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endocrine Flashcards

(50 cards)

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1
Q

acromegaly lab first line diagnostic test

A

Elevated insulin like growth factor (IGF-1)

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2
Q

Pituitary adenoma stimulation tests

A

triple bolus test of hypopituitarism

  1. Rapid IV infusion of insulin, GnRH, and TRH
  2. Insulin bolus leads to hypoglycemia which increases GH and ACTH/cortisol
  3. GnRH IV push increases LH and FSH
  4. TRH IV push increases TSH and PRL
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3
Q

lab increased in Grave’s disease

A

thyroid stimulating IMMUNOGLOBULIN (TSI)

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4
Q

HLA associations with Graves

A

HLA-B8 and HLA-DR3

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5
Q

hyperparathyroidism is usually caused by what?

A

parathyroid adenoma

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6
Q

lab for adrenal hyperfunction

A

24 hour urinary free cortisol

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7
Q

Serum ACTH is high or low in what conditions

A

high - primary adrenal insufficiency

low - secondary “ “

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8
Q

Tx for adrenocortical insufficiency (addison’s disease)

A
  • IV normal saline or D5W in large volumes

- Hydrocortisone 100mg IV every 6-8 hours for 24 hours, then taper

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9
Q

Electrolyte findings in adrenocortical insufficency (addisons)

A

hyponatremia
hyperkalemia
metabolic acidosis

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10
Q

lab findings in adrenocortical insufficency (addisons)

A
  • ACTH stimulation test shows NO inc in cortisol
  • electrolyte findings (low Na, high K)
  • high ACTH
  • low urinary cortisol
  • fasting hypoglycemia
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11
Q

Waterhouse-Friderichsen syndrome and anticoagulation therapy (neisseria mening) can cause what

A

acute adrenocortical insufficiency (adrenocortical hypofunction)

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12
Q

Cushing’s disease is excess cortisol due to what

A

ACTH-secreting pituitary adenoma

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13
Q

Labs for Cushing’s disease

A
  • elevated 24 hour urinary cortisol
  • increased cortisol after low dose of Dexamethasone suppression test
  • decreased cortisol after HIGH dose dexamethasone
  • subnormal total lymphocytes, low eosinophils, hyperinsulinemia, Abnormal OGTT, increased serum Ca+
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14
Q

what is hyperaldosteronism

A
  • inc aldosterone secretion leading to DIASTOLIC HTN WITHOUT EDEMA, decreased renin secretion, and metabolic alkalosis (b/c aldosterone increases H+ secretion)
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15
Q

Hyperaldosteronism is typically caused by

A

Conn’s syndrome (aldosterone-producing adrenal adenoma)

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16
Q

pheochromocytoma classic triad Sx

A
  1. episodic pounding H/A
  2. palpitations
  3. drenching sweats
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17
Q

food ingredient that can trigger pheochromocytoma Sxs

A

tyramine

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18
Q

labs for pheochromocytoma

A
  • urine catecholamines (increased VMA, HVA)
  • inc plasma metanephrines (MOST SENSITIVE)
  • plasma catecholamines (inc plasma epi unsuppressed by clonidine is DIAGNOSTIC)
  • hyperglycemia
  • CT abdomen
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19
Q

diagnostic medication for pheochromocytoma

A

Clonidine (epi is unsuppressed)

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20
Q

Type 1 DM HLA

A

HLA DR3 and DR4

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21
Q

pancreatic tumor (insulinoma) labs/imaging

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A
  • increased serum insulin and C-peptide
  • Abdominal US
  • CT scan (not sensitive)
22
Q

Multiple Endocrine Neoplasia 1 (MEN I) common Sxs

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A
  • kidney stones, stomach ulcers, Sxs of hyperparathyroidism and insulinoma
23
Q

MEN II common Sxs

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A
  • Sxs related to medullary thyroid cancer (secretes calcitonin), hyperparathyroidism, or pheochromocytoma, scaly skin rash
24
Q

MEN I signs

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A
  • gastrinoma (PUD, esophagitis)
  • glucagonoma (rare)
  • hyperparathyroidism (nephrolithiasis, bone abnormalities, MSK complaints)
  • pituitary tumor (HA, prolactinoma, acromegaly)
25
MEN II signs
- medullary thyroid cancer (goiter, LAD) | - pheochromocytoma (elevated BP, classic triad of pounding HA, palpitations, sweats)
26
MEN I labs/imaging
- elevated serum gastrin (after IV secretin- for gastrinoma) - elevated PTH (hyperparath) - examine GH, prolactin, blood glucose - MRI
27
MEN II labs/imaging
- calcitonin levels (medullary thyroid carcinoma) - Serum Ca and PTH levels (hyperpara) - urine catecholamines, VNA, metanephrines (pheochromocytoma) - CT or MRI on adrenals
28
Tx of MEN I
PPI for gastrinoma | Bromocriptane (dopamine agonist) to suppress prolactin
29
Tx of MEN II
surgery - alpha blocker for pheochromocytoma pre-operatively - hydration for hypercalcemia, consider calcitonin, IV bisphosphonates for hypercalcemia
30
rehydration Tx of ketoacidosis from DM
- 1 L/hr normal saline (0.9%NaCl) in first 2 hours - then 300-400 ml/hr 0.45 NS - when BG reaches 13.9, switch to D5W to maintain blood glucose
31
when to add HCO3 for ketoacidosis rehydration
add to .45%NS if pH < 7 or Pt has hypotension, arrythmia, coma
32
what drugs can mask signs of and prolong recovery from hypoglycemia
beta blockers
33
what drugs can increase insulin requirements
thiazides and steroids
34
what can decrease insulin requirements
alcohol, most NSAIDs, sulfonylureas, warfarin
35
Pioglitazone may reduce levels of what
OCPs
36
what drug can increase levothyroxine requirement
estrogens
37
what drug can decrease levothyroxine absorption
Bile acid sequestrants
38
Lugols solution interacts with what drugs
- ACE-I's - ARBs - diuretics - lithium - drugs with potassium in them
39
Isotretinoin decreases efficacy of what
microdosed progesterone (use 2 forms of contraception)
40
Isotretinoin may increase risk of bone loss/osteoperosis with what drugs
phenytoin, steroids
41
Terbanafine (antifungal) increases effects of what drugs
SSRIs, Beta blockers, MAOI, warfarin; increases hepatotoxicity with hepatotoxic drugs
42
What herb interacts with furosemide
Licorice (may cause rapid potassium loss)
43
what drug does nitroglycerin increase effect of
sildenafil (viagra)
44
antiHTN effect of HCTZ may be decreased with what drugs
steroids, NSAIDs
45
HCTZ may enhance nephrotoxicity of what drug
NSAIDs
46
HCTZ combined with what drugs may cause orthostatic hypotension
opioids, barbituates, alcohol
47
Beta blockers decrease effect of what hormone
dopamine
48
carbamazepine shortens half life of what drug
doxycycline
49
carbamazepine reduces tolerance of what
alcohol
50
carbamazepine reduces efficacy of what
OCPs

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