Flashcards in Endocrine FunMed Deck (103):
What is the most common type of Primary hypothyroidism?
What is the difference between Primary, secondary, and tertiary disorders of hypothyroidism?
Secondary: Anterior Pituitary
Secondary hypothyroidism is a disorder of the _____
Tertiary hypothyroidism is a disorder of the _____
regarding the hypothalamus-pituitary-thyroid axis, the hypothalamus secretes_____
regarding the hypothalamus-pituitary-thyroid axis, the anterior pituitary secretes
symptoms of hypothyroidism
physical exam finding of hypothyroidism
loss of eyebrows
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?
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)
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)
what are some other abnormalities that primary hypothyroidism can manifest as?
what is the first line treatment for hypothyroidism?
Levothyroxine (recheck TSH in 6 weeks)
What can happen if you over-prescribe Levothyroxine?
Cardiovascular consequences including A.fib, tachycardia, cardiomyopathy
What are some of the symptoms of HYPERthyroidism?
anxiety, psychosis, insomnia, palpitations, heat intolerance, weight LOSS, ED, decreased libido
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?
If you draw labs on a patient with subclinical hyperthyroidism, what should the TSH and fT4 look like?
normal fT4 and fT3
In overt hyperthyroidism, what can you expect the TSH and fT4 to look like?
high fT4/ T3
T3 toxicosis (hyperthyroidism)
T4 toxicosis (hyperthyroidism)
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
what is the most common cause of hyperthyroidism?
Which lab value, when positive, indicates Graves' disease as a cause of hyperthyroidism
exophthalmos is commonly seen in which type of thyroid disorder?
Hyperthyroidism - specifically GRAVES DISEASE
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?
What is the pathophysiology of Hashimotos disease? (what does it do to the thyroid)
destroys the thyroid epithelial cells by apoptosis via lymphatic infiltration
T3 and T4 toxicosis is part of WHICH thyroid disorder?
Hyperthyroidism; TSH is low, but either T3 or T4 is higher
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
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
physical exam findings consistent with nodular thyroid disease require which lab test?
-toxic multinodular goiter
Treatment for Hyperthyroid
Beta blockers + thionamides (Methimazole or Propylthiouracil)
True or false: Goiter and TSH levels are inversely related
TRUE: large goiter = LOW TSH
what is the most common cause of goiter?
iodine deficiency (worldwide)(multinodular goiter in the US)
Patient presents with a palpable, painless mass on thyroid. Radiology confirms a "cold nodule" on scan. What is at the top of your differential?
What is the most common type of thyroid cancer?
What is the least common, most aggressive form of thyroid cancer?
What are the 3 layers of the adrenal cortex?
Which area of the cortex is Cortisol secreted? and what does it regulate?
Zona Fasciculata: cortisol regulates glucose metabolism
What does cortisol regulate?
In which area of the cortex is aldosterone secreted?
What is the function of aldosterone?
Salt regulation/balance (mineralcorticoids)
What area of the cortex are androgens secreted from?
Zona reticularis: stimulates masculinity
What are the structures of the Medulla (adrenal layer), and what do they produce?
Chromaffin Cells: produces catecholamines, a stress hormone
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
what hormone in the hypo-pituitary-adrenal axis is secreted by the hypothalamus?
Primary Adrenal insufficiency is also known as?
Addisons disease means a patient is deficient in which cortex hormones?
Glucocorticoids and mineralcorticoids
(it is a PRIMARY disease, meaning directly affecting the adrenals)
Which is more common - primary (Addison's) or secondary adrenal insufficiency?
Secondary Adrenal insufficiency is more common than primary; this means there is an inadequate amount of ____ secretion from the pituitary
-deficiency of GLUCOCORTICOIDS only
Tertiary adrenal insufficiency means that the issue is hypothalamic; meaning there is an insufficiency in ____ secretion
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
When evaluating adrenal insufficiency, you draw labs, results:
-low AM cortisol
-ACTH stimulation test = no response
PRIMARY adrenal insufficiency (addisons)
When evaluating adrenal insufficiency, you draw labs, results:
-Low AM cortisol
secondary/tertiary adrenal insufficiency
get MRI head/CT abdomen to look for a MASS in the pituitary or adrenal areas
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)
What is the syndrome of cortisol EXCESS?
Cushing's syndrome - most commonly exogenous (caused by us by Rx too much steroids)
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?
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)
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
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?
What is the gold standard diagnosis for pheochromocytoma
24 hour urine for metanephrines, catecholamines
You decide to schedule a total adrenalectomy for your patient with pheochromocytoma, but you must administer ____ for 7-14 days prior to surgery
-patients will need Beta blockers or CCBs for hypertension rate control after
You notice that your patient has bilateral adrenal hyperplasia. You diagnose him with ____ and treat with _____
Spironolactone (K sparing)
which hormones are secreted by the posterior pituitary gland?
oxytocin and ADH
where is the most common location for carcinoid tumors?
(also very common to have tumors in multiple places)
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.
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
What type of imaging is used to assess carcinoid tumor?
Somatostatin Receptor scintigraphy (SRS)
Treatment of carcinoid?
SURGERY - debulking (resection)
What is the male endocrine disorder caused by deficient testosterone secretion by teste?
Primary - HIGH LH/FSH because teste is not producing Testosterone
Secondary - LOW LH/FSH because the pituitary is the issue, not secreting it
which lab is most important to obtain to diagnose hypogonadism in males?
-if low, repeat and check LH, FSH to confirm.
Treatment of hypogonadism
what is the endocrine disorder described by palpable glandular breast tissue
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
What are some RED FLAGS for malignancy in a patient with gynecomastia?
location not beneath areola
nipple retraction, bleeding, discharge
what is the A1C for a "normal" patient?
What is the A1C classification for prediabetes?
what is the A1C classification for diabetes?
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
can you use A1C alone to diagnose diabetes?
NO - confirmed by FPG and 2 hour post prandial
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
what are the confirmatory levels of both FPG and 2hr PG levels for diagnosing Type 2 DM?
FPG > 126
2H PG > 200
severe hypoglycemia is when severe confusion, unconsciousness, and coma can occur. What is the typical blood glucose level in a patient with severe hypoglycemia?
IF patient is experiencing severe hypoglycemia to the point where they are unconscious, how do you treat them?
glucagon injection and admit to hospital
Type I diabetic presents with deep, labored breathing which smells fruity. What is this called and what is happening?
Kussmaul respiration, experiencing DKA
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
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)
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
how would you describe DKA?
hyperglycemia in the absence of insulin causes cell starvation, ketogenesis, metabolic gap acidosis
-volume depletion/electrolyte loss
A patient with exophthalmos most likely has which endocrine disorder?
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
if you treat a patient with radioiodine ablation, which other med needs to be prescribed?
Thionamide (and BB) to restore EUTHYROIDISM
T or F: the larger the goiter, the smaller the TSH
In hypoparathyroidism, PTH will be ____, calcium will be ____ and phosphorus will be ____
hyperparathyroidism will have _____ PTH, _____ calcium _____phosphorus
Treatment of choice in central Diabetes insipidous?
what is the most common functional pituitary adenoma?
What is the physical difference between pituitary dwarfism and achondroplasia?
Pituitary: limbs proportionate to body
achondroplasia: limbs disproportionally short compared to trunk
MEN2A and MEN2B are Endocrine neoplasias that result from a mutation in which gene?
-95% chance of developing medullary thyroid cancer
What does the MEN1 gene do?
tumor suppressor; mutation allows for unregulated cell growth and tumors
MEN1 tumor is also called _____
Tumors of the MEN1 neoplasia affect the 3 P's. What happens when tumors arise on the parathyroid?
Hyperparathyroidism - elevated CALCIUM
MEN1 is tumors of which 3 things?