Endo Flashcards
(25 cards)
classic radiographic skeletal changes for osteitis fibrosa cystica
subperiosteal resorption of bone, most prominent at the phalanges of the hands
Why does osteitis fibrosa cystica occur?
high PTH (hyperparathyroidism) = high bone turnover/bone resorption. Patients may have fracture
what is deficient in osteomalacia?
Vitamin D…deficiency in kids is rickets, adults is osteomalacia. Results in low Phos and low Ca, with resultant secondary hyperPTH
what screening tests should be performed when an adrenal mass is discovered?
- 24-hour urine metanephrine: screen all for a pheochromocytoma (can use free plasma metanephrine when high suspicion, there is a higher FP rate)
- 1-mg overnight dexamethasone suppression test: screen for Cushing syndrome (not 24 hour urine cortisol)
- if hypertension present, plasma aldosterone-plasma renin (ARR) ratio: screen for primary aldosteronism (may have hypokalemia)
when do you measure DHEAS?
suspecting hyperandrogenism. women with hirsutism, menstrual irregularities, virilization
what is initial medical management for myxedema coma?
Check serum cortisol asap to chec for adrenal insufficiency, PRIOR to IV thyroid replacement (because otherwise this can precipitate adrenal crisis)
Initial workup in secondary amenorrhea?
pregnancy test, FSH, TSH, Prolactin
how does hypothyroidism contribute to cardiovascular disease?
reduces cholesterol metabolism = hypercholesterolemia
T/F: SGLT2 inhibitors (empagliflozin) carry risk of hypoglycemia like insulin
True. So do GLP-1 agonists (liraglutide), sulfonylureas (Glipizide/glyburide/glimepiride), DPP4 inhibitors,
treatment of prolactinomas
dopamine AGONISTS (bromocriptine, cabergoline)
radiation exposure leading to thyroid cancer
PAPILLARY
thyroid cancers by occurrence
Papillary (esp radiation); Follicular; Medullary (least common, measure RET and think MEN)
T/F: Morning or random serum cortisol is the initial screening test for Cushing’s
False. It is unreliable due to overlap of serum cortisol levels among normal patients and Cushing
Initial diagnostic tests for Cushing syndrome
Options:
- 24-hour urine free cortisol (3x > normal)
- Midnight salivary cortisol
- 1-mg overnight dexamethasone suppression test
(don’t use am cortisol) got to have biochemical dx before imaging b/c frequent incidentalomas
next step after dx of cushings
ACTH (detectable/elevated) dependent:
- pituitary tumor
- ectopic i.e. bronchial carcinoid tumor
- severe psychiatric illness
ACTH (low) independent
- exogenous glucocorticoid
- cortisol-secreting adrenal tumor
what is the fearful adverse effect of Methimazole (used for hyperthyroidism)
Agranulocytosis –> presents as sore throat, fever. stop drug and check cbc.
how low does kidney function need to be to stop metformin?
Safe in GFR >45
Contraindicated GFR <30
HbA1c goal
for most diabetics 7-8%. For those early in dz course with few comorbidities, 6.5-7.5%
T/F: Empagliflozin (SGLT2 inhibitor can improve glycemic control and will also reduce blood pressure and weight
True.
When is dual therapy with metformin + agent initiated?
If patient does not achieve HbA1c target after 3 months of Metformin + Lifestyle mod
how is measurement of cortisol level affected by estrogen?
Increased estrogen (i.e. oral estrogen) = increase cortisol-binding proteins = increase serum total cortisol but not free cortisol
how are thyroid (i.e levothyroxine, endogenous) hormone levels affected by sex hormones (i.e. exogenous)
Estrogen, Raloxifene: increase thyroxine-binding globulin = need to increase dose
Androgens (Testosterone) /Anabolic Steroids: reduce thyroxine-binding globulin = increased metabolically active free thyroxine. Need to reduce dose
how should levothyroxine be taken?
One hour before food or coffee, on empty/fasting stomach. Needs acidic pH. Reduced absorption with chronic PPI use. Wait 4 hours for calcium carbonate or ferrous sulfate.
Gestational thyrotoxicosis
bHCG stimulates TSH receptor, so in first trimester hyperthyroidism with suppressed TSH, elevated T4
