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Internal Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

How should pheochromocytoma be treated prior to surgery?

A

Alpha-blocker (e.g. phenoxybenzamine, nonselective and irreversible) 7-14d before - beta-blocker alone could lead to hypertensive crisis due to unopposed alpha stimulation
Patient encouraged to increase sodium and water intake due to side effect of alpha blockade
Propranolol 2-3d before surgery

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2
Q

Carcinoid syndrome - signs and treatment

A

Signs: flushing, diarrhea, elevated 5-hydroxyindoleacetic acid
Treatment: Somatostatin analog (e.g. octreotide)

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3
Q

Papillary thyroid cancer - primary treatment

A

Surgical resection - smaller tumors may only require partial thyroidectomy/lobectomy

Adjuvant radioiodine ablation, thyroid hormone replacement - for those with increased risk of tumor recurrence

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4
Q

Calcitonin is marker for which thyroid cancer?

A

Medullary - arises from parafollicular C cells

(Papillary and follicular arise from epithelial cells)

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5
Q

In absence of infection, what is likely causing persistent fever, tachycardia, and HTN in patient with severe burns?

A

Hypermetabolic response

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6
Q

Hypermetabolic response to burns - treatment

A
  1. Burn excision and grafting (to decrease inflammation)
  2. Beta blockers (to decrease catecholamine effects)
  3. Nutrition, anabolic steroids (to minimize lean muscle mass loss)
  4. Insulin (to control hyperglycemia)
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7
Q

Which thyroid cancer has calcitonin?

A

Medullary - it is made by C cells

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8
Q

What paraneoplastic syndrome is associated with thymoma?

A

Myasthenia gravis

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9
Q

What should be done for patient in adrenal crisis?

A

IV dexamethasone or hydrocortisone + aggressive volume repletion

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10
Q

What are the thyroid parafollicular cells?

A

These are the neuroendocrine C cells that secrete calcitonin
They are in medullary thyroid cancer
Surveil with calcitonin levels

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11
Q

Signs of medullary thyroid cancer

A

Asymptomatic but may have some diarrhea and flushing
Calcium usually normal unless part of MEN2A hyperparathyroidism

Risk of metastasis and surveillance can both be assessed with calcitonin levels
Also measure carcinoembryonic antigen

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12
Q

What protooncogene is associated with MEN2?

A

RET

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13
Q

MEN1

A
  1. Parathyroid
  2. Pituitary
  3. Pancreas (enteropancreatic endocrine cell tumor)
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14
Q

What cancers use thyroglobulin as a cancer marker?

A

Papillary and follicular differentiated thyroid cancers

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15
Q

MEN2

A
  1. Medullary thyroid cancer
  2. Pheochromocytoma
  3. A: Hyperparathyroidism; B: marfanoid habitus + mucosal neuromas
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16
Q

Describe testicular cancer appearance on scrotal ultrasound

A

Seminoma - solid, hypoechoic
Nonseminomatous germ cell tumor - cystic areas and calcifications

17
Q

What does PTH do?

A

Increases calcium mobilization from bone
Decreases phosphate reabsorption at proximal tubule

18
Q

How does CKD lead to hypocalcemia and hyperphosphatemia?

A

Decreased vitamin D conversion
Decreased filtration of phosphate

Secondary parathyroidism and chronic parathyroid stimulation can lead to parathyroid hyperplasia and tertiary parathyroidism due to autonomous PTH secretion, due to downregulation of calcium-sensing receptor and vitamin D receptor in parathyroid glands

At this point, you would see very high PTH, hypercalcemia, and hyperphosphatemia

19
Q

What bone observation on x-ray is highly specific for elevated PTH?

A

Subperiosteal resorption

20
Q

How to treat secondary hyperparathyroidism?

A

Reducing serum phosphorus (e.g. dietary phosphate restriction, phosphate binders

Overtreatment –> adynamic bone disease, low bone turnover
Undertreatment –> osteitis fibrosa cystica, high bone turnover

21
Q

Homocystinuria - common signs

A
  1. Lens dislocation
  2. Intellectual disability
  3. Marfanoid features
  4. Increased risk of arterial and venous thrombi
22
Q

Hypocalcemia symptoms

A
  1. Muscle spasms
  2. Hyperreflexia
  3. Paresthesias
23
Q

Reversible causes of atrial fibrillation

A
  1. Hyperthyroidism
  2. Mitral valve disease
24
Q

Primary adrenal insufficiency

A

Fatigue, malaise, weakness, weight loss
GI symptoms

Hypotension:
Aldosterone deficiency –> volume depletion, hyperkalemia, hyperchloremic metabolic acidosis
Cortisol deficiency –> loss of vascular tone

Increased secretion of ADH –> water retention, hyponatremia

Skin hyperpigmentation (cosecretion of melanocyte-stimulating hormone with ACTH)

25
Q

Euthyroid sick syndrome - labs

A

Early: Low T3, normal T4 and TSH
Late: Low everything else

During recovery, patients may experience modest, transient increase in TSH that can be misinterpreted as subclinical hypothyroidism (elevated TSH, normal thyroxine levels)

26
Q

Explain the hemodynamics of thyroid storm

A
  1. Decreased SVR (increased metabolism, direct endothelial vasodilation)
  2. Increased cardiac output (decreased SVR, direct effect on myocardium)
  3. High venous oxygen content (less time for tissues to extract oxygen –> low arterial-venous oxygen difference)
  4. Increased venous return –> increased pulmonary capillary wedge pressure + pulmonary edema
27
Q

Primary hyperparathyroidism vs familial hypocalciuric hypercalcemia - urinary calcium excretion

A

Both have hypercalcemia and high PTH

Primary hyperPTH: net urinary calcium excretion is increased due to resorption from bone > reabsorption from distal tubule

Familial: low urinary calcium excretion (<100 mg/24 hr)

28
Q

Primary adrenal insufficiency and adrenal crisis - treatment

A

Glucocorticoid (dex > hydro, does not interfere with cortisol measurement), followed by mineralicorticoid (fludrocortisone), which takes a few days to

29
Q

Somatostatin receptor scintigraphy

A

Used in evaluation of pancreatic or metastatic gastrin-producing tumor (Zollinger-Ellison syndrome)

30
Q

What causes hoarseness in hypothyroidism?

A

Deposition of matrix glycosaminoglycans in tissue interstitial space

31
Q

Alpha subunit is common to which pituitary hormones?

A

TSH, LH, FSH, bhCG

32
Q

Main sign of glucagonoma

A

Necrolytic migratory erythema - painful, pruritic papules that coalesce to large indurated plaques

Due to excess catabolism, aa deficiency

33
Q

Primary adrenal insufficiency - testing

A

Concurrently do these tests:
1. AM cortisol + ACTH level
2. ACTH stimulation test

34
Q

Cushing - testing

A

24-hr cortisol
Dexamethasone suppression test

35
Q

What does excess cortisol do to muscle?

A

Catabolic muscle atrophy due to breakdown and impaired regeneration -> proximal weakness

No pain because not direct injury to myocytes
CK is normal

36
Q

VIPoma symptoms

A

VIP increases fluid and electrolyte secretion in intestinal lumen:
1. Watery diarrhea (tea-colored, odorless)
2. Muscle weakness/cramps (hypokalemia)
3. Hypochlorhydria (decreases gastric acid secretion)

Hypercalcemia from bone turnover
Hyperglycemia from glycogenolysis

Stool sodium increased, osmolal gap <50

VIPoma commonly found in pancreatic tail
May have concurrent MEN and hyperthyroidism

37
Q

Systemic mastocytosis

A

Mast cell proliferation, causing pruritius, flushing, and dyspepsia from gastric hypersecretion

Diagnosis via skin or bone marrow biopsy

Internal Medicine (23 decks)

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