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Adrenal Mass

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3521. Multiple Endocrine Neoplasia Type 2 (MEN 2)

. Medullary cell carcinoma of the thyroid See also separate article. In MEN2 the initial thyroid lesion is C-cell hyperplasia, which has been found as early as the age of 3 years in MEN2A and may be present at birth in MEN2B. Over the subsequent 5 to 10 years microscopic MTC develops and finally gross tumours become apparent. MTC typically presents as a neck mass or neck pain at about age 15 to 20 years. However, more than 50% of such patients already have cervical lymph node metastases. MTC may present (...) . Phaeochromocytoma [ , ] See also separate article. Phaeochromocytoma occurs in 50% of MEN2. Phaeochromocytomas in patients with MEN2 are usually found in the adrenals after presentation of MTC. About 70% are bilateral, almost all are benign and they are rarely extra-adrenal. They produce excessive adrenaline (epinephrine) secretion leading to tachycardia, palpitations, hypertension and headache. Investigations include plasma concentrations of free metanephrines (or free metanephrines in urine) and imaging

2008 Mentor

3522. Ultrasound Scanning - Non-obstetric

an ultrasound scan of the liver, bile duct and pancreas. It can show tumour mass and dilated bile ducts as well as any liver metastases. However, it is less good at demonstrating tumours in the pancreatic body and tail. Endoscopic ultrasound may form part of further investigation. Further imaging is usually required when a pancreatic tumour is suspected. In , ultrasound may show a swollen pancreas, dilated common bile duct and free peritoneal fluid. The presence of gallstones may also be important. Standard (...) may be due to imminent AAA rupture. A pulsating mass is an unreliable sign with both false-positive and false-negative results. Clinical signs may be unreliable until rupture has occurred when haemorrhage is dramatic and catastrophic. Urological ultrasound The dose of radiation from an intravenous urogram is very high but ultrasound is very good at showing stones and delineating the outline of kidneys and the collecting system. The renal cortex is seen as grey with some darker circles spaced

2008 Mentor

3523. Syndrome of Inappropriate ADH Secretion (SIADH)

features Hyponatraemia. Plasma hypo-osmolality proportional to hyponatraemia. Inappropriately elevated urine osmolality (>100 mOsmol/kg) commonly > plasma osmolarity. Persistent urine [Na+] >30 mmol/L with normal salt intake. Euvolaemia. Normal thyroid and adrenal function. Extra features include an elevated ADH level and low blood uric acid level. Causes (not exhaustive) Neurological: tumour, trauma, infection, , , intracranial haemorrhage, sinus thrombosis, , . Pulmonary: , , , , , , positive (...) of laboratory error. If necessary, repeat the test. Serum potassium . If raised, consider . SIADH needs to be confirmed by results of paired serum and urine samples: serum hypo-osmolality is <275 mOsm/kg, and urine osmolality >100 mOsm/kg and sodium ≥30 mmol/L, in the absence of hypovolaemia, hypervolaemia, adrenal or thyroid dysfunction and use of diuretics. Urine sodium level . If this is >20 mmol/L, a renal cause should be sought. Serum thyroid-stimulating hormone and free thyroxine level . These should

2008 Mentor

3524. Congenital Urogenital Malformations

mass of cysts and usually absent or atretic ureter. Frequently associated with contralateral abnormalities, especially ureteropelvic junction (UPJ) obstruction. 60% of kidneys affected by renal dysplasia have an obstructive component [ ] . Dysplasia of the renal parenchyma is seen with urethral obstruction or reflux present early in pregnancy, or obstructed ureter. Potter's syndrome occurs in sporadic and autosomal recessive forms with an incidence of 1 in 4,000 births. The name describes (...) . As a result of the abnormal anatomy of a horseshoe kidney, imaging and treatment pathways vary substantially from those for the normal kidney [ ] . Children can present with urinary tract infections (UTIs), abdominal mass and haematuria. Ectopic kidney [ ] In simple ectopy, the kidney does not ascend properly and is found in the pelvis or over the brim. The ureter of a pelvic kidney is tortuous. Ureteropelvic junction (UPJ) obstruction occurs in around 30%. The pelvic kidney is prone to obstruction

2008 Mentor

3525. Chronic Diarrhoea in Adults

. Diarrhoea persisting for more than six weeks, in a person over 60 years of age. Family history of bowel or ovarian cancer. Abdominal mass. Rectal mass. Anaemia. Raised inflammatory markers (may indicate inflammatory bowel disease). Look for other features suggesting an underlying cause (eg, recent travel abroad, laxative and other possible drug causes), features of systemic disease (eg, thyrotoxicosis, diabetes, adrenal insufficiency, systemic sclerosis), and features of pancreatic disease (eg (...) towards looser stools and/or increased stool frequency persisting for six weeks or more. Presenting with a right lower abdominal mass consistent with involvement of the large bowel. Presenting with a palpable rectal mass (intraluminal and not pelvic). 60 years or older, with a change in bowel habit to looser stools and/or more frequent stools persisting for six weeks or more with or without rectal bleeding. Men of any age with unexplained iron-deficiency anaemia and a haemoglobin level of 11 g/100 mL

2008 Mentor

3526. Benign Intracranial Hypertension

evidence, UK and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Idiopathic Intracranial Hypertension In this article Synonyms: pseudotumour cerebri, benign intracranial hypertension in the absence of a mass lesion or of hydrocephalus. It is often idiopathic. Idiopathic intracranial hypertension (IIH) appears to be due to impaired cerebrospinal fluid (CSF) absorption from the subarachnoid space across the arachnoid villi into the dural (...) of IIH was calculated as 10.9 per 100,000 (85.7 per 100,000 in obese women). Risk factors It mostly occurs in young obese females in their third or fourth decade. There is an increased risk in women with menstrual irregularity. Female-to-male ratio is between 3:1 to 8:1. Up to 90% of patients are overweight. In women it may coincide with recent weight gain, fluid retention, the first trimester of pregnancy and the postpartum period. Aetiology Known associations include: Endocrine: adrenal

2008 Mentor

3527. Acromegaly

compression symptoms may occur, especially carpal tunnel syndrome (20-40%). Cardiac features include hypertension (40%), left ventricular hypertrophy, cardiomyopathy and arrhythmias. Type 2 diabetes mellitus (40-52%) and glucose intolerance (28-46%) due to insulin resistance. Colonic polyps. Vertebral fractures, possibly due to low-quality bone despite high bone mass. Due to associated hyperprolactinaemia - eg, galactorrhoea, amenorrhoea: in one third of patients with a GH-producing adenoma, the adenoma (...) . If the glucose load fails to suppress the GH level below 1.0 mcg/L this confirms the diagnosis of acromegaly. Random GH is not recommended; secretion is episodic and the half-life is short. GHRH concentration can be obtained if clinically indicated. The major IGF-1 binding protein, IGFBP3, is not useful for diagnosis or monitoring of disease [ ] . Assessment of other pituitary hormones as clinically indicated: prolactin, adrenal, thyroid and gonadal hormones. MRI scan of pituitary and hypothalamus: more

2008 Mentor

3528. Amenorrhoea

dysfunction may cause menstruation to cease. Causes include: stress, excessive exercise, eating disorders, depression, chronic systemic illness and tumours. Loss of weight : this can cause amenorrhoea, especially if rapid. Body mass index (BMI) is rarely above 19 where this is the case, and at least 10% of normal body weight has been lost. Anorexia nervosa and other eating disorders including should be considered. The female athlete triad is well recognised. It consists of eating disorder, amenorrhoea (...) of amenorrhoea. Both androgens and oestrogens may be normal or slightly raised so that, whilst there are signs of virilisation, there is no evidence of oestrogen deficiency. They are usually, but not always, overweight and may have insulin resistance. Fat is very important in the metabolism of the steroid sex hormones and it accounts for both the excess in PCOS and the deficiency in anorexia. : this may be spontaneous or iatrogenic. Late-onset congenital adrenal hyperplasia : produces androgens. Adrenal

2008 Mentor

3529. Hypopituitarism

; decreased muscle mass, osteoporosis, anaemia. Children: . Growth hormone deficiency: . Decreased muscle mass and strength, visceral obesity, fatigue, decreased quality of life, impairment of attention and memory. Dyslipidaemia, premature atherosclerosis. Children: growth restriction. : Polyuria, polydipsia. Decreased urine osmolality, hypernatraemia. May also present with features attributable to the underlying cause: : headaches or visual field deficits. Large lesions involving the hypothalamus (...) be restored after successful surgical or medical removal of the lesion. Medical care consists of hormone replacement as appropriate and treatment of the underlying cause [ ] . Glucocorticoids are required if the ACTH-adrenal axis is impaired, especially in acute presentations. Increased doses of glucocorticoids are required following any form of emotional or physical stress (eg, during an infection) to prevent acute decompensation. Secondary hypothyroidism: thyroid hormone replacement. Gonadotrophin

2008 Mentor

3530. Hyponatraemia

. Plasma hypo-osmolality proportional to hyponatraemia. Inappropriately elevated urine osmolality (>100 mOsmol/kg) commonly > plasma osmolarity. Persistent urine [Na+] >30 mmol/L with normal salt intake. Euvolaemia. Normal thyroid and adrenal function. Extra features include an elevated ADH level and low blood uric acid level. Causes (not exhaustive) Neurological: tumour, trauma, infection, , , intracranial haemorrhage, sinus thrombosis, , . Pulmonary: , , , , , , positive-pressure ventilation. Other (...) . If necessary, repeat the test. Serum potassium . If raised, consider . SIADH needs to be confirmed by results of paired serum and urine samples: serum hypo-osmolality is <275 mOsm/kg, and urine osmolality >100 mOsm/kg and sodium ≥30 mmol/L, in the absence of hypovolaemia, hypervolaemia, adrenal or thyroid dysfunction and use of diuretics. Urine sodium level . If this is >20 mmol/L, a renal cause should be sought. Serum thyroid-stimulating hormone and free thyroxine level . These should be checked

2008 Mentor

3531. Hypertension in Childhood

, sympathomimetics). Mineralocorticoid excess (congenital adrenal hyperplasia, aldosterone-secreting tumours). Obstructive sleep apnoea and sleep disordered breathing [ ] . Phaeochromocytoma. Rheumatological conditions. Essential hypertension (primary hypertension). Presentation [ ] History The condition is usually asymptomatic but may be revealed fortuitously during examination in patients with suspected underlying conditions such as kidney disease or . A very full history is required including: Past medical (...) in the lower limbs. If the amplitude of the pulse is poor this suggests coarctation of the aorta. Look for stigmata of specific diseases: Café au lait spots may suggest . Examination of the abdomen may reveal a mass in and abdominal bruit may suggest coarctation or other vascular abnormalities including in the renal system. Virilisation will point to . Acne, hirsutism, central obesity and striae may suggest Cushing's syndrome. Sweating and tachycardia may indicate medication or illicit substances

2008 Mentor

3532. Hyperprolactinaemia

tumour that prevents dopamine (which inhibits prolactin release) from reaching the normal prolactin-producing cells. Causes of hyperprolactinaemia 'Physiological' causes Pregnancy. Puerperium. Breast stimulation. Stress - physical (including excessive exercise) or psychological - including venepuncture. Macroprolactinaemia: This refers to prolactin of high molecular mass, mostly complexes of monomeric prolactin with immunoglobulins (prolactin autoantibody complexes). These larger molecules have low (...) , Hypogonadism, and Bone Health. World Neurosurg. 2017 Jan97:595-602. doi: 10.1016/j.wneu.2016.10.059. Epub 2016 Oct 20. Prolactinomaand at one time secondary adrenal insufficient and a whole host of other issues. I workout hard and try to eat a healthy diet but it doesnt work... i won't go into all the details but... fendertele84 Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Article Information Last Reviewed 21 December 2017 Next Review 20 December 2022 Document ID

2008 Mentor

3533. Gynaecomastia

. Men with Klinefelter's syndrome have an increased risk of breast cancer and this needs to be considered (risk is increased up to 20 times that of other patients with gynaecomastia). Viral orchitis. Trauma. Castration. Renal disease and dialysis. Increased oestrogen levels : (eg, Leydig's cell tumour) which secrete estradiol. Hermaphroditism. Neoplasms producing human chorionic gonadotrophin (hCG) - eg, : hCG stimulates Leydig's cells to excrete estradiol. Also, , and . Adrenal tumours: these can (...) release oestrogens. (high androgens and oestrogens). Liver disease or . In liver disease there is an increased production of androstenedione by the adrenal glands, increased aromatisation of androstenedione to oestrogen, loss of clearance of adrenal androgens by the liver and a rise in SHBG, resulting in gynaecomastia. Malnourishment and re-feeding syndrome. . Obesity. Extreme stress. Aromatase excess syndrome. Mutation of the aromatase gene causes excess oestrogen levels, prepubertal gynaecomastia

2008 Mentor

3534. Heart Failure (Diagnosis and Investigation)

, hyperthyroidism, Cushing's syndrome, adrenal insufficiency, excessive growth hormone, phaeochromocytoma. Nutritional - eg, deficiencies of thiamine, selenium, carnitine, and obesity, cachexia. Infiltrative - eg, sarcoidosis, amyloidosis, haemochromatosis, Löffler's eosinophilia, connective tissue disease. Infective - eg, Chagas' disease, HIV. Arrhythmias - tachyarrhythmias or bradyarrhythmias. Conditions where there is increased peripheral demand on the heart - this occurs when cardiac output is normal (...) ). Peribronchial cuffing. Diffuse interstitial or alveolar shadowing - classical perihilar 'bat's wings' or nodular (especially with pre-existing COPD). Fluid in the fissures. Pleural effusions. Kerley B lines. Apart from pulmonary congestion, CXR findings are only predictive of heart failure where there are co-existing typical signs and symptoms. Urinalysis. Lung function tests (peak flow or spirometry). Cardiac magnetic resonance imaging - the gold standard for assessing ventricular volumes, mass and wall

2008 Mentor

3535. Hirsutism and Virilism

. Deepening of voice. Increased libido. Increased muscle mass (primarily shoulder girdle). Loss of breast tissue or normal female body contour. Malodorous perspiration. Infertility. Menstrual dysfunction. Other abnormalities associated with excessive levels of androgen are cardiovascular disease, dyslipidaemia, glucose intolerance/insulin resistance and hypertension. Acanthosis nigricans, a marker for insulin resistance, may also be present. Pelvic mass: ovarian (bimanual vaginal examination) or adrenal (...) in a generalised non-sexual distribution and is unrelated to androgens. Idiopathic hirsutism and polycystic ovary syndrome (PCOS) are the most common causes [ ] . When hirsutism in women is accompanied by other signs of virilism, it may be a manifestation of a more serious underlying disorder causing hyperandrogenism, such as an ovarian tumour or adrenal neoplasm. Epidemiology [ ] Hirsutism is a common disorder affecting between 5% and 15% of women of reproductive age [ ] . It is less common in Asian people

2008 Mentor

3536. Fungal Lung Infections

in immunocompromised patients suspected of having invasive fungal pneumonia can help identify and treat disease early, leading to an improved outcome. [ ] Halo sign: ground-glass opacity surrounding a pulmonary nodule or mass. Most commonly associated with invasive pulmonary aspergillosis. [ ] Reversed halo sign: focal rounded area of ground-glass opacity surrounded by a crescent or complete ring of consolidation. Most often associated with pulmonary mucormycosis. [ ] Bronchoscopy - to obtain bronchoalveolar (...) of fungal infection to other sites such as the brain, meninges, skin, liver, kidneys, adrenal glands, heart, eyes, spleen. Progressive . Systemic fungaemia and septic shock. Blood vessel invasion causing massive , pulmonary infarction, myocardial infarction, cerebral infarction/embolism. Associated rheumatological complex/pericarditis with endemic fungal pneumonias. Lung cavitation. Development of mycetoma in a lung cavity. Local pulmonary damage causing bronchopleural or tracheo-oesophageal fistulas

2008 Mentor

3537. Genitourinary History and Examination (Female)

who cannot be pregnant is one who has not been having intercourse). Psychological: look for mood abnormalities. Record BMI (low BMI suggesting anorexia nervosa). Extrinsic hormonal causes: drugs such as the contraceptive pill, and progestogen-only contraceptive methods. Intrinsic hormonal causes: hypothalamic, pituitary, thyroid and adrenal disorders. Ovarian factors: polycystic ovaries, ovarian tumours, ovarian infection, primary ovarian failure. The pattern of the menstrual cycle. Record: First (...) masses arising from the pelvis: Large ovarian cysts, which can be detected by abdominal percussion revealing central dullness. Pregnancy (often used to equate the size of other pelvic tumours): 12 weeks - palpable above the pubic bone. 16 weeks - palpable midway between the pubic bone and umbilicus. 20 weeks - just below the umbilicus. 28 weeks - just midway between the umbilicus and xiphisternum. 34 weeks - just below the xiphisternum. Palpable bladder in urinary retention. Tender bowel loops

2008 Mentor

3538. Neuroblastomas

. [ ] The neuroblastoma originates most commonly in the adrenal or paraspinal sites. Metastases are present in approximately 60% at the time of diagnosis. Epidemiology Fewer than 100 children are diagnosed with neuroblastoma each year in the UK. However, neuroblastomas are the most common extracranial solid tumour of childhood. [ ] Neuroblastoma is the third most common paediatric cancer. Although neuroblastoma accounts for 7% of paediatric malignancies, it is responsible for more than 10% of childhood cancer-related (...) into the strategies used for a risk group staging system - see below. The most important of these is the oncogene MYCN. Amplification of the MYC family member (MYCN) is found in about 25% of cases and correlates with high-risk disease and poor prognosis. MYCN is the most established genetic marker of risk in neuroblastoma. [ ] Presentation Presentation is usually quite late and the majority of symptoms and signs occur either due to the mass effect of the tumour or as a result of metastases. Symptoms Loss

2008 Mentor

3539. loin mass

loin mass loin mass - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search loin mass Loin masses are usually the result of some enlargement of the kidneys or their collecting systems, unilaterally or bilaterally. Unusually, massive enlargement of the adrenals can cause a loin mass. Causes of loins masses include: renal tumours hydronephrosis adult polycystic disease adrenal tumours renal vein thrombosis acute tubular necrosis (...) Note that a massively enlarged liver or spleen, or a mass arising from the gastrointestinal system may cause an apparent mass in the loin. Links: General Practice Notebook General Practice Notebook The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2016 Oxbridge Solutions Ltd®. Any distribution or duplication

2010 GP Notebook

3540. flank mass

flank mass flank mass - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search flank mass Loin masses are usually the result of some enlargement of the kidneys or their collecting systems, unilaterally or bilaterally. Unusually, massive enlargement of the adrenals can cause a loin mass. Causes of loins masses include: renal tumours hydronephrosis adult polycystic disease adrenal tumours renal vein thrombosis acute tubular necrosis (...) Note that a massively enlarged liver or spleen, or a mass arising from the gastrointestinal system may cause an apparent mass in the loin. Links: General Practice Notebook General Practice Notebook The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2016 Oxbridge Solutions Ltd®. Any distribution or duplication

2010 GP Notebook

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