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Flashcards in Endocrine Deck (162):
1

Causes of panhypopituitarism

Anything that damages the brain
- Tumor
- Infection
- Trauma
- Stroke

2

In what order are hormones lost in the pituitary

GH, and LH, FSH first
ACTH last

3

Results of LH, FSH deficiencies

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

4

Kallman syndrome points

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

5

Presentation of GH deficiency

Children - Short stature
Adults - Central obesity, Increased LDL, chol, Reduced lean muscle

6

Features of pituitary apoplexy

Prior adenoma
HA
Changing MS
Send to ICU for hormone replacement

7

What is Sheehan

Postpartum pituitary necrosis
Can't lactate

8

Confirmatory test for low TSH and thyroxine

Decreased TSH response to TRH

9

Confirmatory test for decreased ACTH and cortisol

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

10

Confirmatory test for Low GH

No response to arginine
No response to GHRH

11

Confirmatory test for low prolactin

No response to TRH

12

Failure of GH to rise in response to insulin

Pituitary insufficiency

13

What does metyrapone do

ACTH levels rise

14

Hormonal problems in empty sella

NONE

15

What is diabetes insipidus

Decrease in ADH amount or function on kidneys

16

Causes of central DI

Any destruction
- Stroke
- Trauma
- Hypoxia
- Infiltration

17

Causes of nephrogenic DI

Chronic pyelo
Amyloidosis
Myeloma
Sickle cell

18

Drugs inducing NDI

Li
Demeclocycline
Colchicine

19

Metabolic changes inducing NDI

Hypercalcemia
Hypokalemia

20

Presentation of DI

High volume urine
Excessive thirst
Volume depletion
Hypernatremia

21

What causes neuro sx in SI

Hypernatremia

22

What does water deprivation test show in DI

Urine osmolality doesn't increase

23

Vasopressin effect in CDI

Decrease urine volume
Increase urine osmolality

24

Vasopressin effect in NDI

Nothing

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