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• MEN SYNDROME

  MEN 1 - Pituitary adenoma, parathyroid hyperplasia, pancreatic tumours

  MEN 2A - Parathyroid hyperplasia, medullary thyroid carcinoma, phaeochromocytoma

  MEN 2B - Mucosal neuroma, marfanoid appearance, medullary thyroid carcinoma, phaeochromocytoma
• Papillary thyroid cancer


  65% of thyroid cancers, generally affects young females, metastasizes to cervical lymph nodes, thyroglobulin can be used as a tumour marker, characteristic Orphan Annie eyes on light microscopy, good prognosis
• Follicular thyroid cancer


  20% of thyroid cancers, generally affects women over 50 years old, metastasizes to lung and bones, thyroglobulin can be used as a tumour marker, moderate prognosis
• Medullary thyroid cancer


  5% of thyroid cancers, can be sporadic or part of MEN2 syndrome, originates from parafollicular cells which produce calcitonin that can be used as a tumour marker
• Anaplastic thyroid cancer


  Very rare, affects elderly patients, very poor prognosis
• Thyroid lymphoma


  5% of thyroid cancers, might present with dysphagia or stridor
• Excessive autonomous secretion of parathyroid hormone (PTH) from the parathyroid gland results in a (usually mild) hypercalcaemia and a low serum phosphate. PTH levels are raised or 'inappropriately' normal in primary hyperparathyroidism. A low vitamin D is a common finding in the UK in patients with and without primary hyperparathyroidism.
• SGLT-2 inhibitor


  Medication prescribed for patients with type 2 diabetes mellitus who have concurrent chronic heart failure, established atherosclerotic cardiovascular disease, or a high risk of developing cardiovascular disease
• If the patient had not developed cardiovascular disease and the HbA1c level was 48 mmol/mol, further antidiabetic agents would not be necessary
• HbA1c level of 48 mmol/mol


  Target for patients whose type 2 diabetes mellitus is well-controlled on monotherapy with a drug that does not cause hypoglycaemia, such as metformin
• Gliclazide could be considered if the patient did not have cardiovascular disease and his HbA1c levels indicated suboptimal control; typically, a second-line agent would be added to metformin therapy when HbA1c exceeds 58 mmol/mol.
• Insulin lacks cardioprotective effects and is reserved for scenarios where glycaemic control remains inadequate despite optimal use of oral antidiabetics. Before considering insulin therapy, additional oral antidiabetic medications would be trialled.
• Pioglitazone is not advisable as thiazolidinediones are not cardioprotective and may exacerbate heart failure in individuals with predisposing factors.
• Sulphonylureas and Pioglitazone causes weight gain.
• Addison's disease, also known as primary adrenal insufficiency, is a condition where the adrenal glands do not produce sufficient steroid hormones. The main hormones that are deficient are cortisol and aldosterone. Hydrocortisone is used to replace cortisol and fludrocortisone replaces aldosterone. This combination of medication helps to maintain the balance of these hormones in the body.
• In diabetes insipidus, the serum is very concentrated (high osmolality) and the urine is very dilute (low osmolality). If the source is central/cranial (lack of ADH production), this can be corrected with desmopressin which will cause the urine to concentrate (higher urine osmolality). If the source is nephrogenic (the kidneys do not respond to ADH), the urine remains dilute (low osmolality) even after desmopressin.
• Radioiodine treatment may lead to the development / worsening of thyroid eye disease in up to 15% of patients with Grave's disease
• PCA stroke is classically associated with contralateral homonymous hemianopia with macular sparing
• Sarcoidosis is characterised by non-caseating granulomatous inflammation and most commonly affects the lungs. Sarcoidosis can affect other extrapulmonary structures such as the pituitary gland, where it can cause hypopituitarism (e.g. diabetes insipidus) or hyperpituitarism (e.g. hyperprolactinaemia).
• Somatroph pituitary adenoma is a pituitary adenoma that secretes growth hormone. This causes a condition called acromegaly, characterised by skeletal effects (enlarged nose, forehead, jaw, hands and feet) as well as soft tissue effects (hyperhidrosis, deepening of the voice, macroglossia and obstructive sleep apnoea).
• Causes of hypoglycaemia can be remembered by the mnemonic EXPLAIN

  • Exogenous drugs (typically sulfonylureas or insulin)
  • Pituitary insufficiency
  • Liver failure
  • Addison's disease
  • Islet cell tumours (insulinomas)
  • Non-pancreatic neoplasms