Endocrine

Question 1

Prolactinoma

Answer 1

A tumor that produces prolactin. Causes galactorrhea, loss of peripheral vision, decreased libido. Can also be caused by meds, hypothyroidism.

Question 2

How to treat prolactinoma

Answer 2

Bromocriptine or surgery

Question 3

How does hypothyroidism cause prolactinoma?

Answer 3

Because TRH (increased in hypothyroidism) stimulates prolactin release from anterior pituitary

Question 4

Hormones produced by anterior pituitary

Answer 4

ACTH, TSH, GH, LH/FSH

Question 5

Hormones produced by the posterior pituitary?

Answer 5

Oxytocin and ADH.

Question 6

Acromegaly

Answer 6

Tumor producing GH. Causes gigantism in children, causes acromegaly in adults with diabetes, diastolic heart failure

Question 7

How to diagnose acromegaly?

Answer 7

Look at IGF-1 level, confirm with MRI, also glucose suppression test

Question 8

Glucose suppression test

Answer 8

Glucose challenge, GH should decrease. In acromegaly it doesnt.

Question 9

How to treat acromegaly?

Answer 9

Octreotide or surgery.

Question 10

Acute hypopituitarism caused by? Presentation?

Answer 10

Infection, infarction (sheehan’s, apoplexy), surgery, radiation
Presentation: lethargy, coma, hypotension.

Question 11

Empty sella syndrome

Answer 11

Pituitary is outside sella but still functions.

Question 12

How to treat empty sella syndrome?

Answer 12

Do nothing

Question 13

Chronic hypopituitarism caused by?

Answer 13

Autoimmune disease, deposition, cancer

Presents with decreased libido, decreased GH. Much less severe.

Question 14

How to diagnose chronic hypopituitarism

Answer 14

Insulin stimulation test, with insulin, GH and epi should increase

Question 15

SIADH

Answer 15

Brain lesion produces lots of ADH, water retained, very concentrated urine, decrease in serum osms.

Question 16

How to treat SIADH

Answer 16

Demeclocycline, vaptans, stop taking drug, water restriction

Question 17

Diabetes insipidus

Answer 17

Polydipsia, polyuria, normal BG, diagnose with water deprivation test.

Question 18

How to treat central diabetes insipidus?

Answer 18

Vasopressin

Question 19

How to treat nephrogenic diabetes insipidus?

Answer 19

Gentle diuresis.

Question 20

How to conduct water dep test?

Answer 20

Deprive water, measure U osm. if increases, then polygenic polydipsia. Then add ADH, if U osm increases, then Central DI. If it doesn’t then nephrogenic DI.

Question 21

Symptoms of hyperthyroidism

Answer 21

Tachycardia, diarrhea, increased DTRs, heat intolerance, weight loss, +/- afib

Question 22

How to diagnose hyperthyroidism

Answer 22

Decreased TSH, increased free T4, increased radioactive iodine uptake.

Question 23

Graves disease

Answer 23

Autoimmune with antibody stimulation, diffuse growth of thyroid with diffuse radioactive iodine uptake. Exopthalmos and pretibial myxedema.

Question 24

Thyroid storm

Answer 24

Shock, fever, delirium after a stress.

Question 25

How to treat thyroid storm?

Answer 25

IVF + cooling blankets, PTU/Methimazole, B blocker, IV steroids. Then surgery and iodine ablation.

Question 26

Thyroiditis

Answer 26

Transient hyperthyroidism followed by hypothyroidism. Can heal or can become hashimotos.

Question 27

Hypothyroidism

Answer 27

Bradycardia, constipation, decreased DTRs, cold intolerance, increased weight. Caused by hashimotos, iatrogenic

Question 28

Myxedema coma

Answer 28

Shock, cold, coma Treat with IVF, warm blankets, T4 and T3.

Question 29

How to work up thyroid nodules

Answer 29

If the patient is elderly or has radiation exposure in the past, do an FNA. Otherwise check a TSH/T4. If TSH and T4 is normal, do an FNA, if TSH is down, do an RAIU scan. If RAIU is positive, then resect the hot nodule. If RAIU is negative, do a FNA.

Question 30

Papillary carcinoma

Answer 30

Orphan annie eyes, psammoma bodies. Most common. Tx resect

Question 31

Follicular carcinoma

Answer 31

FNA may appear normal, hematogenous spread. Treat with I2 ablation

Question 32

Medullary carcinoma

Answer 32

C cells produce calcitonin. Common in MEN2A/@B.

Question 33

Anaplastic carcinoma

Answer 33

Elderly, fatal