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Endocrinology Flashcards

1
Q

What are two antibodies to measure to confirm T1DM?

A

GAD65 and IA-2

*Will be negative especially in African or Asian ancestry

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2
Q

If you have nocturnal hypoglycemia, what type of insulin is too much?

A

basal

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3
Q

What is an autosomal dominant form of T2DM that presents before 25 years old?

A

MODY-maturity onset diabetes of youth

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4
Q

When do you screen for T2DM? USPSTF vs ADA

A

USPSTF: 40-70 yo in patients who are overweight or obes. Can consider screening earlier with 1+ risk factors (positive family history, h/o gestational diabetes or PCOS, ethnic groups)

ADA: overweight BMI >25 or >23 in Asian Americans with at least 1 additional risk factor`

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5
Q

What are 3 ways to screen for T2DM?

A

fasting plasma glucose, 2 hour postprandial glucose during oral glucose tolerance test, A1c

If 1 of 2 is abnormal, repeat the abnormal test
If 2/2 is abnormal, then diagnose

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6
Q

T/F: if random plasma glucose >200 and have hyperglycemic symptoms–>diagnosis as DM

A

T

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7
Q

What is the cut off for prediabetes in:

1) fasting glucose
2) random glucose
3) 3 hour glucose during OGTT
4) hemoglobin A1c

A

1) 100-125
2) 140-199
3) 140-199
4) 5.7-6.4

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8
Q

What is the cut off for diabetes in:

1) fasting glucose
2) random glucose
3) 3 hour glucose during OGTT
4) hemoglobin A1c

A

1) >126
2) >200 with symptoms
3) >200
4) >6.5

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9
Q

When should blood glucose be measured if preprandial readings look good, but the a1c is still elevated?

A

postprandial blood glucose levels

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10
Q

What is a1c goal for diabetic?

A

7-8%

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11
Q

What 3 situations will the a1c be falsely low?

A

1) hemolytic anemia
2) EPO
3) kidney injury

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12
Q

What is a contraindication to metformin?

What is a vitamin deficiency with metformin?

A

1) eGFR<30

2) vit B12

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13
Q

What is the 3 side effects of sulfonylureas?

When do you avoid using it?

A

3 side effects: weight gain, hypoglycemia, rash

avoid using in renal failure

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14
Q

What are 3 side effects of metformin?

When do you avoid it?

A

3 side effects: diarrhea, abdominal pain, lactic acidosis, (also vit B 12 deficiency)
avoid: eGFR<30

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15
Q

What is a side effect of alpha glucosidase inhibitors (acarbose, miglitol, voglibose)
When do you avoid it?

A

abdominal pain

avoid in kidney injury

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16
Q

What are 6 side effects of thiazolidinediones (rosiglitazone, pioglitazone)
When do you avoid it?

A

6 side effects: weight gain, edema, HF, macular edema, osteoporosis, bladder cancer risk
avoid if have CV events (especially with rosiglitazone)

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17
Q

What are 2 side effects of meglitinide (reaglinide, nateglinide)
When do you avoid it?

A

2 side efects: weigth gain, hypoglycemia

avoid in renal failure

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18
Q

What are 2 side effects of amylinomimetics (pramlintide)

What caution do you need to take with prescribing with insulin?

A

2 side effects: nausea, vomiting

increased risk of hypoglycemia with insulin

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19
Q

What are 2 side effects with GLP-1 mimetics (exenatide, liraglutide)
What are 2 things you are at risk of?

A

2 side effects: nausea, vomiting

increased risk of pancreatitis and kidney failure

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20
Q

What are 3 side effects of DPP-4 inhibitors (sitagliptin, saxagliptin, vildagliptin, linagliptin, alogliptin)
What 2 things are you at risk of?

A

3 side effects: nausea, skin rash, infections

increased risk of pancreatitis, HF exacerbation

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21
Q

What are 2 side effects of SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin)
What medical history would you caution you to use this?

A

2 side effects: genital candidal infections and UTIs
medical history: peripheral vascular idsease, previous amputations, diabetic ulcers or neuropathy

can have hypoglycemia with insulin, DKA, canagliflozin is associated with lower extremity amputation

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22
Q

What are 3 DM meds that can help with weight loss?

A

GLP-1 mimetics , pramlintide, SGLT2 inhibs

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23
Q

When should screening for complications begin for T1DM? T2DM?

A

T1DM: 5 years after diagnosis and annually
T2DM: at diagnosis and annually

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24
Q

What is the BP goal for DM?

1) ACC/AHA
2) ADA

A

1) <130/80

2) <140/90

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25
Q

When do you start a statin (and what) in a diabetic:

1) >40 yo, diabetes, ASCVD risk <7.5%
2) CAD, peripheral vascular disease or ASCVD risk >7.5% (AHA/ACC)
3) 40-75 yo, diabetes and ASCVD >10% (USPSTF)

A

1) moderate intensity
2) high intensity
3) moderate to high intensity

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26
Q

When do you start ACE/ARB when measuring urine albumin excretion of acreatinine?

A

> 30

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27
Q

What are 3 treatments for diabetic retinopathy?

A

1) excellent blood glucose and BP control and smoking cessation
2) panretinal laswer photocoagulation
3) intraocular injections of bevacizumab or ranibizumab for severe or macular edema

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28
Q

How can you treat diabetic peripheral neuropathy?

A

amitriptyline, venlafaxine, duloxetine, paroxetine, pregabalin, gabapentin, valproate or capsaicin cream

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29
Q

T/F: Treat diabetic mononeuropathy (like a 3rd nerve palsy)

A

False, it was resolve spontaneously

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30
Q

What do you need to think about when there is a patient with AMS, hypovolemia, normal pH and bicarb?

A

HHS

glucose >600
plasma osmolality >320

management: NS to replenish extracellular space, then switch to hypotonic solution. Give IV insulin after expansion of intravascular space. Then subQ insulin once eating and glucose <200

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31
Q

How do you manage DKA?

A

NS then switch to 1/2NS if sodium level is high or normal. Then give insulin (delay if K <3.3), replace K when K is <5.5, glucose infusion when glucose level is <250, continue until AG is closed

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32
Q

When do you screen pregnant women for gestational diabetes?

A

24-28 weeks with 75 gram 2 hour OGTT

continue screening for T2DM with annual screening after delivery

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33
Q

What are the glycemic targets in pregnancy for:

1) premeal plasma glucose
2) 1 hour postprandial values
3) 2 hour postprandial values

A

1) <95
2) <140
3) <120

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34
Q

What meds are used during pregnancy for diabates?

A

insulin

stop ACE/ARBs, statins

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35
Q

When should comprehensive eye exam be done during pregnancy for diabetes?

A

once per trimester

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36
Q

Which antihypertensives can be used in pregnancy?

A

methyldopa, BB (NOT atenolol), CCB, hydralazine

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37
Q

What is whipple triad?

A

neuroglycopenic sx, hypoglycemia <55, resolution of sx with glucose ingestion

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38
Q

What is a common cause of postprandial hypoglycemia?

A

previous gastrectomy or gastric bypass surgery

meals of simple CHO is the cause

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39
Q

What is C peptide level if surreptitious use of oral hypoglycemic agents?

A

elevated during hypoglycemia

urine screen for sulfonylurea and meglitinide metabolites

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40
Q

What is C peptide level if surreptitious use of insulin?

A

low during hypoglycemia

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41
Q

What is seen with a 72 hour fast if insulinoma is suspected?

1) fasting plasma glucose
2) serum insulin
3) C peptide

A

1) <45
2) >5-6
3) high

schedule abdominal CT

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42
Q

What can present as hyperparathyroidism, pituitary neoplasms, pancreatic neuroendocrine tumors (gastrinomas and insulinomas)

A

MEN1

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43
Q

What dx is suspected with sudden headache, visual change, ophthalmoplegia and AMS associated with hypopituitarism?

A

pituitary apoplexy 2/2 hemorrhage or infarction

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44
Q

What dx is suspected with postpartum amenorrhea, inability to lactate and fatigue?

A

postpartm pituiary necrosis (Sheehan syndrome)

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45
Q

What dx is suspected with hypopituitarism and mass lesion but during pregnancy?

A

lymphocytic hypophysitis

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46
Q

Which hormone deficiency is seen with:

1) amenorrhea, loss of libido, ED
2) fatigue, n,v, weight loss, abdominal pain
3) cold intolerance, weight gain, constipation
4) loss of muscle mass
5) polydipsia, polyuria, nocturia

A

1) FSH/LH
2) ACTH
3) TSH
4) GH
5) DI 2/2 ADH deficiency

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47
Q

How do you test for the following hormone deficiency?

1) GH
2) FSH/LH
3) TSH
4) ACTH
5) prolactin

A

1) IGF decreased, decreased resonse to insulin tolerance test
2) FSH, LSH, estradiol/testosterone levels low
3) decreased T4 and TSH
4) low cortisol and ACTH, depressed response of 11 deoxycortisol and cortisol to metyrapone; positive cortisol resonse to ACTH
5) elevated prolactin

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48
Q

What is treatment for adrenal insufficiency?

A

hydrocortisone

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49
Q

What is treatment for pituitary apoplexy

A

glucocorticoids until adrenal insufficiency has been r/o

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50
Q

How do you titrate thyroxine dose for central hypothyroidism?

A

based off T4 and NOT TSH

treat after hypoadrenalism has been r/o or treated

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51
Q

When is pituitary gland enlarged w/o mass? (2)

A

1) untreated primary hypothyroidism

2) pregnancy

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52
Q

Where does pituitary adenoma come from?

A

anterior

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53
Q

How do you test for cushing disease? (proximal muscle weakness, facial rounding, centripetal obesity, purple striae, DM, HTN)

A

24 hoururine cortisol excretion, dexamethasone suppression test or late night salivary cortisol level (ELEVATED), serum ACTH level (ELEVATED or “NORMAL”)

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54
Q

What meds can cause hyperprolactinemia?

A

TCAs, antiseizure meds, metoclopramide and domperidone, CCB, methyldopa, opiates, protease inhibs

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55
Q

T/F: hypothyroidism can cause hyperprolactinemia

A

T

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56
Q

What is tx for sx prolactinoma?

A

cabergoline >bromocriptine (dopamine agonist therapy)

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57
Q

What is tx for pituitary adenomas that secrete hormones?

A

surgery

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58
Q

What hormone deficiency causes central DI?

A

ADH

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59
Q

What electrolyte can also cause polyuria?

A

hypercalcemia

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60
Q

What will confirm dx of DI?

A

urine osm <200 and inabilit to increase urine concentration during water deprivation test

then do desmopressin challenge test to differentiate between central and nephrogenic forms (if urine concentrates –>positive–>central DI–>order MRI of pituitary gland)
(if urine doesn’t concentrate–>negative–>peripheral DI–>order kidney US)

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61
Q

TX for DI

1) DI after neurosurgery or head trauma
2) chronic central DI
3) lithium-induced peripheral DI
4) non-drug induced peripheral DI

A

1) D51/2NS if can’t drink + desmopressin if UOP high or hyperNa develops
2) desmopressin
3) stop lithium OR add amiloride
4) thiazide diuretic and salt restriction

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62
Q

What 3 hormones need to be measured if you see empty sella syndrome?

A

cortisol, TSH, T4 (if asx)

all hormones if sx

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63
Q

What are 3 types of destructive thyroiditis?

A

subacute (de Quervain), post partum, silent (painless)

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64
Q

Which thyroidtoxicosis presents as a nonautoimmune inflammation that has a firm and painful thyroid gland?

A

subacute

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65
Q

T/F: Permanent hypothyroidism can follow destructive thyroiditis

A

T

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66
Q

What occurs when ou have hyperthyroidism associated with cardiac decompensation, fever, delirium and psychosis?

A

thyroid storm

can follow surgery, infection, iodine load (contrast) and untreated Graves

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67
Q

What is the next step if TSH is suppressed but T4 is normal?

A

measure T3 to see if there is a T3 toxicosis

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68
Q

What hyperthyroid do you see with this:

1) decreased TSH, increased T4
2) decreased TSH, increased T3, normal free T4
3) decreased TSH, normal T3 and free T4 w/o symptoms
4) increased TSH, increased T3, increased T4

A

1) primary hyperthyroidism
2) primary hyperthyroidism with T3 toxicosis
3) subclinical hyperthyroidism
4) secondary hyperthyroidism from pituitary tumor (central hyperthyroidism

69
Q

What is the treatment for toxic multinodular goiter or toxic adnoma?

A

iodine therapy or surgery

70
Q

What is the first line medical treatment for hyperthyroidism?

A

methimazole

71
Q

Which medication is used for hyperthyroidism in the first trimester of pregnancy or during tyroid storm?

A

propylthiouracil

72
Q

What are 3 side effects of methimazole? What is side effects of propylthiouracil?

A

3: agranulocytosis, drug rash, hepatotoxicity
PPU: more hepatotoxicity but same as above

73
Q

What is the definitive treatment for severe Graves ophthalmopathy?

What treatment needs to be AVOIDED?

A

thyroidectomy

radioacive iodine (can make ophthalmopathy worse)

74
Q

What is the treatment for subclinical hyperthyroidism?

A

methimazole if TSH <0.1

75
Q

What 4 medications can cause hypothyroidism?

A

amiodarone, lithium, interferon alfa, interleukin-2

76
Q 
What can the following labs look like with hypothyroidism?
prolactin
sodium
CK
AST
cholesterol
A 
prolactin high
sodium low
CK elevated
AST elevated
cholesterol elevated
77
Q

How do you treat subclinical hypothyroidism?

A

levothyroxine if TSH >10

78
Q

What 4 things can decrease levothyroxine absorption?

A

celiac disease
calcium supplements
iron supplements
PPIs

79
Q

What happens to hypothyroidism in pregnancy?

A

thyroid demand increases by 50%

80
Q

What is the treatment for myxedema coma?

A

levothyroxine and hydrocortisone (until adrenal insufficiency is r/o)

81
Q

When is FNA biopsy indicated?

1) all thyroid nodules >__cm with suspicious sonographic features and normal TSH
2) nodules

A

1) >1 cm

2) <1cm

82
Q

When is calcitonin measured in a thyroid nodule?

A

if have hypercalcemia or fhx of thyroid cancer of MEN2

83
Q

When is surgery indicated for a thyroid nodule?

A

if continued nodule growth despite normal FNA
If malignant cytology
if large multnodular goiters associated with compressive symptoms

84
Q

What will ACTH levels look like in Cushing syndrome if:

1) ACTH dependent
2) ACTH independent

A

1) ACTH normal/elevated

2) low or normal

85
Q

What are 2 causes of:

1) ACTH dependent
2) ACTH indepdent

A

1) ACTH secreting pituitary adenomas (Cushing disease) and ACTH secreting carcinomas and carcinoid tumors
2) adrenal adenomas; adrenal carcinomas

86
Q

What are 3 first line tests for cushing disease?

A

1) 1 mg overnight dexamethasone suppresion test (positive is if failure to suppress serum cortisol to <3)
2) 24 hour urine cortisol level (positive is elevated)
3) late night salivary cortisol level (positive is elevated)

87
Q

What is the next test to order if cortisol level is elevated or is not suppressible?

A

order ACTH level

88
Q

If morning ACTH is elevated (over 20), then what is the next step?

If morning ACTH is suppressed or normal (<5), then what is the next step?

A

1) pituitary imaging

2) adrenal CT

89
Q

What is the next step if ACTH is elevated, but no pituitary tumor is visualized?

A

order 8 mg dexamethasone suppression test to differentiate between pituitary and ectopic tumor ACTH production

  • if it doesn’t suppress cortisol production–>ectopic tumor releasing ACTH such as SCLC, bronchial carcinoid, pheochromocytoma, medullary thyroid carcinoma–>chest and abdmen CT
  • if it suppreses pituitary ACTH production and adrenal cortisol secretion–>is pituitary and will need intrapetrosal sinus sampling
90
Q

What can cause false positives (failure to suppress cortisol) with the 1mg dexamethasone suppression test?

A

alcohol, obesity, psychological disorders

91
Q

What are the treatments for cushing syndrome?

A

surgery and bisphosphonates for the low bone density from hypercortisolism

92
Q

What is the next step after finding an adrenal incidentaloma ?

A

1mg overnight dexamethasone suppression test and 24 hour urine metanephrines/catecholamines

If having HTN or hypokalemia, also measure plasma aldosterone-plasma renin activity ratio

93
Q

What characteristic of the adrenal mass makes it more likely that it is malignant?

A

size >6cm

94
Q

What is the treatment for adrenal masses?

A

surgery if >4cm or functional tumors

masses <4cm are monitored radiographically in 6-12 months and repeat screning for hormonal hypersecretion

95
Q

What hormones are deficient in Addison’s disease?

A

cortisol, aldosterone, adrenal androgens

96
Q

What hormones are deficient in secondary adrenal insufficiency?

A

cortisol and adrenal androgens

97
Q

What symptoms are unique to primary adrenal insufficiency?

A

hyperpigmentation, hyponatremia and hyperkalemia

98
Q

What is the most comon cause of primary insufficiency

A

autoimmune adrenalitis

99
Q

What morning cortisol level diagnosis cortisol deficiency?

A

<3

> 18 excludes the diagnosis

100
Q

What test can distinguish between primary and secondary adrenal insufficiency if morning cortisol level is equivocal

A

morning ACTH

101
Q

What is the next step if evaluating for cortisol deficiency and ACTH level is:

1) morning ACTH is elevated >20
2) morning ACTH is supresse dor normal <5

A

1) adrenal CT

2) pituitary MRI

102
Q

What is the next step if there is a nondiagnostic cortisol value when evaluating for adrena insufficiency?

A

stimulation testing with synthetic ACTH (cosyntropin)–>stimulated serm cortisol >18 excludes adrenal insufficiency

103
Q

What is the acute adrenal insufficiency treatment immediately?

A

high dose dexamethasone and IV saline

**dexamethasone doesn’t mess up serum cortisol assay

104
Q

What is the treatment after adrenal insufficiency is made?

A

primary: hydrocortisone and fludocortisone (but not if hydrocortisone >40mg)
secondary: hydrocortisone

105
Q

What can happen during anesthesia if someone has pheochromocytoma?

A

hypotension

Also gets orthostatic hypotension

106
Q

What 3 diseases are associated with pheochromocytoma?

A

MEN2, von Hippel-Lindau disease, NF type 1

107
Q

What is the appropriate test to order if the pretest probability of pheochromoctyoma is low? High?

A

low: 24 hour metanephrine and catecholamine urine
high: serum plasma metanephrine

if positive, then order MRI/CT of A/P–>if negative then iodine or I-MIBG scan can help

108
Q

What medications are used to treat HTN pre/intra-operative pheochromocytoma?

A

pre: phenoxybenzamine
intra: nitroprusside or phentolamine

109
Q

What are 3 signs that are suggestive of primary hyperaldosteronism? (inrelation to HTN, K, family history)

A

HTN: difficult to treat
K: difficult to treat or provoked hypokalemia
Fhx: positive for primary hyperaldosteronism

110
Q

What 2 lab values are suggestive of hyperaldosteronism?

1) plasma aldosterone-plasma renin activity ratio
2) plasma aldosterone level

A

1) >20
2) >15

**spironolactone and eplerenone can antagonize the aldosterone receptor and messes up measurement

111
Q

How is the diagnosis of hyperaldosteronism done?

A

nonsuppressibility of elevated aldosterone in response to high salt load

112
Q

What is the treatment for hyperaldosteronism?

A

spironolactone/eplerenone for adrenal hyperplasia. adrenalectomy is indicated if aldosterone producing adenoma (but need to do adrenal vein sampling first), but if need more BP control, then use thiazide diuretic

113
Q

What is the testing for primary amenorrhea?

A

pregnancy
karyotype
FSH/LH/TSH/prolactin
pelvic US

114
Q

What is the definition of secondary amenorrhea

A

abscence of menstruation for 3 cycles or 6 consecutive months

115
Q

What medication can cause secondary amenorrhea?

A

metaclopramide and antipsychotics

116
Q

What are 4 causes of hypogonadotrophic hypogonadism? (low estradiol and low/normal FSH/LH)

A

hypothyroidism
hyperporlactinemia
hypothalamic (stress, weight loss, exercise)
pituitary

117
Q

What test can be peformed in patients with secondary amenorrhea?

A

progesterone challenge

if no bleeding, it’s because of low estrogen–>hypothalamic hypogonadism

if bleeding–>normal estrogen–>hyperandrogenism

118
Q

What are 3 things that cause hypergonadotrophic hypogonadism

A

premature ovarian insufficiency (autoimmune)
chemo
pelvic radiation

(low estradiol and elevated FSH/LH)

119
Q

What two hormones are elevated in PCOS?

A

testosterone and DHEAS (not needed for diagnosis)

120
Q

What is the first hormone deficiency to r/o with hyperprolactinemia?

A

hypothyroidism

121
Q

What syndrome is caused by h/o dilatation and curettage, amenorrhea caused by fibrous uterine scarring?

A

Asherman syndrome (uterine synechiae)

122
Q

What are 3 criteria needed for PCOS diagnosis (you only need 2 of the 3)

A

1) ovulatory dysfunction
2) lab or clinical evidence of hyperandrogenism
3) US evidence of polycystic ovaries

123
Q

What are typical labs in PCOS:

1) testosterone
2) DHEAS
3) LH/FASH ratio

A

1) elevated
2) elevated
3) >2:1

124
Q

What is the treatment of hirsutism?

A

fertility not desired: OCP, spironolactone if hirsutism is still a problem

fertility desired: ovulation induction with clomiphene or letrozole

125
Q

What is the next step in measurement if the two testosterone morning measurements or euivocal?

A

measure free testosterone level by equilibrium dialysis or mass spectrometry

126
Q

What is the next step in labs after testosterone level is low?

A

measure LH, FSH, prolactin

127
Q

What are 5 examples of primary testicular failure (elevated LH/FSH)

A

1) Klinefelter
2) atrophy 2/2 mumps orchitis
3) autoimmune destruction
4) previous chemo or pelvic irradiation
5) hemochromatosis

128
Q

What are 4 examples of secondary hypogonadism (low/normal LH/FSH)

A

1) sleep apnea
2) hyperprolactinemia
3) hypothalamic or pituitary disorders (hemochromatosis, pituitary/hypothalamic tumor)
4) use of opiates, anabolic steroids, glucocorticoids

129
Q

What two labs should be monitored during testosterone therapy?

A

hematocrit and PSA

130
Q

What is the most common cause of hypercalcemia?

outpatient vs inpatient

A

outpatient: primary hyperparathyroidism

Less common presentations: kidney stones, osteooprorosis, pancreatitis, fractures

inpatient: malignancy

131
Q

What are 2 medications than can cause hypercalcemia?

A

thiazides and lithium

132
Q

What syndrome presents as PTH suppressed, P, Cr and CO2 elevated. Can be caused by ingestion of calcium-containing antacids

A

milk-alkali syndrome

133
Q

What imaging should be done if hyperparathyroidism is confirmed and surgery is indicated?

A

sestamibi paraythyroid scan to look for adenoma

134
Q

What is the most common manifestation of MEN1?

A

primary hyperparathyroidism

135
Q

What is the treatment of hypercalcemia?

A

volume with NS, IV bisphosphonates and serum calcitonin, oral glucocorticoid if caused by multiple myeloma or sarcoidosis

136
Q

What are the 3 diseases under MEN1? Which is the most common?

A

1) multigland hyperparathyroidism (most common)
2) pituitary neoplasm (prolactinoma, acromegaly, Cushing disease)
3) pancreatic NETs (gastrinoma, insuinoma, vasoactive intestinal polypeptide-secreting tumor, carcinoid syndrome)

DIAMOND

137
Q

What are the 3 diseases under MEN2? Which is the most common?

A

1) multigland hyperparathyroidism (least common)
2) medullary thyroid cancer (most common)
3) pheochromocytoma

138
Q

T/F: You should measure vit D in all patients with hyperparathyroidism.

A

T

139
Q

What is indicated if patients have primary hyperparathyroidism and hpercalcemic complications like with kidney stones, bone dsiease or previous hypercalcemic crisis?

A

parathyroidectomy

140
Q

At what threshold are asymptomatic hyperparathyroid patients needing surgery?

1) serum calcium level
2) eGFR
3) reduced bone mineral density
4) age

A

1) >1 above normal
2) <60mL/min/1.73m2
3)

141
Q

What is the treatment for hyperparathyroidism if patients are not candidates for surgery?

A

cinacalcet or bisphosphonates

142
Q

What is the adjustment for Calcium in the setting of low albumin?

A

Ca decreases by 0.8 for each 1 g/dL decrease in albumin

143
Q

What are 4 physical findings for hypocalcemia?

A

1) circumoral and acral paresthesia
2) carpal-pedal spasm
3) Trousseau sign (carpopedal spasm induced by ischemia secondary to the inflation of a cuff)
4) Chvostek sign (contraction of facial muscles provoked by lightly tapping over the facial nerve anterior to the ear as it crosses the zygomatic arch. )

144
Q

What is the syndrome that including mucocutaneous candidaisis, adrenal insufficiency, hypogonadism, malabsorption and hypoparathyroidism?

A

polyglandular autoimmune syndrome type 1

145
Q

What are 6 differentials for hypocalcemia?

A

1) hypoparathyroidism (hyperphosphatemia, low PTH)
2) pseudohypoparathyroidism (hyperphos, elevated PTH, normal vit D)
3) CKD (hyperphos, elevated PTH and low 1, 25OH vit D)
4) vit D deficiency (hypophos, bone tenderness/fibromyalgia, weakness, gait difficulty, osteomalacia)
5) impaired PTH secretion and resistance (Mg deficiency)
6) hungry bone syndrome (recent parathyroidism)

146
Q

What is the acute treatment of hypocalcemia?

A

IV calcium gluconate and vit D

147
Q

When does USPSTF recommend DEXA scan?

A

> 65 yo or under if have risk factor using FRAX >8.4%

148
Q

What is the recommended repeat DEXA scan for normal/slightly low bone density and no risk factors?

A

10-15 years

149
Q

What is the definition of osteopenia vs osteoporosis?

A

1) osteopenia -1.0 to -2.4

2) osteoporosis

150
Q

What are secondary causes of osteoporosis related to the following things:

1) hormones
2) GI disease
3) meds

(other secondary causes are rheumatoid arthritis, multiple myeloma, CKD, chronic liver disease, vit D deficiency)

A

1) hyperthyroidism, hyperparathyroidism, Cushing syndrome
2) malabsorption with Crohn disease, interstinal resection, celiac disease
3) thyroid hormone, glucocorticoids, phenobarbital, phenytoin, thiazolidinediones

151
Q

When is FRAX is indicating antiresorptive treatment? (major osteoporotic fracture % and risk of hip fracture %)

A

major osteoporotic fracture: >20%

risk of hip fracture: >3%

152
Q

When denosumab indicated?

A

stage 4 CKD or intolerant of bisphosphonates

Not effective when stopped

153
Q

When is teriparatide indicated in osteoporosis?

A

postmenopausal women, glucocorticoid-induced osteoporosis at high risk, men with hypogonadism related osteoporosis at high risk

Use only for 2 years

154
Q

When is calcitonin indicated in osteoporosis?

A

pain from osteoporotic fractures

155
Q

When are oral bisphosphonates contraindicated?

When are IV bisphosphonates contraindicated?

A

oral: if have CKD or esophageal disease

(then use IV zoledronate as alternative–once a year)

IV: severe hypocalcemia and CKD

156
Q

What is adverse effects of:

1) oral bisphosphonates?
2) IV bisphosphonates?
3) denosumab?
4) teriparatide

A

1) erosive esophatitis and atypical hip fracture
2) osteonecrosis of jaw
3) osteonecrosis of jaw
4) osteosarcoma

157
Q

When do you do a follow up DEXA after starting therapy for osteoporosis?

A

2 years

158
Q

What do Looser zones indicate? (bands perpendicular to bone surface visible on XR)

A

osteomalacia

159
Q

What is osteomalacia caused by?

A

vit D and sometimes deficiencies of calcium or phosphate

160
Q

What is the treatment for osteomalacia?

A

ergocalciferol and elemental calcium

161
Q

What will prolonged and severe vit D deficiency cause?

A

secondary hyperparathyroidism, osteomalacia, sx of bone pain, muscle weakness and fracture

162
Q

What do you measure to eval status of vit D?

A

25 OH vit D

aim for >30

163
Q

What 4 populations will have lower vit D due to medical conditions or meds?

A

1) obesity
2) glucocorticoids
3) orlistat
4) malaborption disorders like bariatric surgery

164
Q

How do you treat vit D deficiency?

A

acute treat with 50,000 U of ergocalciferol or cholecalcicerol then maintenance therapy of 1500 to 2000

165
Q

What is a focal disorder of bone remodeling that leads to greatly accelerated rates of bone turnover and therefore disrupts normal architecture of bone leading to gross deformities?

A

Paget disease

166
Q

What lab value is abnormal in Paget disease?

A

alk phos

167
Q

What are 4 sx/signs of Paget disease?

A

1) bone pain, fractures
2) CN compression syndromes, spinal stenosis, nerve root syndromes
3) high output cardiac failure
4) angioid retinal streaks

168
Q

What is the treatment for Paget disease?

A

bisphosphonates

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