembling hands TSH and normal T3+T4 Surgical removal
hyperthyroidism Infertility
(mother with Exophthalmos Iodine scintigraphy
Graves)
5. Ant. Pit tumour
Graves Autoimmune B cells produce Goiter
antibodies against Heat intolerance
the thyroid Insomnia
proteins Weight loss
Exophthalmos
Periorbital myxoedema
Adenovirus Triggered by viral Enlrgaed painful thyroid ↓TSH, T3 and T4 levels NSAIDS
De Quervain’s
mumps inf of upper resp gland
Granulamous
coxsakie tract antibodies Throtoxic state →
inflammation of the
produced against hot.sweaty, diarrhoea,
thyroid gland
virus also attack eapid weight loss
thyroid
1° Excess PTH Stones – kidney/gall stones 1°- ↑Ca ↓P Resection of
Adenoma secreted → Thrones - poluria 2° - ↓Ca ↑P ↓Vit D parathyroid gland
Multiple endocrine hypercalcinaemia Groans – peptic uclers, 3° - ↑Ca (due to CKD)
neoplasia → slow muscle constipation, muscle +↑P (due to Hyperparathyroid
Hyperplasia (rare) contractions, ↓AP weakness cotransport with K) crisis →furosemide
Parathyroid firing Bones – pains
carcinoma (demineralisation)
Excess PTH Psychiatric overtones
2° produced in Depressed mood, confusion
Hyperparathyroidism
Vitamin D def response to ↓Ca in
↓kidney function blood 2°/3°
Renal dystrophy
Compensatory Calcification in BV + sort
3° (2° but long term) parathyroid tissues
CKD hormone produced
independently of
Ca levels

Removal of gland ↓PTH → ↓Ca + Tetnay ↓PTH + ↓Ca + ↑P Ca and Vit D

Hypoparathyroidism ↑P Parathesia supplement
Calcification
 Autoimmune Chovostek’s sign Recombinant human
polyendocrine Trousseu’s sign parathyroid hormone
syndrome type 1 Seizures
Genetic – DiGeorges, Arrhythmia
AD
hypoparathyroidism
Autoimmune ↓aldosterone Depends on layer effected: Synthetic ACTH test Lifelong hormonal
destruction +cortisol ZG = ↑K, ↓Na, ↓vol, ↑H+ →Measure cortisol replacement therapy
Tb = nausea, vomiting, aldosterone →cessation of
Metastatic carcinoma fatigue, dizziness, crave medication can lead to
salty foods Addisonian crisis
Addison’s Disease
ZF = weak tired disoriented,
hyperpigmentation of joints
ZR = M = little affect
= F = loss of pubic hair,
↓libido
Exogenous ↑CORTISOL Muscle wasting 24hr urine sample Treat cause
Steroid meds Easy bruising Dexamethasone
Osteoporosis suppression test → Exogenous – SLOWLY
Endogenous Abdominal striae positive test = no remove
Excess ACTH Buffalo hump change in cortisol level = corticosteroids from
Pit adenoma Facies moon Cushing’s their regime
(Cushing’s Diseases) Truncal obesity ↓ACTH
Small cell carcinoma ↑BP Adrenal Surgery
Cushing’s Syndrome
(ectopic) DM adenoma/carcinoma
Adrenal adenoma/ Adrenal steroid
carcinoma ↑ACTH inhibitors –
Cushing’s Disease ketoconazole,
Ectopic ATCH metyrapone

Imaging
MRI- pituitary
 CT- adrenal glands,
chest, abdomen, pelvis
→look for ectopic
growths
1° ↑aldosterone → Can be asymptomatic but.. Plasma aldosterone CCB
hyperaldosteronism ↑Na reabsorption levels and plasma renin Spironolactone
and ↓ K and H+ Hypertension activity Glucocorticoids
loss Headaches
Facial flushing Adrenalectomy
Conn’s adenoma
Seizures
Constipation
Polyuria + polydipsia
Weakness
Arrhythmias
Adrenal tumour ↑NE/E secretion ↑ BP ( >18/120) ↑NE/E levels Alpha blockers
leading to cells from the ➔ Headache, Metanephrine found in Surgery to remove
darkening chromaffin cells of sweating, anxiety the urine tumour
Pheochromocytoma
the medulla → can lead to CHF, stroke, Hypertensive crisis –
retinal haemorrhages, renal US/CT -locate the BP meds
failure tumour