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Flashcards in Endocrine High Yield Deck (49):
1

What is Hyperthyroidism and what does it do in your body

High T3/T4 = Increases Metabolism
Increases glucose absorption from GI
Catabolic effect on muscle mass
Increased CO and RR
Increased Catecholamine Levels
Increased Oxygen Consumption

2

What is the most common cause of Hyperthyroidim

Graves
Autoimmune against TSH receptor

3

What is a common cause of Hyperthyroidism in the elderly

Toxic Nodular Goiter
Leads to Thyrotoxicosis (increased T3/T4)

4

Sx of Hyperthyroidism

Anxiety, Emotional Lability, Weight Loss, Weakness, Tremor, Palpitations, Heat Intolerance, Warm, Moist Skin, Thin Hair, Tachycardia, Fine Resting Tremor, Hyper-Reflexia

5

What is a unique sx seen in Graves

Exopthlamos: Proptosis, Lid Lag, Eyes bulging

6

Dx of Hyperthyroidism

Low TSH, High T3/T4
If Graves see thyroid-stimulating Immunoglobulin Antiodies

7

Tx of Hyperthyroidism

Anti-Hormone Therapy: PTU (Propylthiouracil) or Methimazole
Radioactive Iodine destroys gland

8

Which of the tx for Hyperthyroidism can be used in pregnancy

PTU

9

What drugs can you use to curb sx of Hyperthyroidism

Beta Blockers: Propranolol decreases HR and BP
Glucocorticoids prevent conversion of T4 to T3

10

Dx of TSH Secreting Pituitary Adenoma

High TSH, High T3/T4
MRI to look for pituitary adenoma

11

Tx of TSH secreting Pituitary Adenoma

Transphenoidal Surgery to remove pituitary tumor

12

What is Hyperparathyroidism

Overactive Parathyroid Glands that lead to increased Calcium Absorption

13

What is Primary Hyperparathyroidism and what causes it

Excess inappropriate PTH production
Parathyroid Adenoma is most common cause

14

What is Secondary Hyperparathyroidism and what causes it

Increased PTH due to hypocalcemia or Vitamin D Deficiency
Chronic Kidney failure is common cause

15

Sx of Hyperparathyroidism

Bones, Stones, Groans, and Psychic Groans
Bony Pain, Kidney Stones, Abdominal Pain, Constipation, Depression and Confusion

16

Dx of Hyperparathyroidism

Increased PTH
Hypercalcemia
Decreased Phosphate
Check 24 hour urine calcium excretion
Osteopenia on bone scan

17

Tx of Hyperparathyroidism

Surgery, Parathyroidectomy
Vitamin D/Calcium supplement if secondary

18

What is Hypoparathyroidism

Due to low PTH or Insensitivity to its action

19

What are the more common causes of Hypoparathyroidism

Accidental damage/removal of parathyroid during neck/thyroid surgery
Autoimmune destruction of parathyroid gland

20

Sx of hypoparathyroidism

Hypocalcemia: Carpopedal Spasms, Trousseau and Chvostek Sign, Perioral Parasthesias, Increased DTR
Chvostek Sign: Tap on facial nerve causes facial twitching
Trousseau Sign: Blood pressure cuff on arm blocks flow to brachial artery, causes flexion in fingers, extension of wrist

21

Dx of Parathyroidism

Hypocalcemia
Decreased PTH
Increased Phosphate

22

Tx of Parathyroidism

Calcium Supplement and Vitamin D
Vitamin D helps absorb Calcium in gut
(Ergocalciferol or Calcitriol)

23

What is Chronic Adrenocortical Insufficiency

Disorder where adrenal gland does not produce enough hormones

24

What is Primary Adrenocortical Insufficiency (Addison's Disease)

Adrenal Gland Destruction
Leads to both lack of Cortisol and Aldosterone
High ACTH, Low Cortisol
Normal RAAS system, Low Aldosterone

25

What are causes of Primary Adrenocortical Insufficiency

Autoimmune, Infection (TB, Fungal), Vascular

26

What are causes of Secondary Adrenocortical Insufficiency

Pituitary failure of ACTH secretion (lack of Cortisol)
You will see Low ACTH and Low Cortisol
Aldosterone is intact because ACTH has nothing to do with Aldosterone, instead RAAS system controls that
Exogenous Steroid Use

27

Sx of Primary Adrenocortical Insufficiency

No Cortisol, No Aldosterone, No Sex hormones from Adrenal Gland
Hyperpigentation due to increased ACTH
Orthostatic Hypotension, Severe Hyponatremia, Hyperkalemia and non-anion gap Metabolis Acidosis, Hypoglycemia
Reduced sex hormones in women leads to loss of libido, amenorrhea, loss of axillary and pubic hair

28

Dx of Adrenocortical Insufficiency

1. Get baseline ACTH, Cortisol, and Renin
2. High dose ACTH Stimulation Test. Normal response is a rise in blood/urine cortisol levels. If no rise in cortisol = Adrenal Insufficiency
3. CRH Stimulation Tests will differentiate the cause. Primary will produce high levels of ACTH but low Cortisol. Secondary will produce low ACTH and low Cortisol

29

Tx of Adrenocortical Insufficiency

Primary: Glucocorticoids + Mineralocorticoids
Secondary: Glucocorticoids only
Glucocorticoids: Hydrocortisone 1st line, Presdnisone, Dexamethasone
Mineralocorticoids: Fludrocortisone

30

What does the Anterior Pituitary Secrete

Prolactin, Somatotropin (GH), ACTH, TSH, FSH/LH

31

Sx seen with Prolactinomas

Oligomenorrhea, galactorrhea, amenorrhea, infertility

32

What inhibits prolactin

Dopamine

33

Sx of Somatotropinoma

In adults: Acromegaly
In Children: Gigantism
DM and glucose intoelrance

34

Dx of Acromegaly

Insulin-like growth factor screening test
Confirmatory test: Oral Glucose suppression. If increased GH levels you have Acromegaly

35

Sx of Adrenocorticotropinomas

They secrete ACTH
Cushing's Disease and Hyperpigmentation

36

Sx of TSH secreting Adenomas

Secrete TSH
Thyrotoxicosis
Increased T3/T4

37

Dx of Anterior Pituitary tumors

MRI
Endocrine Studies

38

Tx for Anterior Pituitary Adenomas

Transsphenoidal Surgery

39

Tx for Acromegaly

TSS + Bromocriptine
Octeotride

40

Tx for Prolactinoma

Cabergoline or Bromocriptine (Dopamine agonist that inhibits prolactin)

41

What is DM Type I

Insulin Deficiency
Inability to produce insulin and insulin resistance
Autoimmune destruction of pancreatic beta cells

42

What is DM type II

Insulin Resistance and Relative Impairment to insulin secretion
Likely genetic and environmental, especially weight gain and decreased physical activity

43

Dx of DM

Fasting blood sugar >126
Random blood glucose >200
Blood Sugar after oral glucose tolerance test >200
HgA1C >6.5%

44

Sx of DM

Polyuria, Polydipsia, Polyphagia, Weight Loss
DKA

45

Complications of DM

Parastehsias, Abnormal Gait, Decreased Proprioception, Pain, Decreased DTR
Orthostatic Hypotension, Gastroparesis Constipation
Retinopathy: Painless deterioration of small retinal vessels, may lead to permanent vision loss/blindness

46

Sx of Nephropathy and Tx

Progressive kidney function deterioration leading to microalbuminuria
Tx: Ace-I

47

How does a Sulfonylureas Work

Stimulates pancreas to release more insulin
Can cause hypoglycemia
Glipizide

48

How do Biguanides work

Suppress Hepatic Gluconeogenesis
No Hypoglycemia
Can cause lactic acidosis
GI side effects are common
Metformin

49

How do Thiazolidenediones work

Increase sensitivity to insulin
Affect fat metabolism
Side effects are hepatitis and edema, Acites