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Endo Flashcards

(61 cards)

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1
Q

Causes of panhypopituitarism

A 
Tumors
Trauma 
Radiation 
Hemochromatosis
Sarcoidosis
Histocytosis X 
Infection: TB, fungus, parasite
Autoimmune infiltration
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2
Q 
Amenorrhea
Decrease libido 
Decreased secondary sex characteristics 
Erectile dysfunction 
Decreased muscle mass
A

LH/FSH deficiency

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3
Q

Pediatric short stature

A

GH deficiency

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4
Q

Central Obesity
Increased LDL and cholesterol
Reduced lean muscle mass

A

GH deficiency

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5
Q

Diagnosing secondary hypothyroidism?

A

Initial: low TSH & fT4
Diagnostic: TRH stim- fails to increase TSH

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6
Q

Diagnosing hypogonadotropic hypogonadism?

A

Measure LH/FSH (low) and testosterone (low)

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7
Q

Hypogonadotropic hypogonadism
Anosmia
50% renal agenesis

A

Kallman Syndrome

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8
Q

Diagnosing growth hormone deficiency?

A

Initial: Measure Igf-1 (somatostatin)
Diagnostic:
No response to arginine infusion (should stimulate GH)
No response to GHRH

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9
Q

Metyrapone test

A

Inhibits 11-beta-hydroxylase to decrease adrenal output.

Normally cause increase in ACTH levels.

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10
Q

Insulin stimulation test

A

Decrease in glucose should stim GH.

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11
Q

Central DI Etiology

A

50% idiopathic
trauma, stroke, tumor
infiltration from sarcoidosis/infection

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12
Q

Nephrogenic DI Etiology

A 
Lithium 
Hypercalcemia 
Hypokalemia
Chronic pyelonephritis 
Amyloidosis 
Myeloma
Sickle Cell Disease
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13
Q

High volume urine
Excessive thirst
Hypernatremia: neuro symptoms

A

DI

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14
Q

Diagnose DI

A

Water deprivation test:
Restrict water and measure Urine Osm every hour until normalize.
Administer desmopression and remeasure urine Osm in 1 hour

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15
Q

Central DI treatment

A

Long term vasopressin

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16
Q

Nephrogenic DI

A

Treat underlying cause or remove causative agent

Use thiazide diuretic, amiloride, or NSAIDs

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17
Q

Acromegaly Etiology

A

ALWAYS pituitary adenoma

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18
Q

Diagnose acromegaly

A

Elevated glucose
Hyperlipidemia
Test prolactin-cosecretion

Measure IGF-1
Glucose supression test

MRI

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19
Q

Treatment of acromegaly

A

Transphenoidal resection

Cabergoline-dopamine inhibit GH
Octreotide/lanreotide- somatostatin inhibit GH
Pegvisomant- GH receptor antagonist

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20
Q

Hyperprolactinemia etiology

A 
Cosecreted with GH 
Hypothyroidism- Increase TRH stim prolactin 
Pregnancy 
Intense exercise 
Nipple stim 
Pituitary adenoma
Renal insufficiency 
Antipsychotics 
Methyldopa
Metoclopramide 
TCA 
Opioids 
Verapamil
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21
Q

Diagnose hyperprolactinemia

A

Thyroid function
Pregnancy test
BUN/Cr
Liver function

If all normal: MRI

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22
Q

Treat prolactinoma

A

Dopamine agonist- Cabergoline/bromocriptine

Transphenoidal resection

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23
Q

Hypothyroidism eitology

A

Almost always Hashimoto’s thyroiditis burnout

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24
Q 
Bradycardia
Constipation 
Weight gain 
Fatigue, lethargy, coma
Decreased reflexes
Cold intolerance 
Hypothermia 
Hair loss 
Edema
A

Hypothyroidism

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25
Hypothyroid diagnosis
1. Measure TSH 2. Measure fT4 If TSH double normal- treat If TSH elevated, but less than double- anti-TPO Ab
26
``` Tachycardia, palpitations, a.fib Diarrhea Weight loss Anxiety Hyperreflexia Heat intolerance Fever ```
Hyperthyroid
27
Hyperthyroid + eye and skin changes
Graves Disease
28
Hyperthyroid + tender thyroid
Subacute thyroiditis
29
Hyperthyroid + normal exam
Painless thyroiditis
30
Hyperthyroid + involuted non-palpable gland
Exogenous thyroid hormone use
31
Hyperthyroid + elevated TSH
Pituitary adenoma
32
High TSH | RAIU- elevated
Graves Disease
33
Low TSH | RAIU- decreased
Subacute thyroidits, painless thyroiditis, exogenous thyroid hormone **correlate with exam
34
Graves treatment
Radioactive iodine
35
Subacute thyroiditis treatment
Aspirin
36
Painless thyroiditis
No treatment
37
Treatment for acute hyperthyroidism
1. Propanolol-blocks target organ, prevents peripheral conversion 2. Thiourea- blocks hormone production 3. Iodinated contrast material- block peripheral conversion, blocks hormone release 4. Hydrocortisone 5. Radioactive iodine
38
Treatment for Graves opthalmopathy
First line: steroids Radiation for non-responders Decompressive surgery last resort
39
Hypercalcemia etiology
``` ***Primary hyperparathyroidism Osteolytic cancer Hypercalcemia of malignancy Vit D intoxication Sarcoidosis Thiazide diuretics Hyperthyroidism ```
40
``` Confusion Stupor Constipation Short QT syndrome HTN Osteoporosis Nephrolithiasis DI Renal insufficiency ```
Hypercalcemia
41
Treat acute hypercalcemia
1. IVF 2. Bisphosphonates 3. Calcitonin (If sarcoid treat with steroids)
42
Hyperparathyroid etiology
Solitary adenoma Hyperplasia Malignancy
43
Diagnose hyperparathyroidism
``` High Ca High PTH Low Phos Urine Ca > 250 High Cl ECG- short QT ```
44
Surgical candidates for parathyroidectomy
``` Symptomatic Asx and: - Ca at least 1 above upper limit - Age less than 50 - Bone density < T -2.5 - Reduced renal function ```
45
Treatment for hyperparathyroidism and not surgical candidate
Cinacalet
46
Hypocalcemia etiology
``` Thyroidectomy Hypomagnesemia Renal failure Vit D deficiency DiGeorge syndrome Fat Malabsorption Low albumin (not symptomatic!!) ```
47
``` Chvostek sign Carpopedal spasm Perioral numbness Mental irritability Seizures Trousseau sign ```
Hypocalcemia
48
Diagnose hypocalcemia
EKG- long QT | Slit lamp- cataracts
49
Etiology of Cushing syndrome
Pituitary overproduction ACTH production from carcinoid/cancer Overproduction of cortisol from adrenals Iatrogenic
50
``` Striae Easy bruising Decreased wound healing Osteoporosis HTN Menstrual disorder Erectile dysfunction Cognitive disturbance Polyuria ```
Hypercortisolism
51
Lab findings in hypercortisolism
``` Hyperglycemia Hyperlipidemia Hypokalemia Metabolic alkalosis Leukocytosis ```
52
Establish presence of hypercortisolism
Best initial test: 24-hour urine coritsol (more specific) 1mg overnight dexamethasone suppression test- false positives: depression, alcoholism, obesity
53
Establish cause of hypertcortisolism
Measure ACTH ACTH elevated- pituitary or ectopic ACTH depressed- adrenal
54
Establish source of ACTH
High dose dexamethasone suppression test
55
Evaluate adrenal incidentaloma
1. measure urine metanephrines- rule out pheo 2. Measure renin and aldosterone 3. 1mg overnight dexamethasone suppression test
56
Etiology of Addison's disease
***Autoimmune destruction ***TB Adrenoleukodystrophy Cancer to adrenals
57
``` Weakness Fatigue Altered mental status N/V Anorexia Hypotension Hyponatremia Hyperkalemia ```
Hypoadrenalism
58
Profound hypertension Fever Confusion Coma
Acute adrenal crisis
59
Lab findings in hypoadrenalism
``` Hypoglycemia Hyperkalemia Hyponatremia Metabolic acidosis High BUN ```
60
Diagnose hypoadrenalism
Cosyntropin (synthetic ACTH) stim test
61
Treatment of Addision's
Replace steroid with hydrocortisone

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