Endocrine/Puberty Flashcards
(34 cards)
Familial hypocalciuric hypercalcemia
Defect Ca sensing receptor of PT cells
PTH not suppressed by high Ca levels
Jod-Basedow phenomenon
Thyrotoxicosis if patient that was formerly iodine def is give some iodine
Thyroid storm symptoms
Agitation, delirium, fever, diarrhea, coma, tachyarrthymia (cause of death)
Increased ALP due to increased bone turnover
Treat with 3 Ps: Propranolol, propothiouracil, prednisolone (prevents T4 to T3)
Give propranolol first
What are the signs of cretininism (congenital hypothyroidism?
6 Ps
Pot-bellied, Pale, Puffy faced, Protruding umbilicus, Protuberant tongue, Poor brain development
What is the Wolff-Chaikoff effect?
Thyroid gland downregulation due to excess iodine
What is the inflammation of subacute thyroiditis (de Quervain)
Granulomatous inflammation
Increased ESR, jaw pain, VERY TENDER THYROID
What is the difference in hashimotos thyroiditis and de Quervain?
Hashimoto there is not pain
De Quervain there IS PAIN
Hashimoto has lymphocyte infiltrate with Germinal Centers
Associated with HLA-DR5
How do you diagnose cushing’s disease from syndrome?
Screen: Increase free cortisol on 24 hr urine
- Increase midnight salivary cortisol
- No suppression low-dose dexamethasone test
If ACTH low SUSPECT ADRENAL TUMOR
IF ACTH HIGH distinguish between adenoma and ectopic production
- Adenoma: Secretion suppressed by dexamethasone
- Ectopic: Secretion not suppressed by dexa
CRH will NOT increase ECTOPIC secretion
How to diagnose adrenal insufficiency?
ACTH stimulation test (no increase is related to primary)
METYRAPONE TEST: Blocks 11-deoxycortisol-cortisol
- Should produce increase in ACTH
- If no increase in ACTH you know you have adrenal insufficiency (secondary)
What is the most common cause of adrenal insufficiency in the modern world?
Autoimmune
What diseases are associated with pheochromocytoma?
NF type 1, VHL disease, MEN2s
- Symptoms occur in spells (relapse remit
Treatment is alpha antagonism then B antagnoism
Derived from Chromaffin cells (neural crest)
What are neural crest cell derivatives?
Melanocytes, chromaffin cells,
What are the lab findings in hypothyroidism?
Incresae TSH
Decresae T3/T4
HYPERCHOLESTEROL (due to decrease in LDL receptor)
What are the lab findings in hyperthryoidism?
Decreased TSH
Increased T3,T4
Hypocholesteroleia (due to upregulaiton of LDL receptors)
What causes severe fetal hypothyroidism?
Maternal hypothyroidism Thyroid agenesis (DiGeorge) Thyroid Dysgenesis (most common in US) Iodine def Dyshormonogenetic goiter
How do you diagnose Acromegaly?
Incresaed serium IGF-1
Cannot suppress GH after oral glucose test
Pituitary mass on MRI
How to treat excess GH?
Resect adenoma
Treat with OCtreotide or PEGVISOMANT (GH receptor antagonist)
How to distinguish Central DI vs. Nephrogenic DI?
Water deprivation test
- Give ADH: If increase >50% osmolality then have Central if no change then Nephrogenic
What are some causes of neprhogenic DI?
Hereditary, 2 to hypercalcemia,
Lithium
Demeclocycline (ADH antagonist)
Treat: HCTZ, Indomethacin, Amiloride
Hydration
What are some causes of central DI?
Pituitary tumor Autoimmune Trauma Surgery Ischemic Idiopathic
Treatment: Desmopressin acetate
Hydration
How does the body respond in SIADH?
Will decrease aldosterone (hyponatremia) to maintain euvolemia
Must correct slowly or get osmotic central pontine myelinolysis
Causes: Ectopic ADH (Small Cell Lung cancer)
CNS disorder
Pulmonary disease
Drugs (Cylcophosphamide)
Treat: Fluid restrict: IV hypertonic saline, conivaptan, tolvaptan, demeclocycline
What are symptoms of glucagonoma?
Dermatitis (necrolytic with central induration)
Diabetes
DVT
Depression
What is the most common cause of death in Diabetes?
MI is the most common
What causes cataracts in diabetics?
Sorbitol accumulation in organs (osmotic damage)
- Due to aldose reductase and decrease in sorbitol dehydrogenase (eyes and neurons)
