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Endocrine Flashcards

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1
Q

LH/FSH deficiency in MWB

A

M: no T/no sperm/ED/lower muscle mass
F: amenorrhea
B: decreased libido/decreased body hair

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2
Q

Kallman syndrome

A

Decreased GnRH leads to decreased FSH and LH
Anosmia
Renal Agenesis in 1/2

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3
Q

2 electrolytes that inhibit ADH’s effects

A

HyperCa

HypoK

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4
Q

How do you distinguish central and nephrogenic DI

A

Central: corrects with vasopressin
Nephrogenic: responds to correction of underlying cause

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5
Q

Cause of death in acromegaly

A

CHF and cardiomegaly

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6
Q

3 tests for acromegaly

A

Initial: IGF1
Accurate: glucose suppression test
Additional: Prolactin (consecrated with GH - increase causes ED)

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7
Q

Specific acromegaly medication

A

Pegvisomant: GH receptor antagonist inhibiting IGF release from the liver

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8
Q

What other hormone changes with hypothyroidism?

A

Prolactin increases

1) low thyroid levels
2) extremely high TRH
3) prolactin secretion

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9
Q

Meds that raise prolactin level

A

Verapamil, Antipsychotics, methyl dopa, metoclopramide, opioids, TCAs

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10
Q

What do you never do first with endocrine disorders

A

MRI the head!

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11
Q

What tests do you order after confirming a high prolactin (4 + bonus)

A

TFTs
Pregnancy test
BUN/Creatinine (renal disease raises prolactin)
LFTs (cirrhosis raises prolactin)
*MRI once level confirmed + not pregnant + 2ndary causes excluded

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12
Q

3 causes of hypothyroidism

A

Hashimotos&raquo_space; iodine deficiency = amiodarone

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13
Q

What is the one process not slowed in hypothyroidism

A

Menstrual flow (actually increases)

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14
Q

If very high TSH and normal T4, how do you treat

A

Hormone replacement

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15
Q

If TSH is mildly elevated, how do you treat

A

Get antibody tests and replace thyroid hormone if they are positive

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16
Q

Thyroid abnormality tests

A

Initial: TSH

Suppressed TSH?: free T4

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17
Q

Hyperthyroidism with tender thyroid?

A

Subacute thyroid itis

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18
Q

High thyroid hormone with nonpalpable gland?

A

Exogenous use

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19
Q

Treating acute hyperthyroidism

A

Propranolol (blocks target organ effect/inhibits peripheral conversion)
MMU>PTU
Steroids (esp for eyes)

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20
Q

Next step after finding a mass on the thyroid?

A

Measure T4 and TSH (cancer is not hyper functioning)

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21
Q

What size thyroid nodule requires a biopsy

A

> 1cm needs FNA

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22
Q

Most common cause of high calcium

A

Hyperparathyroidism

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23
Q

Cardiovascular concerns with high calcium?

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A

Short QT syndrome and HTN

24
Q

Treating high calcium

Study These Flashcards
A

1) saline hydration
2) bisphosphonates (pamidronate, zoledronic acid)
3 if BPs fail) Calcetonin
4 if sarcoidosis) prednisone

25
HyperPTH causes
Adenoma >>> hyperplasia of all 4 glands >> cancer
26
High PTH presents with high calcium and...
Low Phopshate
27
Causes of low calcium
Prior neck surgery >> hypomagnesium (needed to release PTH) > renal failure
28
What is the effect of low albumin on calcium
Decreases total calcium but free calcium stays normal (thus no symptoms)
29
EKG and eye findings of low calcium
Long QT | Early cataracts on slit lamp exam
30
Prolactin deficiency in men Sx
None!
31
High cortisol causes
Pituitary acth >>> adrenals > ectopic > unknown ACTH
32
Initial test for high cortisol (1st and 2nd choices)
24 hour urine cortisol (more specific) > 1mg overnight dex suppression test (false positive risk)
33
What is the next step if ACTH is elevated and does not suppress?
Brain MRI
34
Why do you not start with imaging the pituitary if you suspect a cortisol issue?
>10% of people have a pituitary abnormality on MRI, so you may be removing the pituitary when the Adrenals are the problem
35
What tests do you order if you find an asymptomatic adrenal lesion on imaging?
metanephrines (rule out Pheo) Renin/aldosterone (rule out hyperaldosteronism) 1mg overnight dex suppression test
36
How does acute adrenal crisis present?
Profound hypoTN, fever, confusion, coma
37
What is the most specific test of adrenal function
Cosyntropin (synthetic ACTH) --> should cause rise in cortisol if adrenals work
38
How do you treat a patient with suspected acute adrenal insufficiency?
Hydrocortisone (and then draw cortisol level to confirm)
39
Most common causes of primary hyperaldosteronism
Solitary adenoma >>> bilateral hyperplasia >> cancer
40
Testing for hyperaldosteronism
Initial: plasma renin to aldosterone ratio Accurate: sample venous blood from adrenal for aldosterone level
41
Initial treatment of a pheochromocytoma
Phenoxybenzamine (alpha blocker)
42
Testing for Pheo
Initial: plasma free metanephrines Confirmatory: 24 hour urine metanephrines
43
Diabetes dx criteria
2 fasting glucose levels >125 Single glucose of >200 with symptoms Increased glucose level on oral tolerance testing Hba1c >6.5 (best criteria to follow)
44
Goal of dm treatment
Hba1c
45
Metformin contraindication
Renal failure patients (can accumulate and cause metabolic acidosis)
46
Sitagliptin/ -gliptin
DPP-IV inhibitors: block incretin metabolism (GIP/GLP) --> insulin release is inhibited and glucagon release is maintained
47
Exanatide/ -glutide
Incretin mimetics need to be injected Slow gastric motility -- weight loss!
48
Glitazones
TZDs: no clear benefits, contraindicated in CHF because they increase fluid overload
49
Nateglinide/ -glinide
Insulin stimulators
50
Acarbose/Miglitol
Alpha glucosidase inhibitors: block glucose absorption in the bowel Decrease hba1c by .5 Cause stomach issues
51
Pramlintide
Amylin analog: decreases gastric emptying + decreases glucagon levels + decreases appetite
52
Insulin formulations and durations
``` Lispro/Aspart/Glulisine = peak @ 1, duration 3 hours Regular = peak @ 2, duration 6-8 NPH = peak @ 6, duration 10-20 Glargine = peak @ 1, duration 24 ```
53
How do you best measure the severity of DKA
Serum bicarbonate (if low the AG is high which is bad)
54
Diabetes health maintainance
Pneumococcal vaccine Yearly eye exam for proliferative retinopathy Statin if ldl is >100 ACE/ARB if BP > 140/90 or positive urine microalbumin ASA if >30 years old Foot exam
55
How do you treat diabetes induces gastroparesis
Metoclopramide and erythromycin
56
How do you treat diabetes induced proliferative retinopathy
Laser photocoagulation
57
How do you treat the pain of diabetic neuropathy
Pregabalin/gabapentin/TCAs

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