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Flashcards in Endocrine 6% Deck (112):
1

Primary Hyperparathyroidism =

MC cause =

excess (inappropriate) PTH production

Parathyroid Adenoma

2

MEN I

MEN IIa

MEN I = HyperPTH, Pituitary Tumors, Pancreatic Tumors

MEN IIa = HyperPTH, Pheochromocytoma, Medullary Thyroid Carcinoma

3

Secondary Hyperparathyroidism =

MC cause =

Increased PTH in response to hypocalcemia or vit D deficiency

Chronic kidney failure: d/t hyperphosphatemia --> increased ionized Ca, decreased renal production of active vit D

4

Primary hyperparathyroidism:
(Increased/decreased) DTR
(Increased/decreased) Ca
(Increased/decreased) PTH
(Increased/decreased) phosphate
(Increased/decreased) 24 hr urine calcium excretion
Increased/decreased) vit D

Primary hyperparathyroidism:
DECREASED DTR
INCREASED Ca
INCREASED PTH
DECREASED phosphate
INCREASED 24 hr urine calcium excretion
INCREASED vit D

5

Tx of primary hyperparathyroidism

Tx of secondary hyperparathyroidism

Primary: Parathyroidectomy

Secondary: Vit D, Ca supplementation

6

MC causes of hypoparathyroidism (2)

Postsurgical
Autoimmune

7

Hypoparathyroidism:
(Increased/decreased) DTR
(Increased/decreased) Ca
(Increased/decreased) PTH
(Increased/decreased) phosphate

INCREASED DTR
DECREASED Ca
DECREASED PTH
INCREASED phosphate

8

Hypocalcemia causes ____ on EKG.

Hypercalcemia causes ____ on EKG.

Hypo: Prolonged QT interval

Hyper: Shortened QT interval

9

Tx of hypercalcemia

Avoid ___

1st line: Loop diuretics (Furosemide)
Severe: Calcitonin, Bisphosphonates

HCTZ--> caused increased Ca

10

Elevated calcium, low PTC indicates ___

Secondary HYPERPTH --> malignancy

11

All pts should be screened for ____ with ____ for ____ before treating hyperparathyroidism

Familial benign hypoclaciuric hypercalcemia
24 hr urine for Ca and Cr

12

DiGeorge Syndrome

Features (3)

Congential cause of hypocalcemia

Parathyroid hypoplasia
Thymic hypoplasia
Outflow tract defects of heart

13

Avoid ____ in hypocalcemia

Phenothiazine
Furosemide

14

Thyroid stimulating Ab

Graves dz (hyperthyroidism)

15

Abs in Hashimoto's OR autoimmune thyroiditis

Antithyroid peroxidase Ab
Anti-Thyroglobulin Ab

16

Decreased radioactive iodine uptake

Thyroiditis

17

Diffuse radioactive iodine uptake

Grave's Dz
Pituitary Adenoma

18

Low TSH, Low FT4

(rare) 2ry/3ry hypothyroidism
Usually pituitary
Drugs: dobutamine, octreotride, high-dose glucocorticoids

19

Riedel's thyroiditis =
Presentation =
Tx =

Normal thyroid stroma replaced by fibrotic tissues

Painless fixed nodular that may grow rapidly

Steroids, tamoxifen, levothyroxine

20

Opthalmopathy w/ lid lag, exophthalmos/proptosis is exclusively seen in ___

Grave's Dz

21

Pretibial myxedema =
Seen in__

nonpitting, edematous, pink-brown plaques/nodules on shins

Grave's Dz

22

Methimazole and PropylThioUracil (PTU) used to tx ____
SE ____
Safe in pregnancy?

Grave dz, Toxic multinodular goiter (Plummer Dz)

SE: agranulocytosis, hepatitis --> monitor w/ CBC

PTU safe in pregnancy

23

Elevated TSH, High FT4

Presentation:
RAIU:

TSH secreting pituitary adenoma

Bitemporal hemianopsia

Diffuse uptake

24

MC therapy for Grave's Dz and Plummer Dz

Radioactive Iodine

25

Antimicrosomial Ab seen in

Hashimoto's Hypothyroidism

26

Post viral hypothyroidism =

Presentation =

Hallmark dx findings =

Tx =

De Quervain's (Granulomatous)

PAINFUL neck/thyroid
Clinical HYPERthyroidism --> hypothyroid

Increased ESR
NO thyroid Ab

Tx: Aspirin, NO anti-thyroid meds

27

Medications that may induce HYPOthyroidism

Amiodarone*
Lithium*
Alpha interferon

28

MC cause of hypothyroidism in US =
MC cause of hypothyroidism worldwide =

Hashimoto's

Iodine deficiency

29

Myxedema crisis =
MC in ___

Tx =

Extreme form of HYPOthyroidism

MC in elderly women w/ long standing hypothyroidism in cold weather

IV Levothyroxine
PASSIVE warming
Supportive

30

Best initial test to evaluate a thyroid nodule

Fine Needle Aspiration w/ Biopsy

31

MC type of benign thyroid nodule

Thyroid adenoma

32

MC type of thyroid carcinoma

Papillary

33

type of thyroid carcinoma MC associated w/ MEN2

Medullary

34

type of thyroid carcinoma MC after radiation exposure

MC in ___

Papillary

Young females

35

type of thyroid carcinoma MOST aggressive

MC in ___

Anaplastic

Males > 65 y/o

36

type of thyroid carcinoma w/ good prognosis

Papillary, Follicuar

37

type of thyroid carcinoma that commonly mets to local/cervical lymph nodes

Papillary

Early Medullary

38

type of thyroid carcinoma that commonly mets to distant areas via vascular invasion of lung, neck, brain, bone, liver, skin

Follicular

Late Medullary

39

____ used to monitor if residual dz present after tx or detect recurrence of MEDULLARY thyroid cancer.

Calcitonin levels

40

HYPERcalcemia stimulates ____

increased calcitonin secretion --> decreases blood Ca via decreased GI/kidney absorption and increased bone mineralization

41

Symptomatic tx of hyperthyroidism

beta blocker (propranolol)

42

IV methylprednisolone used to tx ___

Ophthalmopathy in hyperthyroidism

43

Ab that CAUSES hypothyroidism

Anti-TSH ab

Antiperoxidase, antithyroglobulin ab are disease markers

44

MC type of thyroid adenoma

Follicular

45

Osteopenia: T-score =

-1 to -2.5

46

Osteoporosis: T-score =

< -2.5

47

Recommended repeat DEXA scan scheduled based on T-score

-1.0 to -1.5: Q 5 years
-1.5 to -2.0: Q 3-5 years

48

Genetic mutation of type 1 collagen =

Associated w/:

Osteogenesis Imperfecta

Severe osteoporosis, *spontaneous fractures in childhood, *blue sclerae, *presenile deafness

49

Cystic brown tumors

Seen in renal osteodystrophy
NOT an actual tumor

Seen on biopsy d/t appearance of hemosiderin depositis

50

Osteitis Fibrosis Cystica d/t ___

Xray

d/t osteoclast activity from increased PTH in hypocalcemia in chronic kidney disease

Periosteal erosions
Bony cysts
"salt and pepper" appearance of skull

51

Looser lines (zones)

Rickets/Osteomalacia in Vit D deficiency

= transverse "pseudo fracture" lines

52

Osteomalacia:
(Increased/decreased) Ca
(Increased/decreased) Phosphate
(Increased/decreased) ALP

Decreased Ca
DECREASED phosphate
Increased ALP

53

Renal osteodystrophy:
(Increased/decreased) Ca
(Increased/decreased) Phosphate
(Increased/decreased) ALP

= osteomalacia and osteitis firbrosis cystica in pts w/ CKD
Decreased Ca
INCREASED phosphate
Increased ALP

54

3 zones of adrenal gland and what they produce

Zona Glomerulosa (outer) --> aldosterone
Zona Fasciculata (middle) --> cortisol
Zona Reticularis (inner) --> androgen/estrogen

55

Addison's Disease =

Deficiency in ____

(Hyper/hypo)natremia
(Hyper/hypo)kalemia
(non/anion gap)metabolic (acidosis/alkalosis)
(Hyper/hypo)glycemia

PRIMARY adrenocortical insufficiency --> adrenal gland destruction

cortisol AND aldosterone

HYPOnatremia
HYPERkalemia
NON anion gap metabolic ACIDOSIS
HYPOglycemia

56

2ndary adrenal insufficiency

MC cause =

Deficiency in ____

PITUITARY failure of ACTH secretion

MC caused by exogenous steroid

LOW cortisol, NORMAL aldosterone

57

Dx of chronic adrenocortical insufficiency

1st: High dose ACTH (Cosyntropin) Stimulation test --> adrenal insufficiency --> little/no increase in cortisol levels

2nd: CRH stimulation test: Differentiates causes -->
Primary/Addision: High ACTH, LOW cortisol
Secondary (pituitary): Low ACTH, Low cortisol
Teritary (hypothalamus): delated, prolonged, exaggerated ACTH response

58

Tx of Addison's

Glucocorticoid + mineralocorticoid =
Hydrocortisone + fludrocortisone

59

MC cause of Adrenal (addisonian) Crisis

Presentation

Tx

Abrupt withdrawal of glucocorticoids

Shock, hypotension, hypovolemia

Normal saline
Dexamethasone (undiagosed) or Hydrocortison (addison's)
Fludrocortisone

60

SCREENING tests for dx of Cushing's Syndrome (Hypercortisolism)

LOW-dose Dexamethasone Suppression test --> NO suppression = Cushing's syndrome

Increased 24 hr urinary free cortisol

Increased salivary cortisol levels (night time)

61

DIFFERENTIATING tests for causes of Cushing's Syndrome

HIGH dose Dexamethasone Suppression Test -->
Suppression = Cushing's disease
NO suppression = adrenal or ectopic ACTH producing tumor

ACTH levels -->
Decreased ACTH = adrenal tumor (b/c produce high levels of cortisol --> suppress ACTH levels via HPA axis)
Normal/increased ACTH = Cusing's disease or ectopic ACTH producing tumor (b/c secrete ACTH independent of HPA axis)

62

Cushing's Disease =

Cushing's syndrome caused by PITUITARY increased ACTH secretion

HYPERcortisol

63

Cushing's disease tx:

Ectopic/adrenal tumor tx:

Cushing's: Transsphenoidal sx

Ectopic/adrenal tumor: tumor removal. Ketoconazole if inoperable

64

Primary hyperaldosteronism caused by =
Is renin (independent/dependent)

Idiopathic
Idiopathic bilateral adrenal hyperplasia (60%)
Conn Syndrome = Adrenal aldosteronoma

Renin INDEPENDENT

65

Secondary hyperaldosteronism caused by =
Is renin (independent/dependent)

Renal artery stenosis
Decreased renal perfusion (CHF, hypovolemia, nephrotic syndrome)

Renin DEPENDENT: Increased Renin --> increased aldosterone via RAAS

66

Hyperaldosteronism:
(Hyper/hypo)kalemia
(Hyper/hypo)tension
Metabolic (alkalosis/acidosis)

HYPOkalemia
HYPERtension: DBP more elevated than SBP
Metabolic ALKALOSIS (d/t dumping of K+ and H+ in exchange for Na+)

67

Screening test for Hyperaldosteronism

Primary aldosteronism:
ARR = ___ ; plasma aldosterone = ___ ; (high/low) plasma renin

Aldosterone:Renin ratio

Primary: ARR > 20, plasma aldosterone > 20, LOW plasma renin

High plasma renin = 2ndary

68

Conn's syndrome tx

Excision of adrenal aldosteronomas + spironolactone

69

Adrenal hyperplasia hyperaldosteronism tx:

Spiranolactone, ACEI, CCB

70

Pheochromococytoma = ____ secretes ____

Presentation:

Dx:

Tx:

Catecholamine-secreting adrenal tumor; Norepinephrine, epinephrine

Palpitation, HA, Excessive sweating
HTN

Increased 24 hr urinary catecholamines including metabolites (metanephrine, vanillylmandelic acid)

Complete adrenalectomy
Preoperative nonselective alpha blockade (phenoxybenzamine, phentolamine x 7-14 days) --> beta blockers/CCB

**DO NOT initiate BB before alpha blockade

71

T/F: Transsphenoidal sx is 1st line tx of prolactinomas.

False: medical tx for prolactinomas. Cabergoline OR bromocriptine (dopamine agonists inhibit prolactin)

TSS for Active or compressive pituitary tumors EXCEPT prolactinomas.

72

Tx of Acromegaly

Transsphenoidal sx + Bromocriptine (dopamine agonist --> decreases GH production)

Octreotride: somatostatin analogue that inhibits GH secretion

73

Gold standard of dx for DM

Other dx of DM

Fasting plasma glucose >126 mg/dL

HA1C >6.5%
Plasma glucose >220
GGT: 2 hr plasma glucose >200

74

Gold standard of dx for gestational DM

3hr oral glucose tolerance test
Plasma glucose > 200 mg/dL

75

Screening of DM recommended for:

Pts >45 y/o w/ BP > 135/80
Younger adults w/ BMI >25
>1 additional RF: FHX, low HDL, Polycystic ovarian syndrome, NON-caucasian

76

1st sign of diabetic nephropathy

Microalbuminuria

77

Kimmelstiel-Wilson

Nodular glomerulosclerosis; pink hyaline material* around glomerular capillaries

Seen in DM

78

Type of insulin:
Lispro (Humalog)
Aspart (Novolog)

Insulin coverage?
Onset? Peak? Duration?

Rapid-acting

Given at same time of meals

Onset: 5-15 min
Peak: 1 hr
Duration: 3 hrs

79

Type of insulin:
Ultralente (U)
Insulin Glargine (Lantus)
Detemir (Levemir)

Insulin coverage?
Onset? Peak? Duration?

Long acting

Covers insulin 1 full day (basal insulin)

Onset: 6-8 hr
Peak: 12-16 hr
Duration: 20-30 hrs

80

T/F: Lantus (insulin glargine) causes more hypoglycemic episodes than NPH.

T/F: Lantus should not be mixed with other types of insulin

False. Causes less.

True.

81

Type of insulin:
REgular (humulin-R)

Insulin coverage?
Onset? Peak? Duration?

Short-acting

Given 30-60 mins prior to meals

Onset: 30 min-1 hr
Peak: 2-3 hr
Duration: 4-6 hrs

82

Type of insulin:
NPH
Lente

Insulin coverage?
Onset? Peak? Duration?

Intermediate

Overs 1/2 day (or overnight)

Onset: 2-4 hrs
Peak: 4-12 hrs
Duration: 16-20 hrs

83

Dawn phenomenon =
d/t ___

Management:

Normal glucose until 2-8 am when it rises
d/t decreased insulin sensitivity and nightly surge of counter regulatory hormones

Bedtime injection of NPH
Avoid carbohydrate snake late at night

84

Somogyi effect =
d/t ___

Management:

nocturnal hypoglycemia followed by rebound hyperglycemia
d/t surge in growth hormone

Decrease nighttime NPH dose
OR give bedtime snack

85

Insulin waning =

Management:

Progressive rise in glucose from bed to morning

Move insulin dose to bedtime or increase dose

86

Biguanides =
MOA:
SE:

T/F: Causes hypoglycemia and weight gain.
T/F: Decreases HDL

Metformin, Phenformin

MOA:
- decrease hepatic glucose production **
- increase peripheral glucose utilization **
- decrease GI intestinal glucose absorption
- increase insulin sensitivity

SE:
- Lactic acidosis* --> do not give in hepatic/renal impaired pts
- Macrocytic anemia
- Metallic taste

False: Does not effect pancreatic beta cells
False: Decreases triglycerides

87

Tolbutamide, Chlorpropramide
Glipizide, Glyburide, Glimepiride =

MOA:
SE:


Sulfonylureas (1st gen, 2nd gen)

Stimulates pancreatic beta cell insulin release

SE:
- Hypoglycemia**
- Disulfuram reaction (sulfa allergy)
- Weight gain
- Cardiac dysrhythmias

88

Repaglinide, Nateglinnide =

MOA:
SE:

Meglitinides

Stimulates pancreatic beta cell insulin release

SE:
- Hypoglycemia (< sulfonylureas)
- Weight gain

89

Acarbose, Miglitol =

MOA:
SE:
Caution in pts w/ ___

Alpha-glucosidase inhibitors

Delays intestinal glucose absorption
Inhibits pancreatic alpha amylase and intestinal alpha-glucosidase hydrolase
- Does NOT affect insulin secretion

SE:
- Hepatitis (increase LFTs)
- Flatulence, diarrhea, abd pain
- Caution in pts w/ gastroparesis, IBD

90

Pioglitazone, Rosiglitazone =

MOA:
SE:

Thiazolidinediones

Increase insulin sensitivity at peripheral receptor site adipose and mm.
-NO effect on pancreatic beta cells

SE:
- Fluid retention, edema**
Cardiovascular toxicity w/ Rosiglitazone (MI)**
Hepatotoxicity, Bladder CA, Fractures

91

Exenatide, Liraglutide =

MOA:
SE:
CI in:

Glucagon-like peptide 1 (GLP-1) Agonists

-Lowers bloos sugar by mimicking incretin
- Increase insulin secretion, decrease glucagon secretion
- Delays gastric emptying

SE:
-Hypoglycemia
- Pancreatitis

CI if h/o gastroparesis*

92

Sitagliptin (Januvia), Linagliptin =

MOA:
SE:

DPP-4 Inhibitor

Inhibitior of degradation of GLP-1

SE:
-Pancreatitis
-Renal failure
-GI sx

93

Canagliflozin, Dapagliflozin =

MOA:
SE:

SGLT-2 Inhibitor
(SGLT = Sodium-glucose transport)

-Lowers renal glucose threshold --> Increase urinary glucose excretion **

SE:
-Thirst, Nausea, Abd pain, UTIs

94

(Hyper/hypo)kalemia is DKA and HHS

HYPOkalema

*Despite serum K levels, patient is always total body potassium deficient

95

MEN1 =
MEN2a =
MEN2b =

MEN1 = Parathyroid, Pancreas, Pituitary

MEN2a = Medullary thyroid carcinoma, Pheochromocytoma, Hyperparathyroidism

MEN2b = Medullary thyroid carcinoma, Pheochromocytoma, Neuromas/Marfanoid

96

Gene involved in MEN1:

Gene involved in MEN2:

MEN1: menin gene

MEN2: RET proto-oncogene

97

Necrolytic migratory erythema associated w/ ___

Glucagonomas (MC @ head of pancreas)

Seen in MEN1 (pancreatic tumor)

98

MC presenting feature of MEN1

Hyperparathyroidism

(vs. MEN2a)

99

MC presenting feature of MEN2

Medullary thyroid carcinoma

100

VIPomas =

Presentation:

Vasoactive INtestinal peptide tumors

Watery diarrhea, HYPOkalemia, Achlorhydria
Hypovolemia
Dehydration

Seen in MEN1 (pancreatic tumor)

101

USPSTF recommends screening for hyperlipidemia in ____.

National Cholesterol Education Program recommends screening for hyperlipidemia in ____.

35 y/o if no evidence CVD and no other RF

20 y/o regardless of RF

102

Monitor recurrence of papillary thyroid cancer with ___

Neck US
Whole body scan
Serum thyroglobulin

103

Tx of choice for multinodular goiter

Iodine ablation

104

Type 1 DM may present with ____abs

Beta cell ab: insulin ab, glutamic acid decarboxylase
Islet cell ab

105

Catecholamines are synthesized in ____

adrenal medulla

106

Low testosterone w/ low gonadotropin (LH/FSH) suggests ___

secondary hypogonadism = pituitary and/or hypothalamus dysfunction

107

Low testosterone w/ elevated gonadotropin (LH/FSH) suggests ___

Primary hypogonadism (testicular dysfunction)

108

SE of carbamazepine include ____

SIADH --> enhance release/potentiate effects of ADH

109

Tx of Paget disease of bone

Bisphosphate*
Tiludronate

110

Screening dx of gigantism and acromegaly w/ ____.

Insulin-like growth hormone factor 1 (IGF-1)

GH is pulsatile --> bad for random level check

111

Pts w/ DM1 w/ recurrent hypoglycemic spells and goor glycemic control despite attention to dietary intake and insulin administration should be evaluated for ___

Celiac disease

Kids w/ DM1 commonly have coexisting Celiac disease

112

Orthostatic hypotension w/o compensatory increase in heart rate when BP decreases is indicative of ____. MC caused by ___.

Sympathetic autonomic dysfunction

Diabetic autonomic neuropathy