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Flashcards in Endocrine FunMed Deck (103):
1

What is the most common type of Primary hypothyroidism?

Hashimotos

2

What is the difference between Primary, secondary, and tertiary disorders of hypothyroidism?

Primary: Thyroid
Secondary: Anterior Pituitary
Tertiary: Hypothalamus

3

Secondary hypothyroidism is a disorder of the _____

anterior pituitary

4

Tertiary hypothyroidism is a disorder of the _____

hypothalamus

5

regarding the hypothalamus-pituitary-thyroid axis, the hypothalamus secretes_____

TRH

6

regarding the hypothalamus-pituitary-thyroid axis, the anterior pituitary secretes

TSH

7

symptoms of hypothyroidism

fatigue, weakness
cold intolerance
weight gain
dry skin
hoarseness
menorrhagia

8

physical exam finding of hypothyroidism

slow movement/speech
bradycardia
puffy facies
loss of eyebrows
periorbital edema
ascites

9

patient presents with cold intolerance, fatigue, weight gain. On exam she has periorbital edema and puffy facies. Her TSH is high and fT4 is low; What are you thinking?

primary hypothyroidism

10

patient presents with puffy facies and fatigue, weight gain. You draw thyroid labs; TSH is high and fT4 is normal. What do you diagnose?

subclinical hypothyroidism (fT4 isn't affected yet, monitor)

11

you have a patient who has elevated TSH and low fT4; so you diagnose him with primary hypothyroidism. What further test would confirm the most common cause of primary hypoT, Hashimotos?

TPO (elevated in 90% of Hashimotos)

12

what are some other abnormalities that primary hypothyroidism can manifest as?

hypercholesterolemia
macrolytic anemia
elevated CK
hyponatremia

13

what is the first line treatment for hypothyroidism?

Levothyroxine (recheck TSH in 6 weeks)

14

What can happen if you over-prescribe Levothyroxine?

Cardiovascular consequences including A.fib, tachycardia, cardiomyopathy

15

What are some of the symptoms of HYPERthyroidism?

anxiety, psychosis, insomnia, palpitations, heat intolerance, weight LOSS, ED, decreased libido

16

you are examining a patient with suspected thyroid issues. On exam, you note hyperactivity; rapid speech, A.fib, increased cardiac output and tremors. which type of thyroiditis do you suspect, hypo- or hyper?

Hyperthyroidism

17

If you draw labs on a patient with subclinical hyperthyroidism, what should the TSH and fT4 look like?

Low TSH
normal fT4 and fT3

18

In overt hyperthyroidism, what can you expect the TSH and fT4 to look like?

low TSH
high fT4/ T3

19

Low TSH
High T3
normal fT4

T3 toxicosis (hyperthyroidism)

20

Low TSH
normal T3
high fT4

T4 toxicosis (hyperthyroidism)

21

You are reviewing a patient's labwork who came in with tremors and A.fib. You suspect hyperthyroidism, and TSH/fT4 levels correlate with this. However, you want to know if it's of autoimmune origin. Which other 2 labs do you draw to confirm which autoimmune disease associated with HyperT?

TRAb --> if positive, it confirms GRAVES DISEASE

radioactive iodine

22

what is the most common cause of hyperthyroidism?

Graves' disease

23

Which lab value, when positive, indicates Graves' disease as a cause of hyperthyroidism

TRAb

24

exophthalmos is commonly seen in which type of thyroid disorder?

Hyperthyroidism - specifically GRAVES DISEASE

25

after following a patient's TSH levels for some time, you notice an odd trend: patient initially presented with hyperthyroidism and high radioiodine uptake. However, they then developed hypothyroidism. What disorder is this consistent with?

Hashitoxicosis

26

What is the pathophysiology of Hashimotos disease? (what does it do to the thyroid)

destroys the thyroid epithelial cells by apoptosis via lymphatic infiltration

27

T3 and T4 toxicosis is part of WHICH thyroid disorder?

Hyperthyroidism; TSH is low, but either T3 or T4 is higher

28

what is the disorder of the thyroid called when you see diffuse hyperplasia of thyroid cells whose function is INDEPENDENT of TSH regulation?

Toxic Adenoma / Toxic multinodular goiter

29

You determine that a patient has ectopic hyperthyroidism; excess thyroid hormone originating from outside the thyroid gland. What are the main causes of this?

-excess ingestion of thyroid hormone
-levothyroxine overdose-ovarian neoplasm
-thyroid cancer metastasis

30

physical exam findings consistent with nodular thyroid disease require which lab test?

RADIOACTIVE IODINE

-toxic multinodular goiter
-toxic adenoma
-graves' disease

31

Treatment for Hyperthyroid

Beta blockers + thionamides (Methimazole or Propylthiouracil)

32

True or false: Goiter and TSH levels are inversely related

TRUE: large goiter = LOW TSH

33

what is the most common cause of goiter?

iodine deficiency (worldwide)(multinodular goiter in the US)

34

Patient presents with a palpable, painless mass on thyroid. Radiology confirms a "cold nodule" on scan. What is at the top of your differential?

Thyroid cancer

35

What is the most common type of thyroid cancer?

Papillary carcinoma

36

What is the least common, most aggressive form of thyroid cancer?

Anaplastic carcinoma

37

What are the 3 layers of the adrenal cortex?

Zona Glomerulosa
Zona Fasciculata
Zona Reticularis

38

Which area of the cortex is Cortisol secreted? and what does it regulate?

Zona Fasciculata: cortisol regulates glucose metabolism

39

What does cortisol regulate?

glucose metabolism

40

In which area of the cortex is aldosterone secreted?

Zona Glomerulosa

41

What is the function of aldosterone?

Salt regulation/balance (mineralcorticoids)

42

What area of the cortex are androgens secreted from?

Zona reticularis: stimulates masculinity

43

What are the structures of the Medulla (adrenal layer), and what do they produce?

Chromaffin Cells: produces catecholamines, a stress hormone

44

as the thyroid gland has a hypothalamus - pituitary- thyroid axis, so does the adrenal gland. What hormone is secreted directly from the anterior pituitary, acting on the adrenals

ACTH

45

what hormone in the hypo-pituitary-adrenal axis is secreted by the hypothalamus?

CRH

46

Primary Adrenal insufficiency is also known as?

Addison's disease

47

Addisons disease means a patient is deficient in which cortex hormones?

Glucocorticoids and mineralcorticoids
(it is a PRIMARY disease, meaning directly affecting the adrenals)

48

Which is more common - primary (Addison's) or secondary adrenal insufficiency?

Secondary

49

Secondary Adrenal insufficiency is more common than primary; this means there is an inadequate amount of ____ secretion from the pituitary

ACTH
-deficiency of GLUCOCORTICOIDS only

50

Tertiary adrenal insufficiency means that the issue is hypothalamic; meaning there is an insufficiency in ____ secretion

CRH

51

When thinking about the affect that adrenal insufficiency has on hormone secretions, which types (primary, secondary, tertiary) only have an issue with GLUCOCORTICOID release?

Secondary and Tertiary

52

When evaluating adrenal insufficiency, you draw labs, results:
-ELEVATED ACTH
-low AM cortisol
-ACTH stimulation test = no response

PRIMARY adrenal insufficiency (addisons)

53

When evaluating adrenal insufficiency, you draw labs, results:
-LOW ACTH
-Low AM cortisol

secondary/tertiary adrenal insufficiency

get MRI head/CT abdomen to look for a MASS in the pituitary or adrenal areas

54

How does the treatment for primary vs. secondary/tertiary adrenal insufficiency differ?

PRIMARY: need glucocorticoid (sugar) AND mineralcorticoid (salt) replacement

SECONDARY/TERT: only need to taper steroids (not deficient in salt)

55

What is the syndrome of cortisol EXCESS?

Cushing's syndrome - most commonly exogenous (caused by us by Rx too much steroids)

56

Patient presents with central obesity and skinny arms/legs, purple stiae and buffalo hump. Their face represents "moon facies". What is at the top of your Dx?

Cushing syndrome

57

The patient with a buffalo hump, moon facies, and hirsutism needs further workup for suspected Cushing's. What is the gold standard for diagnosis?

get a 24-hour urine cortisol level

(ACTH will be elevated)

58

The treatment for cushings caused by excess steroid consumption is to D/C the steroid. BUT, cushing's disease caused by adenoma requires ___

surgical resection of pituitary adenoma

59

Patient notes that they feel "great" for around 4 months at a time, and then all of a sudden develop palpitations, tremors, and anxiety for around 3 days, with complete resolution. Which adrenal disorder does this sound like?

Pheochromocytoma

60

What is the gold standard diagnosis for pheochromocytoma

24 hour urine for metanephrines, catecholamines

61

You decide to schedule a total adrenalectomy for your patient with pheochromocytoma, but you must administer ____ for 7-14 days prior to surgery

alpha-blockade

-patients will need Beta blockers or CCBs for hypertension rate control after

62

You notice that your patient has bilateral adrenal hyperplasia. You diagnose him with ____ and treat with _____

Primary Aldosteronism

Spironolactone (K sparing)

63

which hormones are secreted by the posterior pituitary gland?

oxytocin and ADH

64

where is the most common location for carcinoid tumors?

small bowel
(also very common to have tumors in multiple places)

65

patient comes in with a flushed appearance; HOT, but "dry" and not sweating, along with diarrhea and wheezing. What are you thinking?

Carcinoid syndrome - provoked by exercise, emotions, foods.

66

When trying to diagnose the extremely VAGUE symptoms of carcinoid, you're looking for an elevation in which lab marker for diagnosis?

Elevated Chromogranin A

67

What type of imaging is used to assess carcinoid tumor?

Somatostatin Receptor scintigraphy (SRS)

68

Treatment of carcinoid?

SURGERY - debulking (resection)

69

What is the male endocrine disorder caused by deficient testosterone secretion by teste?

Hypogonadism

Primary - HIGH LH/FSH because teste is not producing Testosterone

Secondary - LOW LH/FSH because the pituitary is the issue, not secreting it

70

which lab is most important to obtain to diagnose hypogonadism in males?

Morning Testosterone

-if low, repeat and check LH, FSH to confirm.

71

Treatment of hypogonadism

testosterone replacement

72

what is the endocrine disorder described by palpable glandular breast tissue

Gynecomastia

73

Your male patient is going through puberty, and is experiencing gynecomastia. He is concerned something is wrong, and it will be permanent but you tell him:

this will resolve spontaneously within a year

-more common in those who take androgens and anabolic steroids

74

What are some RED FLAGS for malignancy in a patient with gynecomastia?

Asymmetry
location not beneath areola
unusual firmness
nipple retraction, bleeding, discharge

75

what is the A1C for a "normal" patient?

<5.6%

76

What is the A1C classification for prediabetes?

5.7-6.4%

77

what is the A1C classification for diabetes?

>6.5%

78

True or False: In assessing potential diabetics, Type 2 DM will present with weight GAIN, while type 1 presents with weight LOSS

FALSE: both present initially with weight LOSS

79

can you use A1C alone to diagnose diabetes?

NO - confirmed by FPG and 2 hour post prandial

80

patient presents with increased thirst and weight loss. On exam you see acanthosis nigricans and decreased foot sensation. What is at the top of your differential?

Type 2 diabetes

81

what are the confirmatory levels of both FPG and 2hr PG levels for diagnosing Type 2 DM?

FPG > 126

2H PG > 200

82

severe hypoglycemia is when severe confusion, unconsciousness, and coma can occur. What is the typical blood glucose level in a patient with severe hypoglycemia?

<50 mg/dL

83

IF patient is experiencing severe hypoglycemia to the point where they are unconscious, how do you treat them?

glucagon injection and admit to hospital

84

Type I diabetic presents with deep, labored breathing which smells fruity. What is this called and what is happening?

Kussmaul respiration, experiencing DKA

85

when diagnosing a patient with Type 1 DM, you get a FPG of >126 mg/dL, 2 hr PG >200, and A1C >6.5%. Can you diagnose them?

NO - RETAKE these labs on a different day before confirming

86

a 12 year old patient presents with what you think is diabetes. How can you differentiate Type 1 and Type 2 in someone like this?

-endogenous insulin secretion w/ C-peptide

-Test for autoantibodies IA-2 and GAD-65 (Type 1 is autoimmune while Type 2 is genetic/environment)

87

what is the difference in ONSET for Type 1 DM and Type 2?

Type 1: acute, usually first presentation is with DKA

Type 2: slow, gradual onset, subtle

88

how would you describe DKA?

hyperglycemia in the absence of insulin causes cell starvation, ketogenesis, metabolic gap acidosis

-volume depletion/electrolyte loss

89

A patient with exophthalmos most likely has which endocrine disorder?

Grave's Hyperthyroidism

90

why do you need to prescribe both Beta blockers AND thionamides (PTU/MMI) for treatment of hyperthyroidism?

Beta blockers handle symptoms (A.fib, tachycardia), but they don't fix the hormone problem.

-Thionamides fix the hormone problem

91

if you treat a patient with radioiodine ablation, which other med needs to be prescribed?

Thionamide (and BB) to restore EUTHYROIDISM

92

T or F: the larger the goiter, the smaller the TSH

TRUE

93

In hypoparathyroidism, PTH will be ____, calcium will be ____ and phosphorus will be ____

low
low
high

94

hyperparathyroidism will have _____ PTH, _____ calcium _____phosphorus

high
high
low

95

Treatment of choice in central Diabetes insipidous?

Desmopressin (DDVAP)

96

what is the most common functional pituitary adenoma?

prolactin-producing

97

What is the physical difference between pituitary dwarfism and achondroplasia?

Pituitary: limbs proportionate to body

achondroplasia: limbs disproportionally short compared to trunk

98

MEN2A and MEN2B are Endocrine neoplasias that result from a mutation in which gene?

RET gene

-95% chance of developing medullary thyroid cancer

99

What does the MEN1 gene do?

tumor suppressor; mutation allows for unregulated cell growth and tumors

100

MEN1 tumor is also called _____

Werner's Syndrome

101

Tumors of the MEN1 neoplasia affect the 3 P's. What happens when tumors arise on the parathyroid?

Hyperparathyroidism - elevated CALCIUM

102

MEN1 is tumors of which 3 things?

pituitary
parathyroid
pancreas

103

what is the rare, highly vascular adenoma that secretes catecholamines?

paraganglioma