Endocrine Flashcards
In-class endocrine exam study deck (106 cards)
1
Q
> 10 mm pituitary adenoma
- Falls under what category?
- When is it symptomatic?
A
Macroadenoma
- Likely hypersecretory
- Asymptomatic until large
- +/- Bone erosion into sphenoid sinus → CSF rhinorrhea
- +/- Visual defects
2
Q
A macro or micro adenoma at the pituitary presenting d/t CA metastasis is most commonly linked to what 3 CA?
A
Lung
Breast
Melanoma
3
Q
Best mode of imaging to ID a pituitary tumor?
A
MRI
4
Q
2 forms of very acutely presenting anterior HYPOpituitarism?
A
- Sheehan’s Syndrome (pregnancy)
2. Apoplexy
5
Q
Bitemporal hemianopsia
A
Characteristic visual field defect due to a pituitary tumor
6
Q
Loss of this hormone in adults causes DECREASES in the following:
Life expectancy, muscle mass, muscle strength, exercise capacity, RBC mass, bone mineral density, HDL cholesterol, energy levels, cognitive ability
A
Growth Hormone Deficiency (adult)
7
Q
↓ IGF - 1 levels should make you suspicious of what hormone deficiency?
A
Growth Hormone
8
Q
MC form of dwarfism
-What is the genetic link?
A
Achondroplasia
-Autosomal dominant mutation at FGFR3
9
Q
Stature < 4’10’’ + mutation at FGFR3 + delayed bone age on hand X-ray
A
Achondroplasia
10
Q
Acromegaly
A
↑ GH in adults
Large face/hands/feet
11
Q
Gigantism
A
↑ GH in children
Prior to epiphyseal closure in long bones → ↑ height
12
Q
MC cause of acromegaly or gigantism
A
Anterior pituitary adenoma
13
Q
Soft/doughy, sweaty handshake + HTN + ↑ IGF-1
A
↑ GH (acromegaly or gigantism)
14
Q
When should an IGF-1 test be conducted (under what circumstance)?
A
After at least 8 hrs of fasting
15
Q
Succession of tests to ID acromegaly
A
- 8-hr fasting IGF-1 (↑ IGF-1)
2. Glucose challenge (persistant ↑ GH)
16
Q
What medicine can be given to a pt w/ acromegaly or gigantism to suppress GH?
A
Octreotide
-Somatostatin mimicker
*however if caused by a pituitary tumor the tx is a transphenoidal reseciton
17
Q
What thyroid abnormality can cause hyperprolactinemia?
A
Hypothyroidism
18
Q
Galactorrhea, anovulatory amenorrhea, infertility, vaginal dryness
-Presenting sx of what dx?
A
Hyperprolactinemia, MC d/t Prolactinoma
19
Q
MC type of benign pituitary tumor
A
Prolactinoma
20
Q
Prolactin of > 300 ng/mL
A
Value suspicious of a prolactinoma
< 100 ng/dL - likely not a tumor
100-200 ng/dL - likely a tumor
> 200 ng/dL - very likely a tumor
21
Q
Possible secondary causes of ↑ PRL levels
A
Drugs like dopamine antagonists (anti-psychotics)
Hypothyroidism
Chest trauma
22
Q
Prolactinoma
Tx
A
Dopamine agonist:
Bromocriptine
Cabergoline
23
Q
Posterior Pituitary Hormones
A
ADH (vasopressin)
Oxytocin
24
Q
↑ ADH resulting in inappropriate water reabsorption at the kidney → aldosterone attempt at correction leads to ↑ Na+ excretion into urine
-What condition is being described & what are the 3 types?
A
SIADH
Syndrome of Inappropriate ADH Secretion
3 types:
- Central
- Peripheral
- Reset Osmostat
25
Cause of Peripheral SIADH
Paraneoplastic disease like Small Cell Lung Cancer
| *can be from variable causes
26
Blood (↓ Na+/↓ Osmolarity) + Urine (↑ Osmolality/↑ Sodium)
SIADH
27
SIADH 1st line tx
+
Other methods of tx
1. Fluid Restriction
2. Saline + Furosemide
Other methods:
ADH receptor antagonists (Tolvaptan, Conivaptan, Demeclocycline) or Lithium
28
↓ ADH or loss of sensitivity to ADH
Diabetes Insipidus
29
MC type of Diabetes Insipidus
Central
| -often due to autoimmune destruction
30
Dilute urine +/- constantly thirsty
Diabetes Insipidus
31
When is a Water Deprivation Test + ADH Stimulation Test conducted?
Dx of Diabetes Insipidus
32
Central Diabetes Insipidus Tx
Desmopressin (ADH)
33
Inheritance of MEN
Autosomal dominant
34
MEN 1
| The 3 P's
1. HYPER-Parathyroidism
2. Pancreatic Tumors
3. Pituitary Adenoma
35
MEN 2A
| The 2 P's + M
1. Medullary Thyroid Carcinoma
2. Pheochromocytoma
3. HYPER-Parathyroidism
36
MEN 2B
| The 3 M's
1. Mucosal neuromas
2. Medullary Thyroid Carcinoma
3. Marfan-like Body Habitus
37
Stones, thrones, bones, groans, psychiatric overtones
Hyper-parathyroidism
38
L/T: ↑ Ca+ > 10.5 mg/dL ; ↑ PTH ; ↓ PO4
1° Hyper-parathyroidism
39
1° Hyperparathyroidism
Causes
vs.
2° Hyperparathyroidism
```
Parathyroid Adenoma (85%)
Hyperplasia (10%)
Carcinoma (1%)
vs.
Physiologic response from hypocalcemic or vitamin D deficiency (MC: CKD)
```
40
Hyper-parathyroidism
| Sx
```
Early: N/V, loss of appetite, muscle weakness, fatigue, constipation
Joint pain
Polyuria
Polydipsia
Generalized fatigue
Confused, lethargic
PMHx: recurrent kidney stones
Risk: coma
```
41
X-ray: osteopenia, subperiosteal resorption at phalanges *pathognomonic
Hyper-parathyroidism
42
```
Hyper-parathyroidism
Tx for..
1°
2°
3°
```
1°: Subtotal parathyroidectomy
2°: Vit D & Ca+ Supplement + IV fluids w/ Furosemide or Calcitonin
3°: Cinacalcet
43
PE: (+) Chvostek’s sign ; (+) Trousseau’s sign
Hypo-parathyroidism
44
```
Signs of neuromuscular irritability
Carpopedal spasm
Laryngeal spasm
Tingling/paresthesias
Tetany
Facial grimacing
```
Hypo-parathyroidism
45
Hypo-parathyroidism
| Tx
Supplement: Vit D & Ca+
Emergency: IV Ca+-Gluconate
46
Hypo-parathyroidism
| Causes
1. Accidental damage or removal
| 2. Autoimmune destruction
47
Grave's
Hyperthyroidism
48
Hashimoto's
Hypothyroidism
49
Anti-thyrotropin Antibodies
Hyperthyroidism d/t Grave's
50
Anti-thyroid Peroxidase (TPO) Antibodies
Hypothyroidism d/t Hashimoto's
51
Irritability, nervousness, heat intolerance
Sweating
Weight loss, ↑ appetite
Hyperthyroidism d/t Grave's
52
Exophthalmos or proptosis, pretibial myxedema,diffuse enlarged thyroid gland, thyroid bruits
Hyperthyroidism d/t Grave's
Other: tachycardia, fine tremor, 4+ deep tendon reflexes, brittle/fine hair, systolic murmurs
53
Hyperthyroidism d/t Grave's
| L/T
L/T: ↓ TSH w/ ↑ free T4 & ↑ T3 (free & total)
54
Hyperthyroidism d/t Grave's
| Tx
```
PTU (propylthiouracil)
Methimazole
Radioactive iodine
→Destroys the thyroid gland
→Need hormone replacement afterward
Surgery: thyroidectomy
Cardiac sx: ß-blockers
```
55
Acutely presenting hyperthyroidism
| Rare & emergent
THYROTOXICOSIS CRISIS or Thyroid storm
56
Fever, extreme restlessness, N/V/D, possible CV collapse & shock
THYROTOXICOSIS CRISIS or Thyroid storm
57
THYROTOXICOSIS CRISIS or Thyroid storm
| Tx
```
Anti-thyroid meds:
Propylthiouracil PTU IV
Methimazole IV
ß-blocker: Propranolol
High dose iodine
Supportive:
Glucocorticoids IV (inhibit conversion of T4 to T3)
Antipyretics: (never aspirin)
Cooling blankets
```
58
Elderly woman + undiagnosed hypothyroidism + acute health event
-How do you tx?
Myxedema Hypothyroid Crisis
Tx:
L-Thyroxine IV + Supportive
59
```
Fatigue, pallor
↑ weight
Cold intolerance
Worsening constipation
Heavy periods
Dry & cold skin
```
Hypothyroidism d/t Hashimoto's
60
L/T: ↑ TSH (> 9.5 uU/mL), ↓ free T4, +/- normal T3
Hypothyroidism d/t Hashimoto's
61
Hypothyroidism d/t Hashimoto's
| Tx
Thyroxine
L-thyroxine
Take 30 min prior to 1st meal & 4 hrs apart from other meds
F/U labs on TSH periodically
Peak levels achieved in 3-4 weeks post initial tx
62
Thyroid Nodule:
| Benign
Varied: smooth, firm irregular, sharply outlined, discrete, painless
63
Thyroid Nodule:
| Malignant
Rapid growth, fixed in place, no movement w/ swallowing
64
Step-wise approach to evaluating a Thyroid Nodule
PE → > 1 cm → +/- No TSH change (more worrisome) Thyroid U/S → Fine Needle Aspiration Bx
65
Size of thyroid nodule to consider for FNA Bx
Solitary nodule: > 1 cm
| Multiple nodules: > 1 cm
66
MC thyroid CA
Papillary Thyroid Carcinoma
67
In order of MC to LC order the 3 types of thyroid CA
Papillary > Follicular > Medullary
68
Tx for any kind of thyroid CA
Total thyroidectomy
| +/- additional resection at LN of adjacent tissue
69
Most aggressive of the 3 thyroid CA
Medullary
70
Alcohol Related Ketoacidosis
Metabolic complication of alcohol use + starvation
| *not from hyperglycemia
71
When does Alcohol Related Ketoacidosis MC present?
AFTER alcohol ingestion
| Hours → Days later
72
Alcohol Related Ketoacidosis
| Sx
Hx of ETOH abuse +/- malnutrition, recent binge drinking
| Alert & lucid despite ketoacidosis
73
Alcohol Related Ketoacidosis
| Tx
IV Thiamine
| IV Dextrose & Fluids
74
```
Hyperglycemia > 600 mg/dL (+/- 800-2400 mg/dL)
Serum osmolarity > 310 mOsm/kg
Blood pH > 7.3 (not acidotic)
> 15 serum bicarbonate
Normal anion gap
Low or normal ketones
L/T: ↑ Na+; ↑ BUN
```
Hyperglycemic Hyperosmolar State
75
Hyperglycemic Hyperosmolar State
| Tx
Fluid Replacement
| Insulin
76
PE: evidence of dehydration, fruity breath, stuporous pt, hypotension + tachycardia, mild hypothermia, unexplained abdominal pain or tenderness, Kussmaul Breathing
DKA
77
Hyperglycemia > 250 mg/dL
Moderate-severe: 350-900 mg/dL
Metabolic acidosis blood pH < 7.3 (range: 6.9-7.2)
Serum bicarbonate < 15 mEq/L (range: 5-15)
Serum (+) ketones
Dilution ratio of 1:8 OR beta-hydroxybutyrate > 4 nmol/L
DKA
78
DKA
| Tx goals w/ Glucose, Bicarb, pH
Goals: Glucose <200 mg/dL, Bicarb > 18 mEq/L, pH > 7.3
79
Sympathetic response: tachycardia, palpitations, sweating, tremors
Parasympathetic response: nausea, hunger
Hypoglycemia
80
Blood sugar value for Hypoglycemia
< 70 mg/dL
| Severe: < 45 mg/dL + serum insulin level of < 6 micro unit/mL or >
81
Hypoglycemia
| Tx
Glucagon
| 50% Dextrose
82
Leading cause of death in Type 1 DM
CKD
83
Leading cause of death in Type 2 DM
Macrovascular dz w/ MI or Stroke
84
```
Target management values for DM:
A1c: ?
Preprandial Glucose: ?
Postpranidal Glucose: ?
BP: ?
```
A1c: < 7%
Preprandial Glucose: 80-110
Postpranidal Glucose: < 140
BP: < 130/80
85
DM medical visit F/U regimen:
- Q 3 m.o.
- Q 6 m.o.
- Q Yearly
```
-Q 3 m.o.
HgA1c + CMP + BG logs
-Q 6 m.o.
FLP + Dental exam
-Q Yearly
Eye + Foot + Nephropathy + Vax (Flu/Tdap/PCV13)
```
86
4 Diagnostic Values for Type 2 DM
> 200 mg/dL on Random Plasma Glucose + Diabetic Sx
> 126 mg/dL on > 8 hr fasting plasma glucose x > 1 occasion (*Gold Standard)
> 200 mg/dL on 75 g oral glucose challenge + 2 hrs later
> 6.5% HbA1c
→ “Pre-diabetes”: 5.7-6.4% or oral glucose challenge at 140-199
87
(+) GAD 65 Antibodies
Diagnostic to definitively ID type 1 DM
88
HbA1c to diagnose type 1 DM
> 6%
89
Most commonly results from a deficiency of 21 hydroxylase
- Dx?
- Classic sx?
- Early Dx?
- Tx?
Dx: Congenital adrenal hyperplasia (variable adrenal insufficiency)
- Classic sx: Salt wasting
- Early Dx: Newborn screening for 24 hydroxylase deficiency
- Tx: Hormone therapy custom to deficiency
90
Cushing's:
Sx
PE & lab findings
```
Central obesity
Striae
Acne
Moon face
Buffalo hump
```
PE: HTN
L/T:
↓K+
↑ cortisol, glucose, wbc
91
Cushing's:
| Succession of testing
```
LOW Dexamethasone Challenge
↓
ACTH Measure
↓
HIGH Dexamethasone Challenge
```
92
Cushing's:
| Test results to confirm a pituitary adenoma as the source
LOW Dexa: Failure to suppress cortisol
ACTH: ↑ ACTH
HIGH Dexa: Successful suppression of cortisol
93
Cushing's:
| Tx
Adenoma: Transphenoidal surgery
Exogenous: gradually ↓ steroid ingestion
Ectopic ACTH: tx underlying cause
94
1 ° Addison's:
| 2 MC types/causes
1. Autoimmune destruction of adrenal gland
| 2. Tuberculosis destruction of adrenal gland
95
1 °Addison's:
Sx
PE & lab findings
Weakness
Muscle & joint pain
Hyperpigmentation
PE: Orthostatic Hypotension, sparse secondary sex hair
L/T:
↓ Na+
↑ K+
96
1 °Addison's:
| Succession of testing
8 AM serum cortisol & Plasma ACTH
↓
Cosyntropin-Synthetic ACTH Stimulation (*Gold Standard)
+/- CRH Stimulation
→ Failure to stimulate release of cortisol, confirms
97
1 °Addison's:
| Tx
Hydrocortisone (glucocorticoid replacement)
Fludrocortisone (mineralocorticoid replacement)
98
Addison's:
Primary vs. Secondary
Define
Primary: problem w/ adrenal gland
Secondary: no ACTH secretion
99
Addison's:
| MC cause of 2° Addison's
Exogenous steroid use
100
Adrenal crisis or Addisonian Crisis
Sx
Dx
Tx
EMERGENCY!
Sx: Pain in back/abdomen/legs, V/D, dehydration, ↓ BP & loss of conciousness
Dx: BMP shows ↓ Na+, ↓ K+, ↓ blood glucose + Emperic 100 mg of Hydrocortiosone (if they improve then confirm they were having this crisis)
Tx: Hydrocotison bolus
101
Primary vs. Secondary Hyperaldosteronism
Primary: adrenal gland dysfunction
Secondary: something other than the adrenal gland is responsible for it (like chronic ↓ BP)
102
1° Hyperaldosteronism:
Types
Sx
Types:
MC Hyperplasia of Adrenal Glands
Sx:
Polyuria, polydipsia, muscle weakness
103
1° Hyperaldosteronism:
PE
L/T
PE: HTN
| L/T: ↑ urine aldosterone + Aldosterone:Renin ratio interpretation + Confirmatory sodium loading
104
1° Hyperaldosteronism:
| What result from Sodium loading confirms the dx?
Failure to suppress aldosterone via ↑ sodium load
105
1° Hyperaldosteronism:
| Tx
Spironolactone
106
Uncontrolled proliferation of chromaffin cells at the adrenal medulla
- Sx
- Dx
- Tx
Pheochromocytoma (↑ catecholamines)
Sx: Anxiety, HA, palpitations, perspiration
Dx: 24hr Catecholamine Urine Test w/ ↑ metanephrines or vanillylmanelic acid
Tx:
HTN control → Surgery
α-block (phenoxybenzamine) then ß-block
