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Endocrine Flashcards

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1
Q

Causes of panhypopituitarism

A

Anything that damages the brain

  • Tumor
  • Infection
  • Trauma
  • Stroke
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2
Q

In what order are hormones lost in the pituitary

A

GH, and LH, FSH first

ACTH last

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3
Q

Results of LH, FSH deficiencies

A

W - Amenorrhea
M - No testosterone or sperm, ED, decreased muscle
Both have decreased libido, body hair

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4
Q

Kallman syndrome points

A

Decreased GnRH causing decreased LH, FSH
Anosmia
Renal agenesis (50%)

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5
Q

Presentation of GH deficiency

A

Children - Short stature

Adults - Central obesity, Increased LDL, chol, Reduced lean muscle

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6
Q

Features of pituitary apoplexy

A

Prior adenoma
HA
Changing MS
Send to ICU for hormone replacement

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7
Q

What is Sheehan

A

Postpartum pituitary necrosis

Can’t lactate

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8
Q

Confirmatory test for low TSH and thyroxine

A

Decreased TSH response to TRH

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9
Q

Confirmatory test for decreased ACTH and cortisol

A

Normal response to cosyntropin stimulation
No response w/ CRH
Elevated cortisol excludes pituitary problem

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10
Q

Confirmatory test for Low GH

A

No response to arginine

No response to GHRH

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11
Q

Confirmatory test for low prolactin

A

No response to TRH

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12
Q

Failure of GH to rise in response to insulin

A

Pituitary insufficiency

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13
Q

What does metyrapone do

A

ACTH levels rise

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14
Q

Hormonal problems in empty sella

A

NONE

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15
Q

What is diabetes insipidus

A

Decrease in ADH amount or function on kidneys

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16
Q

Causes of central DI

A

Any destruction

  • Stroke
  • Trauma
  • Hypoxia
  • Infiltration
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17
Q

Causes of nephrogenic DI

A

Chronic pyelo
Amyloidosis
Myeloma
Sickle cell

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18
Q

Drugs inducing NDI

A

Li
Demeclocycline
Colchicine

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19
Q

Metabolic changes inducing NDI

A

Hypercalcemia

Hypokalemia

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20
Q

Presentation of DI

A

High volume urine
Excessive thirst
Volume depletion
Hypernatremia

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21
Q

What causes neuro sx in SI

A

Hypernatremia

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22
Q

What does water deprivation test show in DI

A

Urine osmolality doesn’t increase

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23
Q

Vasopressin effect in CDI

A

Decrease urine volume

Increase urine osmolality

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24
Q

Vasopressin effect in NDI

A

Nothing

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25
Obscure manifestation of NDI
Loss of access to water | - NPO before surgery
26
Rx CDI
Long term desmopressin
27
Rx NDI
Treat underlying cause | HCTZ, amiloride, NSAIDs
28
What is acromegaly
Overproduction of GH
29
MCC acromegaly
Pituitary adenoma | Can be part of MEN
30
2 Conditions causing B/L carpal tunnel syndrome
Acromegaly | Hypothyroidism
31
Features of Acromegaly
``` B/L carpal tunnel Increasing hat/shoe/ring size Coarse facial features Macroglossia Colon polyps HTN Cardiomegaly/CHF Bitemporal hemianopsia ED ```
32
Best initial test for acromegaly
IGF-1
33
Most accurate test for acromegaly
Glucose suppression test | NL - glucose suppresses GH
34
What additional tests must be done for acromegaly
Prolactin (cosecreted) | MRI (after labs)
35
Rx acromegaly
``` Surgery - transphenoidal resection Meds - Octreotide (rx of choice) - Cabergoline (inhibit GH) - Pegvisomant (GHr antagonist) Radiotherapy - Non-responsive to meds/surg ```
36
MCC of hyperprolactinemia
Functional adenoma (prolactinoma)
37
What must always be r/o as cause of hyperprolactinemia
Hypothyroidism | - High TRH leads to prolactin secretion
38
ONLY CCB to raise prolactin
Verapamil
39
Physiological causes of hyperprolactinemia
Pregnancy, nursing Intense exercise, stress Renal insufficiency
40
Drugs raising prolactin levels
``` Antipsychotics Methyldopa Metoclopromide Opioids TCAs ```
41
Presentation of hyperprolactinemia
W - Amenorrhea, galactorrhea, infertility | M - ED, decreased libido, visual disturbances
42
First Dx test in hyperprolactinemia
Check prolactin levels
43
Other tests in hyperprolactinemia
``` Exclude pregnancy BUN/Cr LFTs Exclude thyroid and drugs MRI ```
44
Rx hyperprolactinemia
DA agaonists - Cabergoline Transphenoid surgery - No med response Radiation - Last resort
45
Who to aggressively rx for hyperprolactinemia
Pts of childbearing age to prevent infertility | Men
46
Complication of transphenoidal resection for hyperprolactinemia
30% get panhypopituitarism
47
Cause of hypothyroidism
Failure of gland from burnt out Hashimoto's thyroiditis | Rare- Dietary def iodine, Amiodarone, Li
48
When to immediately treat hypothyroidism
TSH 2x NL AND NL T4 | TSH
49
AKA Antithyroid peroxidase
Antithyroglobulin
50
Features of hypothyroidism
``` Brady Constipation Wt gain Fatigue, lethargy, coma ↓ DTRs Cold intolerance Hypothermia Pseudodementia ```
51
Features of hyperthyroidism
``` Tachy, palpitations, arrhythmia Diarrhea Wt loss Anxiety, restlessness ↑ DTRs Heat intolerance Fever ```
52
Best initial test for thyroid disorders
TSH
53
What to do when TSH is suppressed
Measure T4
54
What is seen in exogenous T4 ingestion
Decreased TBG
55
Rx hypothyroidism
Lifelong thyroxine | Secondary hypothyroid - Add hydrocortisone
56
Diagnosis hyperthyroidism w/ proptosis and skin findings
Graves
57
Diagnosis hyperthyroidism w/ tender thyroid
Subacute
58
Diagnosis hyperthyroidism w/ nontender, normal exam
Painless thyroiditis
59
Diagnosis hyperthyroidism w/ Involuted gland (not palpable)
Exogenous thyroid use
60
Diagnosis hyperthyroidism w/ high TSH
Pituitary adenoma
61
TSH receptor Abs are in
Graves
62
Features of Graves
``` Women, 40s Exopthalmos (can get worse w/ rx) High output cardiac failure Pretibial myxedema RAIU - diffuse uptake ```
63
Features of subacute thyroiditis
Elevated ESR May spontaneously resolve Rx w/ ASA, steroids
64
Rx graves
Radioactive iodine ablation
65
Rx painless thyroiditis
None
66
Rx pituitary adenoma
Surgery
67
Rx Thyroid storm
``` Propranolol Methimazole > PTU Iodinated contrast - block peripheral conversion Steroids Radioactive iodine ```
68
Thyroid storm in pregnancy
Surgery > RAI ablation
69
Features of thyroid storm
Fever > 104 CNS sx Cardiac sx
70
Rx graves opthalmopathy
Steroids Radiation if nonresponsive Surgical decompression
71
First step in hyperfunctioning thyroid nodule
TSH, T4 levels | U/S to evaluate size
72
Dx tests in euthyroid thyroid nodule
Bx if >1cm w/ fine needle aspiration | No need to U/S or RAIU
73
Non-functioning nodule w/ Hx head/neck radiation
CA until proven otherwise
74
MC CA thyroid
Papillary | Rx total thyroidectomy
75
FNA shows follicular cells
Remove whole nodule | Can't differentiate between adenoma and carcinoma
76
Features of anaplastic thyroid CA
Older pts Worst prognosis Rare
77
Thyroid CA w/ FHx
Medullary
78
MCC hypercalcemia
Primary hyperparathyroidism
79
2nd MCC hypercalcemia
Malignancy (PTHrP)
80
Other causes of hypercalcemia
``` Vit D tox Sarcoid HCTZ Hyperthyroidism Mets, MM Prolongued immobilization ```
81
Acute Sx in hypercalcemia
Confusion Stupor Lethargy Constipation
82
Cardio manifestation of hypercalcemia
Short QT
83
Bone manifestation of hypercalcemia
Osteoporosis
84
Renal manifestation of hypercalcemia
Stones NDI Renal insufficiency
85
Rx hypercalcemia
Saline hydration at high volume Long term bisphosponates Short term calcitonin Prednisone - sarcoid, granulomatous
86
Drug inhibits PTH release
Cincalcet
87
Causes of primary parathyroidism
Solitary adenoma MCC 4-gland hyperplasia Parathyroid malignancy
88
Sx hyperparathyroidism
Osteoporosis Nephtolithiasis and renal insufficiency Muscle weakness, anorexia, N/V, abd pain PUD
89
Dx tests in hyperparathyroidism
High Ca, PTH, Cl, BUN/Cr, ALP Low PO4 Short QT
90
Rx hyperparathyroidism
Surgical removal | Cincalcet if surgery not an option
91
What to watch for post op in hyperparathyroidism
Hypocalcemia
92
MCC hypocalcemia
Complication of prior neck surgery
93
Other causes of hypocalcemia
``` Hypomagnesemia Renal failure VIt D deficiency Genetic disorders Fat malabsorption Low albumin ```
94
Signs of hypocalcemia
``` Chovstek Spasm Perioral numbness Mental irritability Seizures Tetany ```
95
Dx tests for hypocalcemia
Prolongued QT on EKG | Slit lamp exam shows cataracts
96
Rx hypocalcemia
Replace Ca and Vit D
97
What is Cushing syndrome
Hypercortisolism | Overproduction of ACTH
98
MCC hypercortisolism
Iatrogenic
99
Other causes of cushing syndrome
Pituitary overproduction (Cushing disease) Adrenal overproduction Unknown source Ectopic
100
Features of Cushing
``` Fat redistribution - moon face, buffalo hump Skin - striae, easy bruising Osteoporosis HTN Menstrual disorders, ED Cognitive disturbance Polyuria ```
101
Best initial test for presence of hypercortisolism
24hr urine cortisol
102
Secondary test for presence of hypercortisolism
1mg overnight dexamethasone suppression test
103
Most specific test for presence of hypercortisolism
24hr urine cortisol
104
Best initial test for the cause of hypercortisolism
ACTH levels
105
Cushing w/ elevated ACTH
Pituitary or Ectopic
106
Cushing w/ decreased ACTH
Adrenal source
107
Cushing w/ elevated ACTH suppressed by dexamethasone
Pituitary source
108
Cushing w/ elevated ACTH not suppressed by dexamethasone...what now?
Ectopic or CA - MRI brain - Petrosal sinus sample - Chest scan
109
Rx hypercortisolism
Surgically remove source
110
Workup of incidentaloma
Metanepherines Renin, aldosterone Dexamethasone suppression test
111
What is Addison's disease
Chronic hypoaldosteronism
112
MCC addison's
Autoimmune
113
Less common causes of Addison's
Infection (TB) Adrenoleukodystrophy Mets
114
Causes of acute adrenal crisis
``` Hemorrhage Surgery Hypotension Trauma Sudden removal of steroids ```
115
Presentation of Addison's
``` Fever Altered MS N/V Anorexia Hypotension Hyponatremia Hyperkalemia Hyperpigmentation ```
116
Specific finding in Addison's
Eosinophilia
117
Most specific test for adrenal function
Cosyntropin | No change in Addison's
118
Rx Addison's
Replace steroids Fludrocortisone Mineralocorticoids
119
First thing to do in acute adrenal crisis
Give Steroids
120
What is primary hyperaldosteronism
Autonomous overproduction of aldosterone despite high BP and low renin
121
What causes secondary hyperaldosteronism
Decreased intravascular volume - Dehydration - Edema → Increased renin - Hypotension
122
Who gets secondary hyperaldosteronism
Under 30, over 60 Not controlled w/ 2 HTN meds Characteristic findings or labs
123
Important findings in primary hyperaldosteronism
High BP Low K High aldosterone Low renin
124
Best initial test for primary hyperaldosteronism
Ratio of plasma aldosterone to renin
125
Most accurate test for primary hyperaldosteronism
High aldosterone from venous blood from adrenal showing unilateral adenoma
126
Rx primary hyperaldosteronism
Unilateral adenoma - resect | Bilateral hyperplasia - spironolactone/eplerenone
127
Spironolactone AE
Gynecomastia | Decreased libido
128
Pheochromocytoma rule of 10s
10% - Children - B/L - Malignant - Recur
129
Features of pheochromocytoma
Episodic HTN HA Sweating Palpitations and tremor
130
Best initial test pheochromocytoma
Plasma metanephrines
131
Alternate tests for pheochromocytoma
24hr urine metanephrines | VMA
132
When is MIBG scanning used
Locates pheochromocytoma outside of adrenal
133
Rx Pheochromocytoma
BIT - Phenoxybenzamine/phentolamine esp pre-op BBs, CCBs, IVF Surgical removal
134
What is DM
Fasting glc >125 on 2 occasions
135
Features of DM I
Childhood onset IDDM Insulin deficiency
136
Features of DM II
Adult onset NIDDM - resistance Obesity
137
DM presentation
Polyuria, Polydipsia | Decreased wound healing
138
Dx test for DM
Fasting glc >125 on 2 occasions separated by 1-2wks Glc > 200 w/ sx Increased glc on glc tolerance testing HbA1c >6.5
139
Best initial drug therapy for DM
Metformin
140
Goal of oral hypoglycemics
HbA1c
141
Mechanism of metformin
Block gluconeogenesis
142
Contraindication to glitazones
CHF
143
Contraindication metformin
Renal dysfunction | Can cause metabolic acidosis
144
Mechanism of nateglinide/repaglinide
Stimulate insulin release
145
Mechanism of alpha glucosidase inhibitors
Block glc absorption in the bowel
146
Mechanism of pramlintide
Decrease gastric emptying, glucagon, appetite
147
Glc in HHNS
1000s
148
Glc in DKA
400s-500s
149
Presentation of DKA
``` Hyperventilation Altered MS Metab acid Hyperkalemia Increased anion gap Ketones ```
150
Who gets DKA
I > II | Precipitated by infection, MI, stress
151
Rx DKA
High volume saline Insulin K when serum K NL
152
Most accurate measure of severity of DKA
Low serum bicarb
153
All DM pts should receive
``` Pneumococcal vaccine Yearly eye exam Statins - LDL >100 ACEi/ARB - BP > 130/80 Aspirin - age >30 Foot exam ```
154
CV complications in DM
MI Stroke CHF
155
Renal complications in DM
Microalbuminuria | Levels of albumin have elevated to 30-300 per 24hrs
156
Screening for microalbuminuria in DM
Yearly
157
Rx microalbuminuria in DM
ACE/ARB
158
Rx DM gastroparesis
Metoclopromide | Erythromycin
159
Retinopathy in DM
Proliferative retinopathy
160
Screening of DM retinopathy
I - 5yrs after dx, then yearly | II - yearly
161
Mechanism of neuropathy in DM
Damage to the vasonervosum
162
Rx DM neuropathy
Pregabalin Gabapentin TCAs

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