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
