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Flashcards in Endo Deck (37)
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GH deficiency in adults

Central obesity, increased LDL and cholesterol, reduced lean muscle mass


Insulin's affect on GH

When insulin decreases the glucose level, GH should rise, failure to do so indicates pituitary insufficiency


Hormones to replace in panhypopituitarism

First: Cortisone, then thyroxine, testosterone, estrogen, recombinant human growth hormone


2 hormones of the posterior pituitary

Oxytocin and ADH


What are low in panhypopituitarism

TSH, thyroxine, ACTH, Cortizone, LH/FSH, testosterone, estrogen?
GH – pulsatile however, prolactin


Cosyntropin stim test in panhypopituitarism

Should be normal – Cortizone will rise as the adrenal gland is normal – in response to cosyntropin, however if chronic will be decreased as the adrenal gland has atrophied


Causes of nephrogenic DI

Chronic pyelonephritis, amyloidosis, myeloma, SCD
Also, hypercalcemia and hypokalemia may inhibit ADH affect on kidney


Treatments for nephrogenic DI

Hydrochlorthiazide, amiloride, indomethacin


Unusual presentations of acromegaly

Carpal tunnel syndrome, body odor, deep voice, big tongue, colon polyps, skin tags, arthralgias, hypertension, cardiomegaly, CHF, erectile dysfunction – increase prolactin
GH abuse may result in similar presentation


Diagnosis and treatment for acromegaly

Initial: I GF – 1
Best: glucose suppression test – glucose will not suppress GH
Will see glucose intolerance and hyperlipidemia
MRI after acromegaly is identified
Treatment: transphenoidal resection of the pituitary
Cabergoline – dopamine will inhibit GH release
Octreotide, pegvisomant- GH antagonist
Radio therapy if unresponsive


GH and insulin

GH is anti-insulin, but it makes insulin like growth factor; and has insulin like effects on proteins and amino acids


What may raise prolactin levels

GH release, hypothyroidism, pregnancy, exercise, renal insufficiency, chest wall stimulation, antipsychotics, methyldopa, metoclopramide, opioids, try cyclic antidepressants, verapamil– The only CCB
Dopamine and Hibbetts prolactin a lease so, meds that inhibit dopamine raise prolactin


Test to get first if high prolactin, and when can you get an MRI

Thyroid function test, pregnancy test, BUN/creatinine, LFTs– Both kidney and liver failure increase prolactin
Can get an MRI after high prolactin is confirmed, secondary causes like meds are excluded, patient is not pregnant


Treatment for hyperprolactinemia

Dopamine agonist: cabergoline is better than bromocriptine
If no response, transphenoidal surgery, radiation is rarely needed


Hypothyroidism is characterized by almost all body processes being slow down except?

Menstrual flow, which is increased


How to treat hypothyroidism based on TSH

If TSH is more than double the upper limit of normal with normal T4, replace hormone
If less than double, get anti– TPO/anti-thyroglobulin antibodies, if positive replace thyroid hormone


What is the cause of the hyperthyroidism?
Eye and skin findings?
Tender thyroid?
Nontender, normal exam?
Involuted gland is not palpable?
High TSH?

Eye and skin findings: Graves– Only one to have TSH receptor antibodies
Tender thyroid: subacute thyroiditis
Nontender, normal exam: painless – silent – thyroiditis
Involuted gland is not palpable: exogenous is thyroid hormone use
High TSH: pituitary adenoma


Hyperthyroidism treatments

Methimazole > PTU: Block hormone production, PTU inhibits conversion to active form
Iodinated contrast material: block peripheral conversion to active form, also block release of existing hormone


Treatment for eye problems in graves

Steroids, radiation if not responding, severe cases may need decompressive surgery


First step if small mass found on thyroid gland without symptoms or tenderness

Get T4/TSH levels, if + patient has a hyperfunctioning gland, does not need immediate biopsy as malignancy is not hyperfunctioning
If normal T4/TSH and greater than 1 cm: FNA, no need for US or RAIU– These cannot exclude cancer


Presentation of hypercalcemia

Acute: confusion, stupor, lethargy, constipation
Short QT interval, hypertension, osteoporosis, nephrolithiasis, DI, renal insufficiency


When hypercalcemia does not resolve after fluids and bisphosphonates

Calcitonin, works rapidly whereas bisphosphonate take several days to work
Cinacalcet: may work in hyper PTH but not useful for malignancy, as PTH is already maximally suppressed
Prednisones: controls hypercalcemia from sarcoidosis or other granulomatous disease


Treatment for hyperparathyroidism

Surgical removal, if not possible give cinacalcet


Magnesium and calcium

Will magnesium needs to bow calcium because Magnesium is necessary for PTH to be released from the gland, low levels also lead to increased urinary loss of calcium


Albumin and calcium

For every point decrease in albumin, the calcium level decreases by 0.8
However free calcium is normal


EKG in hypocalcemia
Another unique finding?

Prolonged QT
slit lamp exam shows early cataracts


Best initial tests for hypercortisolism

Best: 24 hour urine cortisol
Next: 1 mg overnight dexamethasone suppression test, should normally suppress morning Cortizone levels, if suppressed hypercortisolism can be excluded, Does have false positives: Depression, alcoholism, obesity
Another: midnight salivary cortisol


Determining the cause of hypercortisolism

Best initial: ACTH
if low source is adrenal
If elevated, pituitary – suppresses with high dose dexamethasone
Or ectopic – lung cancer, carcinoid – not suppressed: get MRI, then sample the inferior petrosal sinus after stimulating patient with CRH, as some pituitary lesions are too small to be seen on MRI
If no pituitary lesion scan the chest for an ectopic source


Affects of cortisol

Hyperglycemia, hyperlipidemia, hypokalemia, metabolic alkalosis– Excretes potassium and hydrogen ions at distal tubule
leukocytosis from demargination of wbc's


Presentation of chronic adrenal failure and acute adrenal crisis

Both: weakness, fatigue, AMS, N/V, anorexia, hypotension, hyponatremia, hyperkalemia, metabolic acidosis, hypoglycemia, high BUN, eosinophilia
Chronic: hyperpigmentation
Acute crisis: profound hypotension, fever, confusion, coma