Endocrine Flashcards
prolcatinoma basics
benign
men - decreased libido, macroadenoma, bitemporal hemaniopsia
women - amenorrhea + galactorrhea - microadenoma
dx of prolactinoma
check meds –> check TSH –> normal –> check prolactin level –> if elevated –> MRI
tx of prolactinoma
dopamine agonist - carbergoline > bromocriptine
sx only if tumor unresponsive to meds or >3cm
Acromegaly basics
benign GH secreting tumor, increased risk for cancer
kids - gigantism
adults - big hands, feet, face, visceral organs (diastolic HF), diabetes
dx of acromegaly
increased ILGF-1 –> glucose suppression test –> (+) –> MRI
glucose suppression test explained
give pt glucose you expect: insulin to go down epi to go up cortisol to go up growth hormone to go up - but here it doesnt change
Acute or sudden hypopituitarism
path - infection, infarction, iatrogenic
(Sheehans, apoplexy (big tumor))
hypotensive, tachy - lack of cortisol
lethargy, coma - lack of T4
dx and tx of acute hypopituitarism
dx - cortisol levels, T4 levels
tx - replace hormones
chronic hypopituitarism
path - autoimmune, deposition dz ( sarcoidosis, etc), tumor
prioritize ACTH and TSH so stop making FSH/LH –> decreased libido, fatigability, menstrual issues
dx and tx of chronic hypopituiraism
dx - insulin stim test - similiar to glucose stim test - no Change in GH –> MRI
tx- replace hormones and fix underyling dz
empty stella
pituitary gland out of place
pt asymptomatic
dx - MRI
tx - nothing
SIADH
path - brain lesion, small cell lung cancer - exogenous ADH production
dx of SIADH
increase Urine Osm and increased Urine Na
decreased serum Osm - due to continuous absorption of water
tx of SIADH
water restriction -> doesnt work –> democlocycline (which basically induces DI)
causes of nephrogenic DI
democlocycline or lithium ADR
leads to decreased ADH
presentation of DI
polydipsia
polyphagia
nml blood glucose
no glucose in urine
dx of DI
water deprivation test
- deprive them of water
- > pts urine osm goes up = psychogenic
- > no change –> give ADH
- –> urine osm goes up = central DI
- –> no change in urine osm = nephrogenic Di
tx of central DI
DDAVP - vasopressin
tx of nephrogenic DI
gentle diuresis with HCTZ +/- amilioride
basic hyperthyroidism symptoms
tachycardia
heat intolerance
increased DTR
weight loss
diarrhea
afib
dx of hyperthryoidism
TSH decreased
T4 increased
TSH decreased
T4 decreased
central thyroid issue TRH issue
Graves dz
thyroid stimulating abs –> increased growth and activity
diffuse increased RAIU
exopthalmus, tibial myxedema
Thyroiditis Painless
painless
due to preformed T4 –> gets released due to inflammation –> spills T4 –> initial transient Hyperthyroidism state –> goes normal or hypothyroidism (Hashimotos)
Painless Thyroiditis RAIU
cold nothing
Mutlinodular goiter
toxic adenoma
RAIU - active in multiple nodules or toxic adenoma
Both of these make T4 –> –> T4 increased –> decreased TSH
Other causes of hyperthyroidism
facticious
stroma ovarii
radioactive ablation can treat which types of hyperthyrodism
multinodular goiter
toxic adenoma
facticious
stroma ovaria
tx of graves
thionomides - PTU or methimazole
thyroid storm presentation
severe hyperthyroidism
medical emergency
afib, shock severe fever, toxic, hypotensive, AMS
tx of thyroid storm
1 - cool IVF and cool blankets
2 - propranolol
3 - PTU or methimazole
4 - steroids
Hypothyroidism
decreased T4
Increased TSH
MCC - Iatrogenic
Hashimoto (TPO - Ab = Dx)
Subclinical hypothyroidism
T4 down
TSH Up
no symptoms
tx - if TSH >9 or if symptoms start
tx - same leveothyroxine
tx of hypothyroidism
levothyroxine
hypothyroidism symptoms
bradycardia
constipation
weight gain
cold intolerance
decreased DTR
heavy periods
carpal tunnel syndrome
Myxedema Coma
coma, hypothermic, hypotension
tx - warm IVF, warm blankets –> IV T4 –> doesnt work IV T3
Subquevervains thyroiditis
painful
risk factors for thyroid cancer
pts who have received head and neck radiation
history of cancer - HL, family hx
hoarseness
Age <20 with nodule
Age >60 with nodule
Physical exam findings suspicous of thyroid cancer
fixed
firm
hard nodule
nontender Lymphadenopathy
U/S findings suspicious of thyroid cancer
solid mass
hyperechogenic
size >2cm
microcalcified
irregular borders
thyroid nodule workup
check TSH
- > low -> RAIU - > hot -> tx
- > low > RAIU -> cold -> U/S -> FNA
-> high or nml –> U/S –>
> 1cm - FNA
< 1cm - U/S - repeat U/S in 6-12mo
Papillary Thyroid cancer
MCC
orphan annie nuclei
tx - resect
Follicular Thyroid Cancer
looks like thyroid tissue on biopsy
spreads hematogenously
tx - radioactive iodine ablation
medullary thyroid cancer
c-cells (parafollicular cells)
produces calcitonin
MEN2A, MEN2B - Ret oncogene - pheochromocytoma
Anaplastic Thyroid Cancer
elderly
locally invasive
rapidly fatal
layers of the adrenal gland outside in
glomerulata - aldosterone
fasculata - cortisol
reticularis - testosterone
medulla - catecholamines
Cushing syndrome
path
cortisol excess
ACTH dependent
ACTH independent
pt presentation of Cushing syndrome
HTN, Obese, DM
bad acne - (moon facies)
truncal obesity (buffalo hump)
stretch marks (purple striae)
workup of cushing syndrome
low - dose dexa suppression test –> fails to suppress –> cushing syndrome –>
ACTH –>
- > nml -> adrenal tumor –> CT/MRI –> resect
- > elevated -> High dose dexa suppress
- —-> suppressed –> cushing dz -> pit tumor -> resect
- —-> fails to suppress - >ectopic -> pan CT
Cushing Syndrome - dx criteria
1 - low dose dexa suppression
2- 24 hr urine
3 - late night salivary cortisol
need 2/3
causes of cushing syndrome
small cell lung cancer
ingestion steroids - cortisol excess
primary pituitary tumor producing cortisol
Addisons Dz
path - autoimmune dz (mcc in US) or TB (mcc worldwide)
pt - acute - hypotensive, N/V Coma - hemorrhage
- chronic - orthrostatic hypotension, hyperpigmentation increased K, decreased Na
addisons workup
cortisol AM –> low cortisol –> cosyntrpin stim test
- –> no change –> adrenal gland –> CT/MRI adrenals -> replace both cortisol and fludrocortisone
- –> rises –> Ant pituitary issue –> MRI –> replace cortisol
tx of adrenal gland tumors causing addisons
cortisol and fludrocortison
basics on renin system
renin (system in TAL) –> ang II –> makes adosterone –> inserts channels in collecting ducts –> reabsorb Na and expels K and reabsorbs H20
path of conn syndrome
Primary Tumor
renovascular
- fibromuscular dysplasia (young women)
- atherosclerosis dz (old man)
pt presentation of conn syndrome
HTN - secondary - refractory to medications
hypokalemia
workup of conn syndrome
check aldo : renin
- -> (-) aldo and (-) renin –> mimicker -> CAH or licorice
- -> (+) aldo and (+) renin <10 –> renovascular HTN –> FMD (stent) or AS (no stent)
–> (+) aldo and (-)Renin, >30 –> Conn syndrome –> salt suppression –> fails –> MRI –> adrenal venous sampling —> resect
pheochromocytoma
catecholamine secreting tumor of medulla p - paroxysmal p - pain (HA) p - pressure (HTN) p - palpitations (tachy) p - perspiration
dx of pheochromocytoma
plasma free catecholamines (faster)
or
24hr urine metenephrines, VMA (more sensitive)
then –> CT/MRI abd –> adrenal vein sampling
tx of pheochromocytoma
pre op management
1st - alpha blockade
2nd - beta blockade
3rd - resect
incidentiloma
path - unknown
asymptomatic
r/o - conn, cushing, pheo – 24hr urine
tx - <4cm - obs
>4cm - resect
functioning - resect
