Endocrine Flashcards
(99 cards)
1
Q
what parathyroid glands are more likely to not be in their normal anatomic position
A
inferior parathyroid glands (follow the thymus around)
2
Q
artery for the parathyroid
A
superior thyroid artery
3
Q
Increases calcium absorption in the gastrointestinal tract
A
Vitamin D
4
Q
Stimulates osteoclasts, renal calcium reabsorption, phosphate excretion, and synthesis of D3
Inhibits osteoblasts
A
Parathyroid hormone
5
Q
Antagonizes PTH
A
Calcitonin
6
Q
what secrete calcitonin
A
Secreted by the C Cells of the THYROID
7
Q
most inpatient cases of hypercalcemia are due to what?
A
malignancy
8
Q
what is the most common cause of hypercalcemia in the outpatient
A
hyperparathyroidism
9
Q
Triggers for hyperparathyroidism
A
family hx MEN syndrome HTN peptic ulcer Vit D def early osteoporosis
10
Q
Presentation of hyperparathyroidism
A
nephrolithiasis renal failure bone pain osteopenia, osteoporosis polyuria constipation depression
11
Q
endocrine disorders are more common in who?
A
women (3:1) in periamenopausal time period
12
Q
a fibormyalgia patient may actually have what?
A
hyperparathyroidism
13
Q
a calcium level over what is a hypercalcemia crisis?
A
> 14.5
14
Q
symptoms of a hypercalcemic crisis
A
anorexia, weakness vomiting, dehydration acute pancreatitis polyuria/ polydypsia nephrocalcinosis coma constipation
15
Q
a patient w/ acute onset pancreatitis w/o gallbladder or liver problems probably is having what?
A
hypercalcemic crisis
16
Q
tx for hypercalcemic crisis
A
volume resuscitation/ rehydration loop diuretic (lasix)
17
Q
drugs to tx hypercalcemic crisis that inhibit bone resorption
A
bisphosphonates
calcintonin
mithramycin
18
Q
what is C/I w/ hyperparathyroidism and hypercalcemia
A
HCTZ
19
Q
phosphorous level in hyperparathyroidism
A
low
20
Q
work up for hyperparathyroidism
A
Serum calcium and phosphorus
Intact parathyroid hormone (PTH)
Vitamin D levels
24 hour urinary calcium excretion
21
Q
common cause of secondary hyperparathyroidism
A
Vitamin D deficiency- just need this replaced and pTH should go back to normal
22
Q
most common cause of hyperparathyroidism
A
benign tumor of a single gland
23
Q
what is a genetic condition that causes hyperparatyroidism
A
familal hypocalciuric hypercalcemia (FHH)
24
Q
lead expensive and invasive way to localize parathyroid tumor
A
Ultra sound
25
Single best test for locating abnormal parathyroid glands
Sestamibi scintigraphy (Dual Tracer- 2 radio-isotopes)
first- iodine
second- Tech 99 (thyroid and abnormal parathyroid)
26
when should you do a CT scan for parathyroid
re-operation
| or can't find it on previous studies
27
how will a parathryoid tumor look like on US?
hypoechoic (black ball)
28
indications for surgery w/ hyperparathyroid- serum caclium > than what?
11.5 mg/dL
29
indications for surgery w/ hyperparathyroid with creatinine clearance
CrCl <30%
30
a 24 hour urinary calcium above what incidactes need for parathyroid surgery
>400 mg/dL
31
bone mass reduced less than ____ SD below normal is an indication for parathyroid surgery
2
32
a PTH level over what is abnormal
75
33
what is when all the parathyroid glands are affected
parathyroid hyperplasia
34
tx for parathyroid hyperplasia
3.5 gland parathyroidectomy
| 4 gland parathyroidectomy w/ autograft
35
sxs of hypocalcemia
muscle twitching on face/ forearm
| muscle twitching on face and fingertips
36
meds that can cause hyperparathyroidism
lithium therapy
rickets
renal failure
37
what is teritary hyperparathyroidism
persistent hypercalcemia after renal transplant
38
Truly a Rare Phenomenon (4g)
Very high serum calcium and PTH (quick onset)
Recurrence of resected adenoma
parathyroid carcinoma
39
surgery for parathyroid cancer
Parathyroidectomy, ipsilateral thyroid lobectomy and central compartment dissection.
40
postoperative treatment w/ parathyoidism removal
treat w/ calcium if <8 (IV)
Vitamin D3 (Rocaltrol)
HCTZ (want Ca reabsorption)
PHOSLO (Lower phosphorous)
41
if both recurrent laryngeal nerves are severed what does a patient need
need a tracheotomy
42
general term for thyroid swelling
goiter
43
inflammation of the thyroid usually from viral or autoimmune condition
thyroiditis
44
present with Heat intolerance, weight loss, tremulousness, palpitations, restlessness, emotional instability, atrial fibrillation, insomnia
hyperthyroidism
45
Precipitating events for thyroid storm
Fever, hypotension, CHF
46
Caused by autoantibiodies that recognize the TSH receptor
Graves Dz
47
what will a thyroid scan w/ Graves Disease show?
diffuse uptake w/o nodularity
48
big ADR w/ Metimazole
agranulocytosis (need a CBC check after every illness)
| liver damage
49
drug for graves that interferes with thyroid hormone synthesis and peripheral conversion of T4 to T3
PTU
50
definitive treatment for graves Dz
radioactive iodine ablation (RAI)
51
contraindicaitons for radioactive iodine ablation
pregnancy
| suspicion of thyroid malignancy
52
if a person has hyperthyroid toxicity and needs to be hospitalized what can you do?
plasmapharesis
| iodine
53
can someone w/ eye disease have radioactive iodine?
No, will worsen and can cause them to be blind
54
Palpable nodules
| Normal T3 and T4 are common, but TSH is decreased
toxic multinodular goiter (Plummer's disease)
55
tx for toxic multinodular goiter
total thyroidectomy
| radioactive iodine ablation (RAI)
56
Hyperthyroid symptoms
| Thyroid scan shows hot nodule with suppression of the rest of the gland
toxic nodule
57
definitive tx for toxic nodule
Thyroid lobectomy
| Radioactive iodine ablation (RAI)
58
Symptoms are cold intolerance, weight gain, constipation, dry skin, brittle hair, difficulty concentrating, and fatigue
hypothyroidism
59
Occurs in middle aged women
Antimicrosomal and antithyroglobulin antibodies
Surgery rarely indicated
Hashimotos
60
what will a thyroid be like w/ hasimotos
can be big
| 2 phases- gland will fight diseae (get big and angry) then eventually become atrophic
61
Associated with thyroid tenderness for 2 - 4 months
subacute thyroiditis
62
treatment for subacute thyroiditis
NSAIDs/ thyroid replacement
63
thyroid nodules that are candidates for FNA
1 cm or bigger
64
most common type of thyroid cancer
papillary
65
what type of thyroid cancer will take up radioactive iodine
well-differentiated carcinoma
66
why do you do lymph node dissection w/ thyroidectomy for thyroid cancer
want to know if the patient need radioactive iodine
67
how does a follicular thyroid cancer metastasize?
blood
68
any evidence of thyroid cells in a lymph node indicates what?
proof of metastasis
69
if there is presence of metastasis of thyroid cancer to lymph nodes in the neck what needs to be done?
radical neck dissection
70
thyroid cancer follow up (Post surgery)
routine US
whole body scans
measure thyroglobulin levels
71
tx for medullary thyroid cancer
total thyroidectomy w/ central compartment lymph node dissection
No RAI
72
do you operate for a anaplastic thyroid cancer usually?
No, usually just do a trach and give meds (radiotherapy and doxorubicin)
73
Most commonly present in childhood or adolescence as a midline swelling or dimple of the thyroid that moves with protrusion of the tongue.
always midline
thyroglossal duct cysts
74
treatment for thyroglossal duct cysts
surgical excision
Sinstrunk procedure always involves removing central 1/3rd of the hyoid bone
tx infection before surgery
75
what does the glomerulosa release?
mineralcorticoids
76
what does the fasiculata release?
glucocorticoids
77
what does the reitcularis release?
sex steroids
78
what part of the adrenal secretes epi/ norepi?
medulla
79
what is the test of choice for pheochromocytoma?
MRI
80
a non-functional lesion will be removed at what size?
>5cm
| can be >3cm- depends on patient
81
Presents w/
Hypertension
Hypokalemia
More common in women
Hyperaldosteronism
82
Rule of 10s w/ pheochromocytoma
10% familial
10% malignant
10% B/L
10% extradrenal (paraganglioma)
83
what hormone does the adrenal gland convert? (how to differentiate pheochromocytoma from paraganglioma)
norepi to epi
84
work-up for hyperaldosternoism
stop all diuretic and antihypertensive meds for 4 weeks
plasma aldosterone/ renin
saline infusion test (should suppress aldosteron)
CT scan
85
a plasma aldosterone to renin level of what indicates hyperaldosteronism
more than 30
86
tx for hyperaldosteronism
Laparoscopic adrenalectomy
| Open adrenalectomy
87
what is pathognomonic for cushings
axillary striae
88
workup for Cushing's
ACTH dependent vs. independent
24 hour urinary free cortisol
low dose dexamethasone supression test
localization- CT/MRI
89
cushing symptoms due to a pituitary problem is called what?
Cushing's Disease
90
should you send a patient w/ an adrenal mass for biopsy w/o ruling out pheo?
Never
91
workup for pheo
24 hour metanephrines, vanillymandelic acid, and fractionated catecholamines
Plasma levels of metanephrine and normetanephrine
CT
MIBG
MRI - test of choice
92
tx for pheo
alpha blockade - phenoxybenzmine (maximize before starting beta blockers)
volume replation
beta blockade
laparosopic adrenalectomy
93
Tx for malignant pheochromocytoma
surgical excision
| chemo
94
Most patients present with endocrinopathy - usually Cushing’s syndrome
Metastasis occurs to liver, lung, bone, and brain
Local invasion is common
adrenocortical carcinoma
95
what is used to tx adrenocortical carcinoma metastasis
mitotane (adrenergic blocker)
96
how will a pheo look on MRI
bright
97
present w/ fever, hyponatremia/ hyperkalemia and have no response to fluids or pressors
adrenal insufficiency
98
Diagnosis for adrenal insufficiency
ACTH stimulation test
99
Tx for adrenal insufficiency (stress dose)
100 mg hydrocortisone IV Q8 hours (stress dose)
| volume resuscitation
