Endocrine Flashcards by Shannon Payseur

USPSTF recommends screening for colon cancer using three different methods for which age groups?

Annual high sensitivity fecal occult blood testing

Sigmoidoscopy every 5 years

Colonoscopy every 10 years

Screen persons 50-75years old

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The USPSTF guidelines recommend that asymptomatic adults with sustained blood pressure greater than 135/80mmHg be tested for

Type 2 diabetes using fasting plasma glucose

2-hour glucose Toler test

Or hemoglobin A1c

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First test to be performed on a patient who presents with a palpable thyroid nodule

Thyroid ultrasound

TSH

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Ultrasound can help detect clinically inapparent nodules and characteristics of cancer. What are high risk characteristics

Microcalcifications, hypoechogenicity, a solid nodule, a nodule more tall than wide, chaotic intranodular vasculature. fNA indicated two in a nonpalpable nodule

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If a TSH is depressed and the ultrasound shows a solitary nodule or multinodular what test can be performed to make the diagnosis

Radioactive iodine uptake

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If the nodule is hot it confirms the presence of

Hyperfunctioning adenoma benign no FNA

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Increased uptake on RAIU in a diffuse heterogeneous pattern is indicative of

Toxic multinodular toxic goiter

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If the TSH is normal or elevated in patient with palpable nodule what test to make diagnosis

Fine needle aspiration

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An FNA positive nodule is malignant management?

Refer

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A FNA negative nodule is benign, management?

Observe with yearly clinical and sonographic examinations

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FNA suspicious nodule management?

REFER

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Nondiagnostic FNA nodule

REFER

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Thyroid nodule palpated first test to perform

Thyroid ultrasound

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Thyroid ultrasound performed reveals single nodule if TSH suppressed what test makes the diagnosis

Radioactive iodine scan

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Nodule with cold uptake on RAIU. Management?

perform FNA

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Pt has palpable nodule. You perform thyroid ultrasound identify single nodule TSH is elevated or normal management?

Perform FNA

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Palpable nodule thyroid ultrasound performed reveals multinodular goiter. TSH SUPPRESSED management?

Perform radioactive iodine scan -diffuse heterogeneous uptake BENIGN. FNA unnecessary

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Patient presents with history of viral illness a few weeks prior to visit complains feeling better but then anterior neck pain/sore throat profuse sweating palpitations now exhausted and constipated. DX?

Subacute granulomatous thyroiditis

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Treatment of subacute thyroiditis?

Thyroid is firm nodular and tender RAIU decreased ⬆️thyroglobulin ⬆️esr

Treat and reassure patient thyroid function will normalize in a few weeks

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In hypothyroidism systemic vascular resistance increase causing ?

Rise in diastolic blood pressure

Other signs- ⬆️LDL cholesterol, reduced exercise tolerance

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What is starting dose replacement once hypothyroidism is diagnosed

Synthetic thyroxine 1.6 mcg/kg per day

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When should TSH be rechecked after initiating therapy

4-6 weeks

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Elderly patients with diagnosis hypothyroidism should be treated at what starting dose?

25-50mcg/day

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Hashimotos the most common cause of hypothyroidism is due to?

Antibody and cell mediated destruction of the thyroid gland

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Patient presents slightly elevated TSH and normal T4. DX?

Subclinical hypothyroidism

Pt presents low TSH and elevated T4 scan: diffuse increased uptake most likely DX?

Graves' disease

Female patient taking contraceptive meds presents c/o irregular menses TSH normal but total T4 elevated Why?

Elevated thyroid binding globulin (TBG)

TBG is elevated in persons with increased levels of?

Circulating estrogen

After hyperthyroidism is confirmed with TSH , what is next most appropriate test to deteriorate underlying etiology?

Radioactive iodine uptake scan

What is treatment of choice for adults with Graves' disease?

Radioactive iodine ablation

What is treatment of choice children and adolescents with hyperthyroidism

Antithyroid drugs PTU, and methimazole

In elderly patient who becomes depressed consider?

Hypothyroidism CHECK TSH

Patients with fruity breath are ketotic and likely have DKA. These patients are usually dehydrated initial treatment?

Large volume IV fluid with isotonic fluids like normal saline

To minimize risk of cerebral edema, lowering of blood glucose should be done no faster than what rate per hour

80 mg/dL

DM is associated with autoimmune disorders like

Hashimotos hypothyroidism, onset usually late adolescence or childhood

Islet cell antibodies are found in what percentage of cases of type 1 diabetes

90%

Goals to reduce macrovascular complications in diabetics

LDL40 men, >50 women, triglycerides

Fluid deficit in DKA is often

6 to 8 L

In DKA the initial fluid replacement should be

Normal (0.9%) saline unless severe hypernatremia

In DKA potassium levels should be monitored frequently during initial treatment phase how?

Every hour at first then every 2-4 hours

In at patient with acute DKA but otherwise organ function, serum potassium concentration is 4 to 5 mEq/L, ivf changes

Add 20-40mEq/L of potassium chloride to IVF

Sulfonylurea that increases insulin sensitivity in the peripheral tissues - causes hypoglycemia in the elderly

Glimepiride ( amaryl | Glyburide

Oral hypoglycemia agent that inhibits gluconeogenesis, decreases production of glucose, decrease rate of glucose absorption, and increases glucose uptake in the periphery

Biguanides (metformin,i.e. Glucophage COMPLICATION lactic acidosis

Two advantages of metformin

1) should not induce | 2) does not promote weight gain

Oral hypoglycemic agent decreases insulin resistance and inhibits liver gluconeogenesis

Thiazolidinediones like Avandia ( rosiglitazone, Actos (pioglitazone) assoc ⬆️liver enzymes, jaundice, contraindicated HF

Nonsulfnylureas benzoic acid derivative works by stimulating insulin release from the pancreas, very short half life

Meglitinides like Prandin (repaglinide ) and starlix (nateglinide

DPP-4 inhibitors like sitagliptin and saxagliptin work by

Increasing incretin which inhibits glucagon release thereby increasing insulin secretion through pancreatic alpha and beta cell stimulation main side effect headache, nausea

Potent antioxidant that enhances glucose uptake and prevents glycosylation of tissues 600mg daily improves diabetic neuropathy

Alpha lipoic acid

How much fish oil is required to lower triglycerides

4g omacor is a high quality and concentrated prescription source of omega 3 fatty acids

This supplement has been shown to reduce progression of macular degeneration

Lutein

Maximal dose of Vit A for retinal function

10,000 units per day

Average insulin doses

0.6-0.8 units/kg of body Weight per day

Glargine insulin is very long acting should be given

Once daily often in the evening or at bedtime

How to calculate starting dose of insulin

Morning 2/3 total daily dose Evening 1/3 total daily dose Morning 2/3 intermediate, 1/3 regular Evening 2/3 intermediate 1/3 regular

Because of high rate recurrence initial treatment prolactinoma

Bromocriptine

This level serum prolactin is almost always the result of a pituitary adenoma in the abscence of pregnancy

300ng/mL

Imaging scan of pituitary gland to confirm confirm diagnosis

MRI with gadolinium

Combination symptoms of gallactorrhea amenorrhea decrease libido, infertility, bitemporal hemianopsia is indicative of

Prolactinoma

Acromegaly is almost always a result of growth hormone excess caused by

Pituitary adenoma

Treatment of acromegaly

Treatment of choice- transsphenoidal pituitary microsurgery | Cabergoline, growth hormone receptor blockers like pegvisomant

Symptoms of hyperpigmentation weakness weight loss and hypotension is indicative of

Addison's disease

Lab findings of hyponatremia, hyperkalemia, hypercalcemia, increased plasma ACTH, decreased serum cortisol are indicative of

Addisons disease

Most common cause of Addison disease

Autoimmune destruction of the adrenal gland

Treatment of choice Addison disease

Dexamethasone sodium phosphate 4 mg every 12 hours or hydrocortisone 100mg IV every 6 hours

The chronic treatment of Addison disease

Combo fludrocortisone (0.05-0.3mg/day) and hydrocortisone 15-25mg/day)

Nephrogenic ( the collecting tubules of the kidneys are unresponsive to ADH produced) diabetes insipidus is usually caused by

Drugs- lithium and amphotercin B

Treatment nephrogenic diabetes insipidus

Stop offending drug

Treatment central diabetes insipidus

Desmopressin either intranasally or orally

Clinical signs of Conns disease | Lab signs- metabolic alkalosis,low renin,

Weakness, hypertension, polydipsia, polyuria, hypokalemic, , increased urine potassium

Treatment of Conn syndrome ;primary hyperaldosteronism,is the result of excess mineralcorticoid production from a unilateral adenoma of the adrenal cortex

Laparoscopic removal adenoma | Or if result of bilateral hyperplasia adrenal glands- spironolactone

Most common cause of Cushing's syndrome is corticosteroid therapy, if yo exclude steroids most common cause

Pituitary adenoma

Metastatic malignant disease is most likely to mimic

Hyperparathyroidism

Recommended treatment for Cushing's

Surgery to remove pituitary adenoma

Best lab test Cushing's

Serum cortisol, low dose dexamethasone suppression test ( in Cushing's no suppression) 24h free urine cortisol Confirm- high dose 8 mg dexamethasone suppression test ( suppresses pituitary adenoma but NOT adrenal Cushing's)

Renal stones most common symptomatic presentation salt pepper skull personality changes

Hyperparathyroidism

Treatment of choice Graves' disease

Radioactive iodine

Drugs of choice treatment Graves' disease

PTU, methimazole, beta blockers | Methimazole much safer than PTU

PTU now second line treatment graves except

Pregnancy and lactation Add 2 more pills per week Keep below2.5

Treatment of choice Graves' disease during pregnancy 1st trimester? 2nd-3rd trimester?

1sr trimester PTU | 2nd trimester switch to methimazole

Treatment Graves' disease if breastfeeding

PTU

Most common type of thyroid cancer

Papillary

For multinodular thyroid cancer more accurate test test than FNA

Dynamic contrast medium enhanced MRI (DCE-MRI)

Difference between primary nod secondary male hypogonadism

Gonadotropin elevated primary ⬆️ LH, FSH, low testosterone no sperm count Secondary ⬇️ gonadotropin, sperm count, testosterone

Primary Hyperparathyroidism is most commonly caused by? Treatment?

Adenoma of parathyroid Treat with surgical parathyroidectomy

Current guidelines recommend screening patients with stage IV chronic kidney disease for

Serum calcium and phosphate levels every 3-6 months and bone specific alkaline phosphatase activity every 6-12 months

Half patients with a GFR

Hyperparathyroidism

Metformin is contraindicated in patients with a creatinine level

Stop metformin when creatinine >1.5

."A 25-Year-Old Man with “Visual Problems- visual field defects,” Headaches, Weight Gain, Sweating, and “enlarging Hands and Feet Gland? Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson's Family Medicine Review.” Saunders, 2013. iBooks. This material may be protected by copyright. Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=573666697

- Acromegaly a tumor in the pituitary that increases growth hormone Pituitary

Tumor that leads to excess prolactin, the hormone that stimulates production of breast milk? Pt presents complaints abnormal lactation, infertility, headache, decreased sexual interest Gland?

Prolactinoma Pituitary gland

Patient with weight loss, fatigue, muscle weakness, low blood pressure Gland?

Addison when the adrenal glands produce too little cortisol Adrenal Skinny Addison adrenal is low pressure low ?"cort "

Patient with fluid retention, high blood pressure weak, muscle spasms Gland?

Hyperaldosteronism when the adrenal glands produce too much aldosterone Adrenal Hyper Aldo adrenal is high pressure and spasms cause he's holding his pee

Patient presents with complaints of fatigue, and osteoporosis Gland Disorder

Parathyroid gland Hyperparathyroidism is when parathyroid produces too much PTH

Possible disorders of the adrenal gland

1) Addison too lit tittle cortisol 2) hyperaldosteronism 3) Cushing's