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Sheehan's Syndrome Diagnosis and Treatment
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Sheehan's Syndrome Diagnosis and Treatment

Created by
@CheeryBlackberryBush

Questions and Answers

What is the primary imaging technique used for diagnosing Sheehan's syndrome?

  • MRA (Magnetic Resonance Angiography)
  • X-ray
  • Ultrasound
  • MRI with contrast medium (correct)

    • What type of surgery is preferred for treating pituitary adenomas?

  • Trans-sphenoidal surgery (correct)
  • Craniotomy
  • Endoscopic sinus surgery
  • Laparoscopic surgery

    • Which medication is typically used to treat prolactinomas?

  • Somatostatin
  • Lisinopril
  • Bromocriptine (correct)
  • Cabergoline (correct)

    • What is the primary cause of hyperprolactinemia?

    <p>Medication-induced effects</p> Signup and view all the answers

    In cases of Sheehan's syndrome, what hormonal condition is typically observed?

    <p>Hypo-prolactinemia</p> Signup and view all the answers

    What is a key consequence of the hypertensive peak during labor in Sheehan's syndrome?

    <p>DIC (Disseminated Intravascular Coagulation)</p> Signup and view all the answers

    What diagnostic step is essential for confirming hyperprolactinemia?

    <p>2-3 determinations of prolactin levels</p> Signup and view all the answers

    What is the primary treatment for growth hormone-secreting tumors (GHoma)?

    <p>Somatostatin analogue</p> Signup and view all the answers

    What is the main feature of central diabetes insipidus?

    <p>Not enough production of ADH</p> Signup and view all the answers

    Which type of thyroid cancer is associated with elevated calcitonin levels?

    <p>Medullary thyroid carcinoma</p> Signup and view all the answers

    What is the most common cause of primary hypothyroidism in Europe and the US?

    <p>Hashimoto thyroiditis</p> Signup and view all the answers

    Which cells in the thyroid gland produce T3 and T4 hormones?

    <p>Epithelial follicular cells</p> Signup and view all the answers

    How is iodide internalized in the thyroid cells?

    <p>Via iodine symporter</p> Signup and view all the answers

    What role does thyroperoxidase (TPO) play in the synthesis of thyroid hormones?

    <p>Oxidizes iodide</p> Signup and view all the answers

    Which of the following is a key characteristic of nephrogenic diabetes insipidus?

    <p>Failure to bind ADH to aquaporin</p> Signup and view all the answers

    What is the primarily vascular supply format of the thyroid gland?

    <p>Four arteries from the external carotid</p> Signup and view all the answers

    Which symptom is NOT considered a classic symptom of hypothyroidism?

    <p>Excessive sweating</p> Signup and view all the answers

    What is the typical hormone replacement therapy for hypothyroidism?

    <p>Thyroxine (T4)</p> Signup and view all the answers

    How should thyroid hormones be taken to ensure proper absorption?

    <p>In the morning on an empty stomach</p> Signup and view all the answers

    Which test result typically indicates hypothyroidism?

    <p>Increased TSH levels</p> Signup and view all the answers

    What condition is most commonly linked to hyperthyroidism?

    <p>Graves' disease</p> Signup and view all the answers

    Which of the following is a characteristic of thyrotoxicosis?

    <p>High levels of thyroid hormones in the bloodstream</p> Signup and view all the answers

    Which laboratory test is important to assess in cases of Hashimoto's thyroiditis?

    <p>Anti-TPO antibodies</p> Signup and view all the answers

    What is the typical ratio of T4 to T3 production in the thyroid?

    <p>20:1</p> Signup and view all the answers

    What is a characteristic symptom of hyperthyroidism associated with Graves disease?

    <p>Tachycardia</p> Signup and view all the answers

    What is likely to be found in the bloodstream of patients diagnosed with Graves disease?

    <p>Typical antibodies</p> Signup and view all the answers

    Which treatment option is contraindicated in the first trimester of pregnancy for hyperthyroidism?

    <p>Methimazole</p> Signup and view all the answers

    Which of the following is an indication for surgical intervention in hyperthyroidism?

    <p>Ineffectiveness of antithyroid drugs after 1.5 years</p> Signup and view all the answers

    What is a potential side effect of thyroidectomy in hyperthyroid patients?

    <p>Hypocalcemia</p> Signup and view all the answers

    What role do beta blockers play in the management of hyperthyroidism?

    <p>Provide symptomatic treatment</p> Signup and view all the answers

    Which condition is considered another cause of hyperthyroidism?

    <p>TSHoma</p> Signup and view all the answers

    What is the recommended approach if anti-thyroid drugs are not effective?

    <p>Radioactive iodine therapy or surgery</p> Signup and view all the answers

    What is a common treatment used in the initial phase of acute thyroiditis before the onset of hypothyroidism?

    <p>Propranolol</p> Signup and view all the answers

    Which thyroiditis is most likely to lead to permanent hypothyroidism?

    <p>Hashimoto thyroiditis</p> Signup and view all the answers

    What does the presence of a hot nodule usually indicate?

    <p>Graves disease or multinodular goiter</p> Signup and view all the answers

    Which factor would prompt the performance of a Fine Needle Aspiration (FNA) for thyroid nodules?

    <p>Family history of thyroid cancer</p> Signup and view all the answers

    Which of the following features is NOT associated with a high risk of thyroid nodules being malignant?

    <p>Regular shape</p> Signup and view all the answers

    When may observation be sufficient instead of FNA for thyroid nodules?

    <p>If nodules are very small without risk factors</p> Signup and view all the answers

    What is the primary clinical presentation feature of subacute thyroiditis?

    <p>Fever and neck swelling</p> Signup and view all the answers

    What TIR classification indicates non-diagnostic cytology in a Fine Needle Aspiration?

    <p>TIR 1</p> Signup and view all the answers

    Study Notes

    Sheehan’s Syndrome

    • Caused by hypophysis infarction due to hypertensive peaks during labor.
    • Results in hypo-prolactinemia instead of hyperprolactinemia.
    • Associated condition includes Disseminated Intravascular Coagulation (DIC) leading to coagulation factor loss.

    Diagnosis of Pituitary Disorders

    • MRI with contrast medium is crucial for diagnosis.
    • CT scans are utilized in emergency settings.
    • Ophthalmologic assessments check for mass effects.
    • Laboratory investigations determine hormone levels for specific populations.

    Treatment of Pituitary Adenomas

    • Functioning adenomas require treatment, while non-functioning ones may be observed.
    • Trans-sphenoidal surgery is the preferred method for adenoma removal.
    • Prolactinomas are treated first with dopamine agonists (cabergoline, bromocriptine).

    Hyperprolactinemia

    • Defined as prolactin levels above 20-25 micrograms.
    • Requires confirmation via multiple tests as stress can elevate prolactin levels.
    • Common causes include drug-induced (e.g., Plasil, antipsychotics) and physiologic reasons (e.g., pregnancy).

    Diabetes Insipidus

    • A condition where aquaporins fail, leading to excessive urination.
    • Two forms exist:
      • Central: insufficient ADH production, often due to trauma or tumors.
      • Nephrogenic: ADH produced but not binding effectively, treated with vasopressin.

    Thyroid Gland Structure and Function

    • Composed mainly of follicles with epithelial cells producing T3 and T4.
    • Iodide from diet is crucial for hormone synthesis, stored as thyroglobulin.
    • Thyroid carcinoma associated with high calcitonin levels is medullary thyroid carcinoma.

    Thyroid Diseases Overview

    • Hashimoto thyroiditis is the main cause of primary hypothyroidism in Europe and the US.
    • Iodine deficiency is the leading cause globally.
    • Symptoms include bradycardia, cold intolerance, weight gain, and potential complications like macrocytic anemia and hyponatremia.

    Diagnosis and Treatment of Hypothyroidism

    • Diagnosed by elevated TSH levels, potentially with normal T3 and T4 in subclinical cases.
    • Treatment involves hormone replacement with T4 due to its longer half-life and conversion to active T3 in the body.
    • Non-fasting and dietary factors (e.g., atrophic gastritis) can affect L-thyroxine absorption.

    Hyperthyroidism and Thyrotoxicosis

    • Hyperthyroidism involves excess hormone production; thyrotoxicosis refers to elevated hormone levels in the bloodstream.
    • Graves' disease is the most common cause, characterized by symptoms like tachycardia and weight loss.
    • Treatment includes beta-blockers for symptoms, antithyroid drugs (methimazole), and potentially radioactive iodine or surgery for severe cases.

    Clinical Management of Thyroid Disorders

    • Propranolol is useful for managing hyperthyroid symptoms alongside hormone control.
    • Surgical interventions carry risks, including hypocalcemia due to parathyroid gland damage.

    Thyroiditis Types

    • Acute thyroiditis may result from an initial overproduction of hormones, followed by hypothyroidism.
    • De Quervain thyroiditis presents with dysphagia post-viral infection, typically resolving with symptomatic care.

    Thyroid Nodules

    • Evaluation begins with TSH levels; low TSH suggests hyperthyroidism and may indicate hot nodules (typically benign).
    • Cold nodules undergo fine-needle aspiration (FNA) for malignancy assessment, especially in the presence of risk factors.
    • EUTIRADS classification provides a framework for nodule risk assessment, ranging from benign to high-risk for malignancy.

    FNAC and Cytology

    • TIR classification is used for cytology post-FNAC; TIR 1 indicates non-diagnostic results, requiring repeat testing.

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    Description

    This quiz covers the key aspects of Sheehan's syndrome, focusing on diagnosis techniques such as MRI and CT scans, as well as the importance of hormonal laboratory investigations. It also explores treatment options based on adenoma functionality. Test your knowledge on this critical condition related to pregnancy.

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