Flashcards in Endocrine Deck (78):
MRI incidentally finds no pituitary, diagnosis and tx?
Empty sella syndrome (benign) - reassurance (no tx needed - they still have a pituitary its just not located in the sella)
Best diagnostic test for prolactinoma? First test when you suspect prolactinoma?
MRI; TSH/fT4 (then you get prolactin levels)
Pregnancy, bloody delivery, altered mental status, hypotension, dx?
First line therapy for prolactinomas?
Dopamine agonists (cabergoline > bromocriptine)
What test do you get first for suspected acromegaly?
ILGF-1 (NOT growth hormone!!)
Galactorrhea and amenorrhea, dx?
prolactinemia (likely a prolactinoma)
Wide-spaced teeth, rings that don't fit, hats too small, dx?
Has a pituitary mass, suddenly goes altered and hypotensive, dx?
Apoplexy (tumor outgrows blood supply and pituitary undergoes necrosis)
Best test for acromegaly? What's the order of three tests you would order?
MRI; ILGF-1, glucose suppression test (expect GH to go down if normal), MRI
Patients with acromegaly undergo cardiomegaly and __ heart failure. They also commonly develop __ (metabolic disorder)
Acute pan hypopituitarism presents with these 4 symptoms due to __. Treat by __. Commonly caused by infxn, infarction, iatrogenic (surgery/radiation)
lethargy and coma due to decreased TSH; hypotension and tachycardia (due to decreased cortisol and reflex tachy); replacing hormones
Chronic pan hypopituitarism presents with __ and __. You diagnose it with __ and __. Tx by __. Commonly cause by autoimmune, deposition, cancer.
decreased libido (changes in menstruation) and decreased growth (chronic affects GH/FSH/LH since body sacrifices those to keep TSH and ACTH up); insulin stiulation test (growth hormone fails to rise) and MRI; Tx by replacing hormones and reversing underlying cause
Water deprivation test corrects with restricting water, diagnosis?
Treatment for central diabetes insipidus?
Intranasal desmopressin (DDAVP)
Water deprivation tests fails to correct with ADH, what is diagnosis?
Water deprivation test corrects with ADH administration, dx?
How do you tx SIADH?
Water restrict, fix the underlying condition
How do you treat the Na in refractory SIADH?
demeclocycline, which induces nephrogenic diabetes insipidus
Thyroid nodule in a pt with weight loss, heat intolerance, and increased DTRs - what's next step?
Get a TSH (probably not cancer)
Thyroid nodule with a low TSH - next step?
RAIU (radioactive iodine uptake test)
Medullary thyroid cancer - what should you associate with it (4)?
Calcitonin, C-cells (which produce calcitonin), MEN2A/2B, RET oncogene
Thyroid nodule with a normal TSH - next step?
Ultrasound (same for high TSH)
What is the thyroid nodule size on ultrasound that automatically goes to FNA?
Size greater than 1 cm
Pathology shows orphan annie nuclei, diagnosis?
Papillary thyroid cancer
Thyroid nodule + hx/o radiation to head and neck, what's next step?
Thyroid nodule with a low TSH, "hot" nodule on RAIU - what's the next step?
Treat hyperthyroidism (no biopsy)
Thyroid nodule with a low TSH, no hot nodule on RAIU - next step is?
U/S (then FNA, but first u/s)
What's the treatment for metastatic follicular carcinoma?
Which thyroid tumor has hematogenous spread? Which is locally invasive? Which has psammoma bodies? Which causes hypocalcemia?
follicular; anaplastic; papillary; medullary
MEN 1 tumors? Inheritance?
pancreas (endocrine tumors), pituitary, parathyroid; AD
MEN2A tumors? Gene?
Pheochromoctyoma + Medullary thyroid
+ Parathyroid; RET oncogene
MEN2B tumors? Gene?
Pheochromoctyoma + Medullary thyroid
+ Neuronal; RET oncogene
Afib with RVR, fever, hypotension, jaundice, dx?
When do you tx hypothyroidism?
symptomatic or TSH gt 10
Painful thyroid, dx?
How do you tx myxedema coma (3)?
warmed IV fluids, blankets, IV T4
Pericardial effusion, coma, hypotension, and hypothermia, dx?
What will you see on RAIU for a toxic adenoma?
cold thyroid, hot adenoma
What will you see on RAIU of Grave's disease?
Whole thyroid is hot and enlarged
What will you see on RAIU for thyroiditis?
No uptake (since in thyroiditis, only pre-formed T4 is released)
Exopthalmos and pretibial myxedema, dx?
How do you tx thyroid storm (4)?
IV fluids, propranolol (to control rate), PTU/methimazole (to decrease fT4), IV steroids (to reduce peripheral conversion of T4 to the more active T3)
CT scan for something else, finds adrenal incidentaloma, next step?
Rule out Conn's, Cushings and pheo
HTN and hypokalemia, dx?
Headache, tachycardia, hypertension, perspiration - dx? Tx?
Pheochromocytoma; alpha adrenergic blockade, beta-blockade, resection (in that order!)
Most common cause of Addison's disease in US? Worldwide?
It's definitely Cushing's Disease, but the MRI is negative, next step?
Inferior petrosal sinus sampling (it's where the pituitary gland drains) (Cushing's Disease = pituitary tumor)
How do you screen for Cushing's syndrome?
Low-dose dexamethasone suppression
Picture of purple stretch marks or the back of the neck with a hump, dx?
How do you screen for pheochromocytoma?
Urinary metanephrines and VMA
Young woman with renovascular hypertension, dx and next step?
Fibromuscular dysplasia, stent her!
Cortisol low, cosyntropin stim test does not stimulate cortisol, dx and next step?
Adrenal failure (Addison's), CT abdomen and give fludrocortisone and cortisol
You suspect Conn's syndrome, first step in diagnosis?
You suspect Conn's, both the aldo and renin are elevated, the A:R ratio is less than 10, dx? Name 2 causes
Renovascular HTN; Fibromuscular dysplasia (young woman, stent) and renal artery stenosis (old man)
You suspect Conn's, both the aldo and renin are not elevated, possible dx (2)?
Mimicker: CAH or licorice ingestion
You suspect Conn's, the aldo is raised and the renin is lowered, A:R ratio greater than 30, dx? Next steps (3)? Tx?
primary hyperaldosteronism; salt suppression test (for definitive diagnosis); MRI (to look for adenoma = Conn's vs hyperplasia); adrenal vein sampling (often side with out mass is the hyperfunctioning side); If tumor, resect!
What non-insulin class is weight neutral?
DPP4-inhibitiors (gliptins) (by inhibiting DPP4 they prevent breakdown of GLP-1)
How do you diagnose diabetes with a fastng blood glucose?
bG greater than 125 on two occasions
A1c goal for tx of diabetes?
less than 7%
What are the annual screening tests diabetics need?
Urinalysis (look for microalbuminuria), retina exam (look for retinopathy), monofilament foot screen (look for neuropathy)
What is the devastating side effect of metformin? Who shouldn't get it (3)?
lactic acidosis; patients with CHF, CKD, liver disease
What non-insulin class causes weight loss?
GLP-1s (exanatide and liraglutide)
What non-insulin class can cause hypoglycemia?
What is the benign side effect of metformin?
Diarrhea (self limiting)
An A1c of 6.0 means what? How do you treat?
Pre-diabetes; lifestyle modifications and metformin
2 hour glucose toelrance test: name the numbers for normal and diabetes
diabetes = greater than or equal to 200
normal = less than 140
Fasting glucose: name the numbers for normal and for diabetes
normal: less than 100
diabetes: greater than 125
What are the antibodies in type I diabetes (2)?
Anti-GAD and anti-IA-2
In DKA tx, what do you need to do before giving insulin?
Check Potassium! Should be gt 4 before giving
Fluid for DKA when the sugar comes towards normal?
D5 1/2 NS
How do you diagnose DKA (4)?
BMP (bG, anion gap), U/A (ketones), serum ketones, ABG for acidosis
Pt in DKA and the gap closes, what do you do?
Bridge subQ insulin
Hypoglycemia + normal c-peptide, dx?
Injxn of exogenous insulin
Hypoglycemia and a coma - what do you do?
IV D50 (or IM glucagon if not at hospital)
Hypoglycemia after working out - what do you do?
Hypoglycemia + high c-peptide - what's the next test?
Secretagogue screen (differentiate btwn insulinoma and ingestion of sulfonylureas which cause increased endogenous insulin production)
Initial fluid resuscitation for DKA?
normal saline or lactated ringers