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Surgery Rotation EORE > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

where does adrenal carcinoma have METS to?

A

liver and lung

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2
Q

what’s the s/s of adrenal carcinoma?

A

Most often hormone HYPERSECRETION

Women- hirsutism, temporal balding, increased muscle mass, amenorrhea

Men- gynecomastia, testicular atrophy, impotence, decreased libido

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3
Q

what’s the PE like for adrenal carcinoma?

A

abdominal mass

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4
Q

what’s the tx of choice for adrenal carcinoma?

A

Surgical excision of tumor

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5
Q

what’s the post-op tx for adrenal carcinoma?

A

corticosteroid replacement

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6
Q

what is Addison’s disease?

A

adrenocortical insufficiency d/t adrenal gland destruction

lack of cortisol AND aldosterone

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7
Q

what’s are the MC causes of Addison’s disease?

A

Autoimmune: MC cause in industrialized countries - causes adrenal atrophy

Infection: MC worldwide -> Tb***, HIV

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8
Q

is Addison’s secondary or primary adrenal insufficiency?

A

primary adrenal insufficiency

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9
Q

what’s secondary adrenal insufficiency d/t?

A

pituitary failure of ACTH secretion (lack of cortisol)

-d/t exogenous steroid use

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10
Q

what’s the sx’s of Addison’s disease?

A
  1. Hyperpigmentation (d/t ACTH stimulation of melanocyte-stimulating hormone secretion)
  2. Orthostatic hypotension, hyponatremia, HYPERKALEMIA***, non-anion gap metabolic acidosis, hypoglycemia (d/t Decr. Aldosterone)
  3. Decr. sex hormones in women: loss of libido; amenorrhea, loss of axillary and pubic hair
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11
Q

how do you dx adrenal insufficiency?

A
  1. High Dose ACTH (cosyntropin) stimulation test:
    - SCREENING test for adrenal insufficiency
    - if adrenal insufficiency then little or no increase in cortisol levels
  2. CRH Stimulation Test:
    - DIFFERENTIATES b/w the causes of adrenal insufficiency
    - Primary/Addisons -> incr. ACTH levels but low cortisol
    - Secondary (pituitary problem) -> low ACTH and low cotrisol
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12
Q

what’s the tx for adrenal insufficiency? (Primary and Secondary)

A

Hormone replacement:

If Addisons/Primary -> Glucocorticoids (Hydrocortisone) + Mineralocorticoids (Fludrocortisone)

If Secondary -> ONLY glucocorticoids b/c body makes aldosterone so don’t need mineralocorticoid
-so ONLY Hydrocortisone

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13
Q

what’s Cushing’s disease?

A

hypercorticolism caused specifically by PITUIARY INCR. ACTH secretion MC d/t benign pituitary adenoma

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14
Q

what’s the s/s of crushing’s syndrome/disease?

A

central obesity, moon facies, buffalo hump, HTN, hypokalemia, acanthuses nigricans, hirsutism

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15
Q

what’s the MC overall cause of Cushing’s syndrome?

A

Long-term high dose corticosteroid tx

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16
Q

what’s Cushing’s syndrome vs. Cushing’s disease/

A

Cushing’s syndrome = s/s of cortisol excess (from exogenous steroid use)

Cushing’s disease = from pituitary tumor increasing ACTH secretion

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17
Q

what’s the MC cause of primary hyperparathyroidism?

A

parathyroid adenoma

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18
Q

what’s the MC cause of secondary hyperparathyroidism?

A

CKD

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19
Q

what is secondary hyperparathyroidism?

A

increased PTH d/t hypocalcemia or Vit. D deficiency (as a result of CKD)

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20
Q

what’s the s/s of hyperparathyroidism?

A

signs of ***HYPERCALCEMIA -> “stones, bones, abd groans, psychiatric moans

decr. DTRs

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21
Q

what’s the dx of primary hyperparathyroidism?

A

***triad: hypercalcemia/incr. Ca + incr. intact PTH + decr. phosphate

incr. 24h urine calcium excretion (incr. Ca, incr. vit D)

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22
Q

what’s the tx of hyperparathyroidism?

A

PARATHYROIDECTOMY

IVF, loop diuretics, bisphosphonates/calcitonin

vit. D/Ca supplement if secondary hyperPTH

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23
Q

what is the criteria to perform a parathyroidectomy for hyperparathyroidism?

A

> 50 y/o or with any symptoms

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24
Q

what are the levels of PTH, Ca, and vit. D in primary hyperparathyroidism?

A

All increased

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25
what are the labs of secondary hyperparathyroidism?
PTH high, Ca decr., vit. D decr. (d/t CKD) -> can't convert vit D to usable form to absorb Ca
26
what's Graves Disease?
hyperthyroidism
27
what's the cause of Graves Disease?
autoimmune circulating TSG receptor antibodies cause incr. thyroid hormone synthesis and thyroid gland growth
28
what's the MC cause of hyperthyroidism?
Graves disease
29
what are the s/s of Grave's disease?
diffuse, enlarged thyroid thyroid bruits*** ophthalmopathy*** -> lid lag, exophthalmos/proptosis -exclusive to Grave's pretrial myxedema*** (non pitting, edematous, pink-brown plaques/nodules on shin) -exclusive to Grave's
30
what s/s of Grave's disease are exclusive to it?
ophthalmopathy*** -> lid lag, exophthalmos/proptosis pretrial myxedema*** (non pitting, edematous, pink-brown plaques/nodules on shin)
31
what's the PE like for Grave's disease?
tachycardia, hyperreflexia, weight loss, diaphoresis
32
what's the labs like for Grave's disease?
Decreased TSH, increased T3/T4 thyroid-stimulating immunoglobin antibodies (+) hypercalcemia
33
how do you dx Grave's disease?
+ Thyroid-stimulating immunoglobulins (most specific) Increased T3/T4 and decreased TSH RAIU -> diffuse uptake
34
what does the RAIU scan show for Grave's disease?
diffuse uptake
35
what's the tx for Grave's disease?
Radioactive Iodine = MC tx used (destroys thyroid gland -> need hormone replacement) Methimazole or PTU (PTU preferred in pregnancy and 1st trimester) BBs (like propranolol) for sx relief Thyroidectomy (if compressive sx, no response to meds)
36
which med for tx of hyperthyroidism (ex. Grave's) is preferred in pregnancy, esp. 1st trimester, Methimazole or PTU?
PTU
37
what's the MOA of Methimazole or PTU? adrs?
MOA = inhibit hormone synthesis Adrs: agranulocytosis, hepatitis
38
what's the MC cause of hyperthyroidism in elderly?
Toxic multinodular goiter
39
what's the RAIU show for toxic multinodular goiter and toxic adenoma for hyperthyroidism?
TMG -> patchy areas of both incr uptake and decr. uptake TA -> incr. local uptake (hot nodule)
40
what's the MC therapy for tx of toxic multinodular goiter and toxic adenoma for hyperthyroidism?
Radioactive Iodine
41
what's the sx's of TSH secreting pituitary adenoma (cause of hyperthyroidism)?
bitemporal hemianopsia
42
most pts with thyroid cancer are what?
euthyroid
43
what are the types of thyroid cancer?
Papillary, follicular, medullary, anaplastic
44
what's the MC type of thyroid cancer?
papillary
45
what's the MC RF for papillary thyroid cancer? most common in who?
radiation exposure = MC RF MC in young females
46
what's the s/s of papillary? thyroid cancer prognosis?
LEAST AGGRESSIVE Mets to cervical LN Prognosis = excellent
47
what's a RF for follicular thyroid cancer? most common in who?
iodine deficiency MC in 40-60 y/o
48
what's the s/s of follicular thyroid cancer? prognosis?
aggressive but slow growing Mets- distant mets common (lung, brain, bone, liver, skin) Prognosis = excellent
49
what's the MC RF for medullary thyroid cancer?
MEN 2
50
what's the s/s of medullary thyroid cancer? prognosis?
arises from parafollicular cells that secrete CALCITONIN LN early, distant mets later Prognosis = POOR, tumor doesn't take up iodine
51
who is anaplastic thyroid cancer MC in?
males >65 y/o
52
what's the s/s of anaplastic thyroid cancer?
MOST AGGRESSIVE, rapid growth, with COMPRESSIVE SX Local & distant METS MAY INVADE TRACHEA Prognosis = poor
53
what's the tx of papillary and follicular thyroid cancer?
TOTAL THYROIDECTOMY must supplement with thyroid hormone (levothyroxine)
54
what's the tx of medullary thyroid cancer?
Total thyroidectomy w neck LN dissection Calcitonin levels used to monitor
55
what's the tx for anaplastic thyroid cancer?
Most cannot be surgically resected - radiation - Chemotherapy Palliative tracheostomy to maintain airway
56
what's a thyroid nodule?
abnormal lump in thyroid gland
57
what are the RFs of thyroid nodules?
extremes of age (very young or hold >60 y/o) h/o head/neck irradiation
58
are most thyroid nodules in women benign or malignant?
benign (follicular adenoma or cysts)
59
what are the s/s of thyroid nodules?
1. Most are asx 2. Compressive sx: diff swallowing/breathing, neck, jaw, or ear pain, hoarseness (if compresses recurrent laryngeal nerve)
60
what's PE like for thyroid nodules (benign vs malignant)?
Benign: -varied- smooth, firm, irregular, sharp outlines, painless Malignant: -rapid growth, fixed, no movement w swallowing
61
how do you dx thyroid nodules?
Thyroid Function Tests -MOST PTS ARE EUTHYROID FNA w/ bx -BEST INITIAL TEST TO EVAL NODULE Radioactive Iodine Uptake Scan (RIAU)
62
what's the BEST initial test to evaluate a thyroid nodule?
FNA w/ bx (done with thyroid U/S)
63
what are the benign thyroid nodules?
Follicular adenoma (colloid) - MC type of thyroid nodule
64
what is the MC type of thyroid nodule?
follicular adenoma
65
when is radioactive iodine uptake scan done for thyroid nodule dx?
if the FNA is indeterminate
66
what does radioactive iodine uptake scan show if thyroid nodule is malignant?
cold nodule (no/low iodine uptake)
67
what's the tx for thyroid nodule?
Surgery if thyroid cancer is suspected or if an indeterminate FNA w/ a cold thyroid scan Observation of suspicious nodules (usu. q6-12 months) with U/S
68
what is pheochromocytoma?
CATECHOLAMINE-SECRETING ADRENAL TUMOR (chromaffin cells) -Secretes norepi & epi autonomously & intermittently
69
what are triggers of pheochromocytoma to secrete norepinephrine & epi?
surgery = big one
70
is pheochromocytoma benign or malignant?
majority are benign
71
what is the s/s of pheochromocytoma?
HTN: most consistent finding (secondary HTN)* “PHE”:* Palpitations, Headaches (paroxysmal), Excessive sweating classic triad of: episodic HA, sweating, tachycardia
72
what's the most consistent s/s of pheochromocytoma?
HTN (secondary)
73
how do you dx pheochromocytoma?
Incr. 24h urinary catecholamines including metabolites (incr. Metanephrine & incr. Vanillylmandelic acid)* OR plasma-fractionated metanephrines test -MRI/CT of abdomen & pelvis when above is positive
74
what's the classic triad of s/s of pheochromocytoma?
episodic HA, sweating, tachycardia
75
when do you perform the 24 hr urinary fractionated metanephrines & catecholamines test for dx pheochromocytoma?
low suspicion of disease (no family history)
76
when do you perform plasma fractionated metanephrines test for dx of pheochromocytoma?
if high suspicion of disease (I.e. family hx - MEN2 and VHL syndrome)
77
what d/o is pheochromocytoma a/w?
MEN2
78
what's the procedure of choice for tx of pheochromocytoma?
laparoscopic complete adrenalectomy
79
when pheochromocytoma pt is pre-op for surgery of tumor, what meds are used to treat their symptoms while in surgery?
PHENOXYBENZAMINE OR PHENTOLAMINE x7-14 days → followed by beta blockers or CCBs to control HTN
80
why do you NOT want to initiate beta-blockers in pheochromocytoma pt tx before surgery?
b/c want to prevent UNOPPOSED ALPHA-CONSTRICTION DURING CATECHOLAMINE RELEASE
81
what type of medication is phenoxybenzamine?
non-selective alpha blocker
82
what's the MC cause of hypothyroidism?
Hashimoto's thyroiditis (autoimmune)
83
what is adrenal crisis?
sudden worsening of adrenal insufficiency d/t a "stressful" event (surgery, trauma, volume loss)
84
what's the MC cause of adrenal crisis?
abrupt withdrawal of glucocorticoids
85
what's the s/s of adrenal crisis?
1. Shock = primary manifestation; hypotension, hypovolemia
86
what's the labs like for adrenal crisis?
hyponatremia, hyperkalemia, hypoglycemia
87
what's the tx for adrenal crisis?
NS or D5NS if hypoglycemic IV Hydrocortisone Fludrocortisone

Surgery Rotation EORE (10 decks)

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