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Clinical Medicine > Endocrine > Flashcards

Endocrine Flashcards

In-class endocrine exam study deck

1
Q

> 10 mm pituitary adenoma

  • Falls under what category?
  • When is it symptomatic?
A

Macroadenoma

  • Likely hypersecretory
  • Asymptomatic until large
  • +/- Bone erosion into sphenoid sinus → CSF rhinorrhea
  • +/- Visual defects
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2
Q

A macro or micro adenoma at the pituitary presenting d/t CA metastasis is most commonly linked to what 3 CA?

A

Lung
Breast
Melanoma

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3
Q

Best mode of imaging to ID a pituitary tumor?

A

MRI

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4
Q

2 forms of very acutely presenting anterior HYPOpituitarism?

A
  1. Sheehan’s Syndrome (pregnancy)

2. Apoplexy

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5
Q

Bitemporal hemianopsia

A

Characteristic visual field defect due to a pituitary tumor

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6
Q

Loss of this hormone in adults causes DECREASES in the following:
Life expectancy, muscle mass, muscle strength, exercise capacity, RBC mass, bone mineral density, HDL cholesterol, energy levels, cognitive ability

A

Growth Hormone Deficiency (adult)

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7
Q

↓ IGF - 1 levels should make you suspicious of what hormone deficiency?

A

Growth Hormone

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8
Q

MC form of dwarfism

-What is the genetic link?

A

Achondroplasia

-Autosomal dominant mutation at FGFR3

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9
Q

Stature < 4’10’’ + mutation at FGFR3 + delayed bone age on hand X-ray

A

Achondroplasia

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10
Q

Acromegaly

A

↑ GH in adults

Large face/hands/feet

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11
Q

Gigantism

A

↑ GH in children

Prior to epiphyseal closure in long bones → ↑ height

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12
Q

MC cause of acromegaly or gigantism

A

Anterior pituitary adenoma

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13
Q

Soft/doughy, sweaty handshake + HTN + ↑ IGF-1

A

↑ GH (acromegaly or gigantism)

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14
Q

When should an IGF-1 test be conducted (under what circumstance)?

A

After at least 8 hrs of fasting

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15
Q

Succession of tests to ID acromegaly

A
  1. 8-hr fasting IGF-1 (↑ IGF-1)

2. Glucose challenge (persistant ↑ GH)

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16
Q

What medicine can be given to a pt w/ acromegaly or gigantism to suppress GH?

A

Octreotide
-Somatostatin mimicker

*however if caused by a pituitary tumor the tx is a transphenoidal reseciton

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17
Q

What thyroid abnormality can cause hyperprolactinemia?

A

Hypothyroidism

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18
Q

Galactorrhea, anovulatory amenorrhea, infertility, vaginal dryness
-Presenting sx of what dx?

A

Hyperprolactinemia, MC d/t Prolactinoma

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19
Q

MC type of benign pituitary tumor

A

Prolactinoma

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20
Q

Prolactin of > 300 ng/mL

A

Value suspicious of a prolactinoma
< 100 ng/dL - likely not a tumor
100-200 ng/dL - likely a tumor
> 200 ng/dL - very likely a tumor

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21
Q

Possible secondary causes of ↑ PRL levels

A

Drugs like dopamine antagonists (anti-psychotics)
Hypothyroidism
Chest trauma

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22
Q

Prolactinoma

Tx

A

Dopamine agonist:
Bromocriptine
Cabergoline

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23
Q

Posterior Pituitary Hormones

A

ADH (vasopressin)

Oxytocin

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24
Q

↑ ADH resulting in inappropriate water reabsorption at the kidney → aldosterone attempt at correction leads to ↑ Na+ excretion into urine
-What condition is being described & what are the 3 types?

A

SIADH
Syndrome of Inappropriate ADH Secretion

3 types:

  1. Central
  2. Peripheral
  3. Reset Osmostat
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25
Q

Cause of Peripheral SIADH

A

Paraneoplastic disease like Small Cell Lung Cancer

*can be from variable causes

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26
Q

Blood (↓ Na+/↓ Osmolarity) + Urine (↑ Osmolality/↑ Sodium)

A

SIADH

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27
Q

SIADH 1st line tx
+
Other methods of tx

A
  1. Fluid Restriction
  2. Saline + Furosemide

Other methods:
ADH receptor antagonists (Tolvaptan, Conivaptan, Demeclocycline) or Lithium

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28
Q

↓ ADH or loss of sensitivity to ADH

A

Diabetes Insipidus

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29
Q

MC type of Diabetes Insipidus

A

Central

-often due to autoimmune destruction

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30
Q

Dilute urine +/- constantly thirsty

A

Diabetes Insipidus

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31
Q

When is a Water Deprivation Test + ADH Stimulation Test conducted?

A

Dx of Diabetes Insipidus

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32
Q

Central Diabetes Insipidus Tx

A

Desmopressin (ADH)

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33
Q

Inheritance of MEN

A

Autosomal dominant

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34
Q

MEN 1

The 3 P’s

A
  1. HYPER-Parathyroidism
  2. Pancreatic Tumors
  3. Pituitary Adenoma
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35
Q

MEN 2A

The 2 P’s + M

A
  1. Medullary Thyroid Carcinoma
  2. Pheochromocytoma
  3. HYPER-Parathyroidism
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36
Q

MEN 2B

The 3 M’s

A
  1. Mucosal neuromas
  2. Medullary Thyroid Carcinoma
  3. Marfan-like Body Habitus
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37
Q

Stones, thrones, bones, groans, psychiatric overtones

A

Hyper-parathyroidism

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38
Q

L/T: ↑ Ca+ > 10.5 mg/dL ; ↑ PTH ; ↓ PO4

A

1° Hyper-parathyroidism

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39
Q

1° Hyperparathyroidism
Causes
vs.
2° Hyperparathyroidism

A 
Parathyroid Adenoma (85%)
Hyperplasia (10%) 
Carcinoma (1%)
vs. 
Physiologic response from hypocalcemic or vitamin D deficiency (MC: CKD)
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40
Q

Hyper-parathyroidism

Sx

A 
Early: N/V, loss of appetite, muscle weakness, fatigue, constipation 
Joint pain 
Polyuria 
Polydipsia
Generalized fatigue 
Confused, lethargic 
PMHx: recurrent kidney stones 
Risk: coma
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41
Q

X-ray: osteopenia, subperiosteal resorption at phalanges *pathognomonic

A

Hyper-parathyroidism

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42
Q 
Hyper-parathyroidism 
Tx for..
1°
2°
3°
A

1°: Subtotal parathyroidectomy
2°: Vit D & Ca+ Supplement + IV fluids w/ Furosemide or Calcitonin
3°: Cinacalcet

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43
Q

PE: (+) Chvostek’s sign ; (+) Trousseau’s sign

A

Hypo-parathyroidism

44
Q 
Signs of neuromuscular irritability 
Carpopedal spasm
Laryngeal spasm
Tingling/paresthesias 
Tetany
Facial grimacing
A

Hypo-parathyroidism

45
Q

Hypo-parathyroidism

Tx

A

Supplement: Vit D & Ca+
Emergency: IV Ca+-Gluconate

46
Q

Hypo-parathyroidism

Causes

A
  1. Accidental damage or removal

2. Autoimmune destruction

47
Q

Grave’s

A

Hyperthyroidism

48
Q

Hashimoto’s

A

Hypothyroidism

49
Q

Anti-thyrotropin Antibodies

A

Hyperthyroidism d/t Grave’s

50
Q

Anti-thyroid Peroxidase (TPO) Antibodies

A

Hypothyroidism d/t Hashimoto’s

51
Q

Irritability, nervousness, heat intolerance
Sweating
Weight loss, ↑ appetite

A

Hyperthyroidism d/t Grave’s

52
Q

Exophthalmos or proptosis, pretibial myxedema,diffuse enlarged thyroid gland, thyroid bruits

A

Hyperthyroidism d/t Grave’s

Other: tachycardia, fine tremor, 4+ deep tendon reflexes, brittle/fine hair, systolic murmurs

53
Q

Hyperthyroidism d/t Grave’s

L/T

A

L/T: ↓ TSH w/ ↑ free T4 & ↑ T3 (free & total)

54
Q

Hyperthyroidism d/t Grave’s

Tx

A 
PTU (propylthiouracil)
Methimazole
Radioactive iodine 
→Destroys the thyroid gland 
→Need hormone replacement afterward
Surgery: thyroidectomy 
Cardiac sx: ß-blockers
55
Q

Acutely presenting hyperthyroidism

Rare & emergent

A

THYROTOXICOSIS CRISIS or Thyroid storm

56
Q

Fever, extreme restlessness, N/V/D, possible CV collapse & shock

A

THYROTOXICOSIS CRISIS or Thyroid storm

57
Q

THYROTOXICOSIS CRISIS or Thyroid storm

Tx

A 
Anti-thyroid meds: 
Propylthiouracil PTU IV 
Methimazole IV  
ß-blocker: Propranolol 
High dose iodine 
Supportive: 
Glucocorticoids IV (inhibit conversion of T4 to T3) 
Antipyretics: (never aspirin) 
Cooling blankets
58
Q

Elderly woman + undiagnosed hypothyroidism + acute health event
-How do you tx?

A

Myxedema Hypothyroid Crisis
Tx:
L-Thyroxine IV + Supportive

59
Q 
Fatigue, pallor 
↑ weight 
Cold intolerance 
Worsening constipation 
Heavy periods 
Dry &amp; cold skin
A

Hypothyroidism d/t Hashimoto’s

60
Q

L/T: ↑ TSH (> 9.5 uU/mL), ↓ free T4, +/- normal T3

A

Hypothyroidism d/t Hashimoto’s

61
Q

Hypothyroidism d/t Hashimoto’s

Tx

A

Thyroxine
L-thyroxine
Take 30 min prior to 1st meal & 4 hrs apart from other meds

F/U labs on TSH periodically
Peak levels achieved in 3-4 weeks post initial tx

62
Q

Thyroid Nodule:

Benign

A

Varied: smooth, firm irregular, sharply outlined, discrete, painless

63
Q

Thyroid Nodule:

Malignant

A

Rapid growth, fixed in place, no movement w/ swallowing

64
Q

Step-wise approach to evaluating a Thyroid Nodule

A

PE → > 1 cm → +/- No TSH change (more worrisome) Thyroid U/S → Fine Needle Aspiration Bx

65
Q

Size of thyroid nodule to consider for FNA Bx

A

Solitary nodule: > 1 cm

Multiple nodules: > 1 cm

66
Q

MC thyroid CA

A

Papillary Thyroid Carcinoma

67
Q

In order of MC to LC order the 3 types of thyroid CA

A

Papillary > Follicular > Medullary

68
Q

Tx for any kind of thyroid CA

A

Total thyroidectomy

+/- additional resection at LN of adjacent tissue

69
Q

Most aggressive of the 3 thyroid CA

A

Medullary

70
Q

Alcohol Related Ketoacidosis

A

Metabolic complication of alcohol use + starvation

*not from hyperglycemia

71
Q

When does Alcohol Related Ketoacidosis MC present?

A

AFTER alcohol ingestion

Hours → Days later

72
Q

Alcohol Related Ketoacidosis

Sx

A

Hx of ETOH abuse +/- malnutrition, recent binge drinking

Alert & lucid despite ketoacidosis

73
Q

Alcohol Related Ketoacidosis

Tx

A

IV Thiamine

IV Dextrose & Fluids

74
Q 
Hyperglycemia > 600 mg/dL (+/- 800-2400 mg/dL)
Serum osmolarity > 310 mOsm/kg 
Blood pH > 7.3 (not acidotic) 
> 15 serum bicarbonate 
Normal anion gap 
Low or normal ketones 
L/T: ↑ Na+; ↑ BUN
A

Hyperglycemic Hyperosmolar State

75
Q

Hyperglycemic Hyperosmolar State

Tx

A

Fluid Replacement

Insulin

76
Q

PE: evidence of dehydration, fruity breath, stuporous pt, hypotension + tachycardia, mild hypothermia, unexplained abdominal pain or tenderness, Kussmaul Breathing

A

DKA

77
Q

Hyperglycemia > 250 mg/dL
Moderate-severe: 350-900 mg/dL
Metabolic acidosis blood pH < 7.3 (range: 6.9-7.2)
Serum bicarbonate < 15 mEq/L (range: 5-15)
Serum (+) ketones
Dilution ratio of 1:8 OR beta-hydroxybutyrate > 4 nmol/L

A

DKA

78
Q

DKA

Tx goals w/ Glucose, Bicarb, pH

A

Goals: Glucose <200 mg/dL, Bicarb > 18 mEq/L, pH > 7.3

79
Q

Sympathetic response: tachycardia, palpitations, sweating, tremors
Parasympathetic response: nausea, hunger

A

Hypoglycemia

80
Q

Blood sugar value for Hypoglycemia

A

< 70 mg/dL

Severe: < 45 mg/dL + serum insulin level of < 6 micro unit/mL or >

81
Q

Hypoglycemia

Tx

A

Glucagon

50% Dextrose

82
Q

Leading cause of death in Type 1 DM

A

CKD

83
Q

Leading cause of death in Type 2 DM

A

Macrovascular dz w/ MI or Stroke

84
Q 
Target management values for DM: 
A1c: ?
Preprandial Glucose: ?
Postpranidal Glucose: ?
BP: ?
A

A1c: < 7%
Preprandial Glucose: 80-110
Postpranidal Glucose: < 140
BP: < 130/80

85
Q

DM medical visit F/U regimen:

  • Q 3 m.o.
  • Q 6 m.o.
  • Q Yearly
A 
-Q 3 m.o.
HgA1c + CMP + BG logs
-Q 6 m.o.
FLP + Dental exam
-Q Yearly
Eye + Foot + Nephropathy + Vax (Flu/Tdap/PCV13)
86
Q

4 Diagnostic Values for Type 2 DM

A

> 200 mg/dL on Random Plasma Glucose + Diabetic Sx
126 mg/dL on > 8 hr fasting plasma glucose x > 1 occasion (*Gold Standard)
200 mg/dL on 75 g oral glucose challenge + 2 hrs later
6.5% HbA1c
→ “Pre-diabetes”: 5.7-6.4% or oral glucose challenge at 140-199

87
Q

(+) GAD 65 Antibodies

A

Diagnostic to definitively ID type 1 DM

88
Q

HbA1c to diagnose type 1 DM

A

> 6%

89
Q

Most commonly results from a deficiency of 21 hydroxylase

  • Dx?
  • Classic sx?
  • Early Dx?
  • Tx?
A

Dx: Congenital adrenal hyperplasia (variable adrenal insufficiency)

  • Classic sx: Salt wasting
  • Early Dx: Newborn screening for 24 hydroxylase deficiency
  • Tx: Hormone therapy custom to deficiency
90
Q

Cushing’s:
Sx
PE & lab findings

A 
Central obesity 
Striae 
Acne 
Moon face 
Buffalo hump

PE: HTN
L/T:
↓K+
↑ cortisol, glucose, wbc

91
Q

Cushing’s:

Succession of testing

A 
LOW Dexamethasone Challenge 
↓ 
ACTH Measure 
↓
HIGH Dexamethasone Challenge
92
Q

Cushing’s:

Test results to confirm a pituitary adenoma as the source

A

LOW Dexa: Failure to suppress cortisol
ACTH: ↑ ACTH
HIGH Dexa: Successful suppression of cortisol

93
Q

Cushing’s:

Tx

A

Adenoma: Transphenoidal surgery
Exogenous: gradually ↓ steroid ingestion
Ectopic ACTH: tx underlying cause

94
Q

1 ° Addison’s:

2 MC types/causes

A
  1. Autoimmune destruction of adrenal gland

2. Tuberculosis destruction of adrenal gland

95
Q

1 °Addison’s:
Sx
PE & lab findings

A

Weakness
Muscle & joint pain
Hyperpigmentation

PE: Orthostatic Hypotension, sparse secondary sex hair
L/T:
↓ Na+
↑ K+

96
Q

1 °Addison’s:

Succession of testing

A

8 AM serum cortisol & Plasma ACTH
↓
Cosyntropin-Synthetic ACTH Stimulation (*Gold Standard)
+/- CRH Stimulation
→ Failure to stimulate release of cortisol, confirms

97
Q

1 °Addison’s:

Tx

A

Hydrocortisone (glucocorticoid replacement)

Fludrocortisone (mineralocorticoid replacement)

98
Q

Addison’s:
Primary vs. Secondary
Define

A

Primary: problem w/ adrenal gland
Secondary: no ACTH secretion

99
Q

Addison’s:

MC cause of 2° Addison’s

A

Exogenous steroid use

100
Q

Adrenal crisis or Addisonian Crisis
Sx
Dx
Tx

A

EMERGENCY!
Sx: Pain in back/abdomen/legs, V/D, dehydration, ↓ BP & loss of conciousness
Dx: BMP shows ↓ Na+, ↓ K+, ↓ blood glucose + Emperic 100 mg of Hydrocortiosone (if they improve then confirm they were having this crisis)

Tx: Hydrocotison bolus

101
Q

Primary vs. Secondary Hyperaldosteronism

A

Primary: adrenal gland dysfunction
Secondary: something other than the adrenal gland is responsible for it (like chronic ↓ BP)

102
Q

1° Hyperaldosteronism:
Types
Sx

A

Types:
MC Hyperplasia of Adrenal Glands
Sx:
Polyuria, polydipsia, muscle weakness

103
Q

1° Hyperaldosteronism:
PE
L/T

A

PE: HTN

L/T: ↑ urine aldosterone + Aldosterone:Renin ratio interpretation + Confirmatory sodium loading

104
Q

1° Hyperaldosteronism:

What result from Sodium loading confirms the dx?

A

Failure to suppress aldosterone via ↑ sodium load

105
Q

1° Hyperaldosteronism:

Tx

A

Spironolactone

106
Q

Uncontrolled proliferation of chromaffin cells at the adrenal medulla

  • Sx
  • Dx
  • Tx
A

Pheochromocytoma (↑ catecholamines)
Sx: Anxiety, HA, palpitations, perspiration
Dx: 24hr Catecholamine Urine Test w/ ↑ metanephrines or vanillylmanelic acid
Tx:
HTN control → Surgery
α-block (phenoxybenzamine) then ß-block

Clinical Medicine (6 decks)

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