Endo Flashcards
(115 cards)
1
Q
cortisol causes
A
BP regulation glucose metabolism immune fxn inflammatory response insulin release
2
Q
aldosterone causes
A
normally low K
inc Na, blood volume and pressure
3
Q
androgens causes
A
produced DHEA
4
Q
ACTH causes
A
release of cortisol from cortex (outer part) of adrenal gland
5
Q
Addisons dz Patho
A
primary adrenal insufficiency
deficiency of aldosterone, cortisol, and androgen
zona fasciculata
problem w/ adrenal glands
5
Q
Addisons dz Patho
A
primary adrenal insufficiency
deficiency of aldosterone, cortisol, and androgen
zona fasciculata
problem w/ adrenal glands
6
Q
acute cause of primary adrenal insufficiency
A
massive adrenal hemorrhage
7
Q
secondary adrenal insufficiency due to problem w/
A
pituitary
8
Q
tertiary adrenal insufficiency due to problem w/
A
CRH secretion –> adrenal glands won’t product cortisol
head trauma or intracranial tumors
9
Q
primary adrenal insufficiency labs
A
adrenal CRH: high ACTH: HIGH cortisol: LOW CRH stim response: inc ACTH aldosterone: low renin: high
10
Q
secondary adrenal insufficiency labs
A
pituitary CRH: high ACTH: LOW cortisol: LOW CRH stim response: no/dec ACTH aldosterone: low renin: normal/low
11
Q
tertiary adrenal insufficiency labs
A
hypothalamus CRH: low ACTH: low cortisol: low CRH stim response: exaggerated/prolonged aldosterone: low renin: normal/low
12
Q
adrenal crisis sx and labs
A
hypotension or shock, vomiting, abd pain
F, AMS
from withdrawal of steroids
dec Na, inc K, dec glu
13
Q
primary adrenal insufficiency sx
A
hyperpigmentation (inc ACTH) salt craving (dec aldosterone) hypoNa, orthostatic hypoTN (dec aldosterone) kyperK, metabolic acidosis (dec aldosterone)
14
Q
secondary and tertiary adrenal insufficiency has normal
A
aldosterone levels
15
Q
adrenal insufficiency BIT
A
AM serum cortisol level
low cortisol = adrenal insufficiency
16
Q
adrenal insufficiency confirmation test
A
cosyntropin stimulation test (ACTH stim)
17
Q
adrenal insufficiency tx
A
glucocorticoid and mineralocorticoid replacement: hydrocortisone/dexamethasone and fludrocortisone (primary only)
ER w/ hypoTN: IV fluids and IV hydrocortisone
secondary: glucocorticoid
18
Q
cushings syndrome MOA
A
high cortisol levels in blood
19
Q
cortisol function
A
circadian rhythm
rise in AM to help us wake up, and decreases in PM to help go to sleep
maintain BP
dec inflammatory and immune response
20
Q
MCC Cushing disease
A
pituitary adenoma
21
Q
MCC Cushing syndrome
A
exogenous steroid use
22
Q
Cushing BIT
A
overnight low dose dexamethasone test
24h free urine cortisol
suppression= Cushing
no suppression= adrenal/ectopic ACTH secreting tumor
23
Q
GLP1 AE
A
“-tide”
pancreatitis
24
SGLT2 AE
"-flozin"
UTI
yeast infx
25
metformin AE
lactic acidosis
no IV contrast
macrocytic anemia, renal impairment
GI issues, metallic taste
26
type I DM pathophys
autoimmune pancreatic islet beta cell destruction and GAD abs
27
DMT1 labs
```
A1c > 6.5
fasting glucose >126 on 2 occasions
random glucose >200
OGTT 2h >200
ABSENT C PEPTIDE
islet leukocytic infiltrate
```
28
rapid insulin
lispro
| aspart
29
short acting insulin
regular
30
intermediate acting insulin
NPH
31
long acting "basal" insulin
glargine
Lantus
Levemir
32
dawn phenomenon
hyperglycemia between 3AM and 8AM
| increase night insulin
33
somogyi effect
nocturnal hypoglycemia at 3AM
high glucose levels by 7AM
decrease night insulin
34
DMT2 criteria labs
```
A1c >6.5
fasting glucose >126 on 2 occasions
random glucose >200
OGTT 2h >200
ELEVATED C PEPTIDE
amyloid polypeptide deposits in pancreas
```
35
DM screening
adult w/ BMI >25 and triglycerides >250 or HDL <35
starting at 45yo
repeat every 3yrs if normal
36
metformin CI if
GFR <45
37
hyperosmolar hyperglycemic state MC in pts w/
DMT2
| infection
38
hyperosmolar hyperglycemic state sx
polyuria, dehydration, lethargy, seizures, coma, death
gradual onset, blurred vision, slurred speech, weakness,
hypotension, AMS
39
hyperosmolar hyperglycemic state tests
```
glu 600-2400
high serum osmolality (>320)
glycosuria, inc BUN/Cr
negative ketones
hyponatremia
```
40
hyperosmolar hyperglycemic state tx
agressive IV fluids w/ NS
replete electrolytes (K)
IV insulin after fluids
41
diabetic ketoacidosis causes
insulin non compliance
new diabetic dx
MCC infection
42
diabetic ketoacidosis sx
abd, N/V, dehydration, fruity breath
| kussmaul respiration
43
diabetic ketoacidosis labs
```
ketonuria
random glucose 250-600
metabolic acidosis
total body K dec
high anion gap
leukocytosis
```
44
diabetic ketoacidosis tx
IV fluids
K replacement before insulin
IV insulin
bicarb for severe acidosis
45
metabolic syndrome criteria
waist circumference: >40in (M), >35in (F)
glucose >100 or tx of hyperglycemia
HDL: <40 M, <50 F or tx HDL
BP: >135 systolic or >85 diastolic or tx HTN
triglyceride: >150 or tx triglyceride
46
klinefelter sx
boy w/ gynecomastia
| small testicles
47
Turner syndrome sx
girl w/ webbed neck
| short stature
48
kallman syndrome sx
anosmia
absent breast development
uterus present
syndactyly
49
MEN1
3Ps
primary hyperparathyroidism: hypercalcemia, inc intact PTH, dec P, inc 24h urine calcium
pancreatic tumor: ZES, gastronome, insulinoma
pituitary adenoma: prolactinoma MC
50
MEN2A
1M and 2Ps
medullary thyroid cancer
pheochromocytoma
primary hyperparathyroidism
51
MEN2B
```
3Ms and 1P
medullary thyroid cancer
pheochromocytoma
marfanoid body habits
mucosal neuromas
```
52
pheochromocytoma rule of 10
```
bilateral
familial
pediatric
malignant
extra adrenal
MEN2A/2B
```
53
pheochromocytoma sx
triad: episodic HA, HTN, diaphoresis
5Ps: pressure (HTN), pain (HA), perspiration, palpitation, pallor
54
pheochromocytoma BIT
24h urinary metanephrine and catecholamines: inc metanephrines and inc vanillylmandelic acid
55
pheochromocytoma MAT
CT/MRI adrenals
56
pheochromocytoma tx
surgical resection
| preop: 1st alpha blockage (phenoxybenzamine) control BP then propranolol
57
primary hyperaldosteronism vs secondary hyperaldosteronism
primary: renin independent. adrenal hyperplasia, conns (adrenal aldosteronoma)
secondary: increased renin. renal artery stenosis
58
Conns syndrome pathology
aldosterone secretion independent from RAAS
59
MCC conn syndrome
adrenal adenoma
60
Conns syndrome sx
refractory HTN
muscle weakness (hypoK), palpitations, arrhythmias
polyuria/polydipsia, N/V/abd dist
dec DTR, dec Mg
61
Conns syndrome tests
screening: plamsa aldosterone to plasma renin if HTN (+ if inc ratio)
definitive: saline infusion test
hypernatremia, hypoK, metabolic alkalosis
62
conns syndrome tx
```
tx underlying (adrenalectomy)
1st line spironolactone or eplerenone
```
63
SIADH med causes
```
narcotics
SSRI, NSAIDS
carbamazepine
TCA, HCTZ
ecstasy
```
64
increased ADH secretion results in
```
concentrated urine (increased urine osmo)
water retention (dec serum osmo)
increased edema and increased ICP --> hyponatremia
```
65
ectopic ACTH secretion commonly from
small cell lung cancer
66
SIADH sx
hyponatremia, muscle weakness,, confusion, N/V/HA
| severe: seizures, AMS from cerebral edema
67
SIADH tests
hyponatremia (isovolemic hypotonic)
inc urine osmo, dec serum osmo
inc plasma ADH
dec uric acid, dec BUN
68
S|ADH tx
asx: fluid restriction and inc salt intake
sx: hypertonic saline, ICU, furosemide
demeclocycline, IV conivaptan/PO tolvaptan
69
medullary thyroid carcinoma produces
calcitonin
70
hyperparathyroidism sx
```
dec DTR
moans: not feeling well
groans: abd pain, GERD
stones: kidney
bones: bone pain
psych overtonesL depression
```
71
primary hyperparathyroidism labs
inc Ca
Inc PTH
dec P
shortened QT
72
hyperparathyroidism tx
IV fluids
loop diuretics
parathyroidectomy: if asx, can be candidate if T score <-2.5 or younger than 50yo
73
hypocalcemia EKG
prolonged QT interval
74
hypoparathyroidism sx
trousseau (BP cuff)
chvostik sign (facial twitch)
inc DTR, tetany
75
hypoparathyroidism lab triad
dec Ca
dec intact PTH
inc P
76
hypoparathyroidism tx
sx or Ca <7.6: IV Ca glutinate
| Ca >7.6: PO Ca carbonate + VitD supplement
77
acromegaly/gigantism tx
transsphenoidal resection
| octreotide
78
acromegaly/gigantism MAT
OGTT w/ serum GH in 2h
79
acromegaly/gigantism study of choice
MRI
80
acromegaly/gigantism BIT
inc IGF1 levels
81
acromegaly vs gigantism
acromegaly: adult
gigantism: children
82
MC type of DI
central
83
rx that causes nephrogenic DI
lithium
84
DI labs
inc vol urine, dec ADH/vasopressin
dec urine osmo (dilute)
inc serum osmo (concentrated)
85
DI BIT
water deprivation test: if inc urine osmo --> psychogenic polydipsia
86
DI tx
central: tx underlying, IN DDAVP
nephrogenic: thiazide, amiloride, indomethacin
87
nephrogenic DI CI
ahminoglycosides: nephrotoxic
88
dwarfism/achondroplasia patho
autosomal dominant: FGFR3
89
tx dwarfism
conservative
| do not give GH
90
prolactinoma labs
dec LH/FSH
dec estrogen
inc serum prolactin
91
prolactinoma MAT
snowman appearance on MRI
92
prolactinoma tx
BItx: cabergoline/bromocriptine
93
MCC hyperthyroidism
graves dz
94
jod basedow phenomenon
iodine induced thyrotoxicosis
| hyperthyroidism after IV iodine contrast
95
hyperthyroidism tx
```
methimazole
PTU (pregnancy)
BB
prednisolone
severe: thyroidectomy
```
96
graves triad
exophthalmos
orbitopathy (lid lag)
peritibial myxedema
97
thyroid storm sx
hyperthyroidism + fever, tachycardia, arrhythmia, and AMS
98
thyroid storm tx
```
ABC
1st step: BB
2nd: PTU/methimazole
3rd: iodine and steroids (dexamethasone)
avoid aspirin
```
99
hashimotos thyroiditis labs
```
+ thyroid ab
thyroid peroxidase
antimicrosomial
dec RAIU
HLADR3
```
100
de quervains thyroiditis sx
follows flu-like illness
| self limiting
101
de quervains thyroiditis phases
3 phases
hyperthyroidism
hypothyroidism
return to normal fxn
102
riedel thyroiditis sx
chronic condition
firm hard woody nodule
fixed hard painless goiter
tx w/ surgery
103
postpartum thyroiditis
up to 1yr after delivery
transient hyperthyroidism then hypothyroidism
self limiting, dont give thyroid meds
+ thyroid ab
104
wolff-chaikoff effect
auto regulatory w/ too iodine
105
medications that can cause thyroid issues
amiodarone
lithium
sulfonamides
106
silent (lymphocytic) thyroiditis
+ thyroid ab
dec RAIU
return to euthyroid in. 12-18mo wo tx
tx w/ aspirin, no thyroid meds
107
hashimotos thyroiditis histology
hurtle cells
108
de quervain thyroiditis sx
1st: enlarged painful thyroid, jaw pain
2nd: weight gain, pretrial myxedema
109
de quervain thyroiditis tests
high ESR
neg thyroid ab
gold standard: RAIU dec
110
de quervain thyroiditis tx
self limiting
1st: NSAIDS and BB
2nd: steroids
111
myxedema coma sx
```
dec mentation
hypothermia
hypotension
hyponatremia
old lady w/ long standing hypothyroidism in cold weather
```
112
myxedema coma tx
ABC in ICU
supportive
IV levothyroxine and hydrocortisone
113
Sheehan syndrome
```
postpartum pituitary infarction
lactation failure (dec prolactin)
amenorrhea, hot flashes, vaginal atrophy (dec FSH/LH)
fatigue, bradycardia (dec TSH)
anorexia, WL, hypoTN (dec ACTH)
dec lean body mass (dec GH)
```
114
diabetic meds that cause hypoglycemia
sulfonylureas: glyburide, glipizide
meglitinides: repaglinide, nateglinide
insulin: regular, lispro, aspart, NPH, glargine
