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Flashcards in endocrine Deck (50)
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1

acromegaly lab first line diagnostic test

Elevated insulin like growth factor (IGF-1)

2

Pituitary adenoma stimulation tests

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

3

lab increased in Grave's disease

thyroid stimulating IMMUNOGLOBULIN (TSI)

4

HLA associations with Graves

HLA-B8 and HLA-DR3

5

hyperparathyroidism is usually caused by what?

parathyroid adenoma

6

lab for adrenal hyperfunction

24 hour urinary free cortisol

7

Serum ACTH is high or low in what conditions

high - primary adrenal insufficiency
low - secondary " "

8

Tx for adrenocortical insufficiency (addison's disease)

- IV normal saline or D5W in large volumes
- Hydrocortisone 100mg IV every 6-8 hours for 24 hours, then taper

9

Electrolyte findings in adrenocortical insufficency (addisons)

hyponatremia
hyperkalemia
metabolic acidosis

10

lab findings in adrenocortical insufficency (addisons)

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

11

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

acute adrenocortical insufficiency (adrenocortical hypofunction)

12

Cushing's disease is excess cortisol due to what

ACTH-secreting pituitary adenoma

13

Labs for Cushing's disease

- 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+

14

what is hyperaldosteronism

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

15

Hyperaldosteronism is typically caused by

Conn's syndrome (aldosterone-producing adrenal adenoma)

16

pheochromocytoma classic triad Sx

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

17

food ingredient that can trigger pheochromocytoma Sxs

tyramine

18

labs for pheochromocytoma

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

19

diagnostic medication for pheochromocytoma

Clonidine (epi is unsuppressed)

20

Type 1 DM HLA

HLA DR3 and DR4

21

pancreatic tumor (insulinoma) labs/imaging

- increased serum insulin and C-peptide
- Abdominal US
- CT scan (not sensitive)

22

Multiple Endocrine Neoplasia 1 (MEN I) common Sxs

- kidney stones, stomach ulcers, Sxs of hyperparathyroidism and insulinoma

23

MEN II common Sxs

- Sxs related to medullary thyroid cancer (secretes calcitonin), hyperparathyroidism, or pheochromocytoma, scaly skin rash

24

MEN I signs

- 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