ENDOCRINOLOGY MNEMONICS

Acromegaly: symptoms

ABCDEF:

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

Addison's disease: features

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]

Adrenal disorders: Cushing's vs Addison's

• Cushing: is Gushing cortisol.
• In Addison's: patient's cortisol doesn't Add up.

Adrenal gland: functions

ACTH:

• Adrenergic functions
• Catabolism of proteins/ Carbohydrate metabolism
• T cell immunomodulation
• Hyper/ Hypotension (blood pressure control)

Adrenal cortex: layers and products

"Get your Facts Right, Men are Glued to their Gonads":

• Glomerulosa
• Fasciculata
• Reticularis
• Mineralocorticoids
• Glucocorticoids
• Gonadocorticoids [androgens]

Carcinomas having tendency to metastasize to bone

"Particular Tumours Love Killing Bone":

• Prostate
• Thyroid
• Lung
• Kidney
• Breast

Corticosteroids: adverse 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

Diabetic ketoacidosis: I vs. II

• ketONE bodies are seen in type ONE diabetes.

Diabetic ketoacidosis: management

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)

Goitre: differential

GOITRE:

• Goitrogens
• Onset of puberty
• Iodine deficiency
• Thyrotoxicosis/ Tumor/ Thyroiditis [Hashimoto's]
• Reproduction [pregnancy]
• Enzyme deficiencies

Gynecomastia: causes

DaLAS:

• Digitalis
• Leydig cell tumors
• Alcohol
• Sertoli cell tumors

Gynaecomastia: causing drugs

DISCOS:

• Digoxin
• Isoniazid
• Spironolactone
• Cimetidine
• Oestrogens
• Stilboestrol

Gynecomastia: common causes

GYNECOMASTIA:

• Genetic Gender disorder (Klinefelter)
• Young boy (pubertal)*
• Neonate*
• Estrogen
• Cirrhosis/ Cimetidine/ Ca Channel blockers
• Old age*
• Marijuana
• Alcoholism
• Spironolactone
• Tumors (Testicular & adrenal)
• Isoniazid/ Inhibition of testosterone
• Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)

  *Asterisk indicates physiologic cause.

Hirsutism vs. virilism

• Hirsutism: Hair on body like a male.
• Virilism: Voice and rest of secondary sexual characteristics like a male.

Hypercalcemia: causes

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)

Hypercalcemia: causes

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

Hypercalcemia: differential

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

Hypercalcemia: symptoms of elevated serum levels

"Bones, Stones, Groans, Moans":

• Bones: pain in bones
• Stones: renal
• Groans: pain
• Psychic moans/ Psychological overtones: confused state

Hyperthyroidism: signs and symptoms

THYROIDISM:

• Tremor
• Heart rate up
• Yawning [fatigability]
• Restlessness
• Oligomenorrhea & amenorrhea
• Intolerance to heat
• Diarrhea
• Irritability
• Sweating
• Musle wasting & weight loss

Hypothyroidism/thyroiditis: maifestations 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

*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 FSH: function in male

• LH: Leydig cells stimulated to produce testosterone.
• FSH: Spermatogenesis stimulated.

MEN I (Multiple Endocrine Neoplasia) syndrome: components

"Please Please Pay Attention To peptic ulceration, you worms":

  *Adenomas of:

• Pituatary
• Pancreatic islets
• Parathyroid
• Adrenal cortex
• Thyroid, associated with peptic ulceration

  *Syndrome is called "Wermer's syndrome".

Multiple Endocrine Neoplasia (MEN) subtype 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 III: components

MEN III is a disease of 3 M's:

• Medullary thyroid carcinoma
• Medulla of adrenal (pheochromocytoma)
• Mucosal neuroma

Oestrogen: functions

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

Oxytocin-producing nucleus of hypothalamus

• Paraventricular nucleus--> Parturition (childbirth is oxytocin's most important role).

Pheochromocytoma: common symptoms

5 P's:

• Paroxysmal rise in BP
• Palpitations
• Perspiration
• Pain in abdomen
• PMV in urine

Pheochromocytoma: diagnositc rule

 *Rule of 10's:

• 10% ectopic
• 10% multiple
• 10% malignant

Pheochromocytoma: 3 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

Progesterone: actions

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.

SIADH: causes

SIADH:

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

SIADH: diagnostic sign

Syndrome of INAPPropriate Anti-Diuretic Hormone:

• Increased
• Na (sodium)
• PP (urine)

  *SIADH is characterized by increased urinary sodium.

SIADH: major signs and symptoms

SIADH:

• Spasms
• Isn't any pitting edema (key DDx)
• Anorexia
• Disorientation (and other psychoses)
• Hyponatremia

Sex hormone drugs: male

"Feminine Males Need Testosterone":

• Fluoxymesterone
• Methyltestosterone
• Nandrolone
• Testosterone

SIADH-inducing drugs

ABCD:

• Analgesics: opioids, NSAIDs
• Barbiturates
• Cyclophosphamide/ Chlorpromazine/ Carbamazepine
• Diuretic (thiazide)

Steroid: side 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 carcinoma: features, 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%).