Endocrinology Flashcards
(35 cards)
Most common cause of Hyperparathyroid?
Parathyroid adenoma
Primary Hyperparathyroidism: defn and symptoms
Elevated Calcium due to high PTH
Sxs: Constipation, Dehydration, abdominal pain, bone pain, Kidney stones, arrhythmias
“Bones, stones, abdominal groans, and psychic overtones”
Most common cause of secondary hyperparathyroidism? What is secondary?
Chronic Renal Disease
PTH is high (as in primary) BUT its because calcium is low
Hyperparathyroidism Diagnosis/findings
Increased PTH confirms dx
Hallmark: Hypercalcemia (If hypocalcemia–renal failure disorder, secondary)
EKG: Prolonged PR interval, Shortened QT interval; “Too much too soon, too little too late”
What is a common cause of hypoparathyroidism?
Thyroidectomy
What are the sxs of hypoparathyroidism?
Sxs are always those of HYPOCALCEMIA:
positive Chvostek’s sign, Positive Trousseau’s phenomenon
Cataracts, Teeth/nail defects, tetany, circumoral tingling
Treatment of Hypoparathyroidism?
Calcium and Vitamin D supplementation for life
Acute attacks: IV calcium gluconate
Differentiate between the three Thyroiditis: Acute, subacute, and Chronic lymphocytic
Acute (Suppurative): Pyogenic bacteria, very painful, tender red thyroid; Tx: abx and surgical drainage
Subacute: (de Quervain’s) Viral, Painful enlarged thryoid, low radioactive iodide uptake, Tx: ASA for pain and inflammation
Chronic lymphocytic: Fatigue, dry eyes, dry mouth; Diffusely enlarged firm nodular thyroid; Tx: Levothyroxine
what is the most common type of thyroid cancer?
Papillary Carcinoma
What is the most aggressive thyroid cancer?
Anaplastic
Thyroid Cancer diagnostics
Elevated serum Thyroglobulin: Metastatic papillary and follicular
Fine needle biopsy: Test of choice for initial evaluation of a thyroid nodule; reliable for all types of the cancer except Follicular!—>Incisional biopsy
Radionuclide scan: Performed if the FNA biopsy is indeterminate. COld nodules–>cancer, Hot nodules benign (still only 20% of cold are malignant)
What sxs are associated with medullary thyroid cancer?
flushing, diarrhea, fatigue, and cushing’s syndrome
Which thyroid disease is associated with excess dietary idodine supplementation and exposure to head/neck radiation during childhood?
Hashimotos thyroiditis
Most common cause of Corticoadrenal insufficiency?
Autoimmune destruction of the adrenal cortex-Addison’s Disease
What are the sxs of Addison’s Crisis? Tx?
Hypotension, Acute pain, vomiting, Diarrhea;
Tx: IV saline, Glucose, glucocorticoids
Diagnostic/Labs of Addison’s dz
labs: hyperkalemia, Hyponatremia, hypoglycemia, hypercalcemia, Low Cortisol, High ACTH
Cosyntropin stimulation–diagnostic
- Cortisol <20 mg/dL=positive
Low AM serum cortisol level with high ACTH level–>dx
(High ACTH, bc cortisol which inhibits ACTH is low)
Treatment of Addisons
DOC=hydrocortisone
Fludrocortisone may be added if inadequate salt-retaining effect
What is the most common cause of Cushing’s syndrome?
Cushing’s Disese (ACTH secreting pituitary tumor)
What is the normal function of ACTH
stimulates production of Cortisol
HOw do you diagnose Cushings syndrome? labs?
- Free urine cortisol >125 mg/dL in 24 hours
-
Dexamethasone suppression test
- Plasma cortisol >10 ug/dL
- Plasma ACTH <20 pg/mL
- suggests adrenal tumor
- MRI to identify pituitary tumor
- Corticotrophin-releasing hormone
- separates ACTH-dependent from ACTH independent hypercortisolism
Labs: Hyperglycemia, hypokalemia
How do you treat Cushings?
- Adrenal Inhibitors: Metyrapone or ketaconazole suppress hypercortisolism
- Resect tumor if cushings dz
What is the most common cause of Acromegaly?
Pituitary Adenoma
How do you dx Acromegaly/Gigantism?
- elevated HGH-won’t suppress with hyperglycemia (as it normally does
- MRI: to visualize possible pituitary tumor
- Radiography: enlarged sella turcica
Treatment of Gigantism
- Surgery: Transnasal transsphenoidal
- If surgery fails–>Dopamine agonist->shrink tumors
- Somatostatin analogs-for persistent dz
