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Flashcards in Endocrinology Deck (80):
1

Nelson syndrome

rapid enlargement of pituitary adenoma after removal of both adrenal glands for Cushing's disease; characterized by bitemporal hemianopsia and hyperpigmentation

2

Dx. nelson's syndrome

MRI - suprasellar extension of pituitary adenoma
labs - very high plasma ACTH levels

3

tx. nelsons syndrome

surgery and/or pituitary radiation

4

lab findings in non-functioning pituitary adenoma

1. hypogonadism - low levels of FSH and LH
2. serum alpha subunit levels are elevated

5

preferred therapy for nonfunctioning pituitary adenoma

trans-sphenoidal surgery

6

tx. prolactin-secreting adenomas

DA agonists ex. cabergoline

7

what dyslipidemia is common in HIV pt

triglyceridemia
assoc. with elevated LDL and TC & decreased HDL

8

tx. of hypertriglyceridemia in HIV pt on antiretroviral therapy

if TG> 500 -> fibrate medication (gemfibrozil)
if TG < 500, can use a statin

9

amiodarone effects on thyroid

decreased conversion from T4 to T3 = decreased T3 and increased T4 levels
- may also cause hypothyroidism and thyrotoxicosis due to high iodine content

10

diagnoses of DM

1. two FPG > 126
2. one random glucose > 200 with symptoms
3. abnormal OGTT
4. HbA1c > 6.5%

11

pt with type 2 DM that is not adequately controlled with metformin - next step?

add sulfonylurea

12

S/E of metformin

lactic acidosis

13

contraindications of metformin

renal insufficiency (Cr > 1.4, CCl < 50)
use of contrast agents --> ARF
alcohol abuse
CHF
liver disease

14

what should you do in pt on metformin about to have a contrast procedure done?

1. stop metformin 1 d prior
2. if high risk for RF, give NaHCO3 or NS before procedure, adequately hydrate

15

s/e of sulfonylrureas

hypoglycemia
SIADH

16

DPP-IV inhibitors

sitagliptin, saxigliptin
- increase insulin release and block glucagon

17

C/I to rosiglitazone/pioglitazone

CHF

18

insulin secretagogues

nateglinide, repaglinide
- short acting
- cause hypoglycemia

19

GLP analogs

exenatide, liraglutide
- decrease gastric motility (increase feeling of fullness)
- increase satiety
- promote weight loss

20

s/e exenatide or liraglutide

NV
dyspepsia
sensation of fullness/bloating

21

best test to determine severity of DKA

serum bicarb
(also: ph < 7.3 or anion gap high)

22

effect of glucose on Na levels

high glucose artificially drops Na levels

23

which hyperlipidemia drug is C/I in diabetes

niacin - worsens glucose intolerance

24

Tx. diabetic neuropathy

gabapentin
pregabalin

25

Tx. diabetic gastroparesis

erythromycin or metoclopramide

26

lab findings in TSH secreting adenoma

elevated TSH and T3/T4
increased serum alpha subunit levels

27

TH resistance syndrome

elevated TSH and T3/T4
symptoms of hypothyroidism

28

increased RAIU

Graves disease
goiter
tsh secreting adenoma

29

decreased RAIU

subacute/painless thyroiditis
iatrogenic/factitious disorder

30

Grave's opthalmopathy

Tx. does not affect the ocular findings
if severe, may lead to compression of the optic N. with visual field deficits

31

what intervention may decrease severity of graves ophthalmopathy

smoking - increases severity

32

Tx. Grave's disease

PTU or MTZ acutely, then RAI to ablate the gland

33

target TSH levels in treatment of thyroid cancer? if mets?

TSH between 0.1 and 0.3 uU/mL. Even lower in distant mets

34

s/e of treatment with suppressive doses of levothyroxine

bone loss
A.fib

35

silent thyroiditis

autoimmune process with a nontender gland and hypothyroidism; RAIU normal or decreased, + TPO ab

36

Tx. silent thyroiditis

none - spontaneously resolves

37

CF: Subacute thyroiditis

likely due to viral infection; pt presents with fever, tender thyroid gland and hyperthyroid followed by hypothyroid symptoms

38

Lab findings in subacute thyroiditis

TSH low, T4 high
RAIU decreased

39

Tx. subacute thyroiditis

Aspirin
propranolol - to decrease sx
Steroids - if symptoms severe and not resolving with NSAIDs

40

only cause of hyperthyroidism with an elevated TSH

pituitary adenoma

41

Tx. thyroid storm

iodine
PTU or MTZ
dexamethasone
propranolol

42

MCC of Hypercalcemia

Primary hyperparathyroidism

43

MCC hypophosphatemia

Continuous glucose infusions

44

Clinical presentation of hypophosphatemia

Muscle weakness, ESP. Diaphragm giving respiratory weakness
Decreased cardiac contractility

45

When do you treat hyperparathyroidism surgically? (4)

Symptomatic disease
Renal insufficiency
Markedly elevated 24 hr urine calcium
Very elevated serum calcium > 12.5

46

Presentation of acute severe hypercalcemia

Confusion
Constipation
Short QT syndrome
Polyuria, polydipsia from nephrogenic DI
Renal insuff, ATN, kidney stones

47

Management of acute hypercalcemia

1. Hydration: 3-4 L normal saline
2. Furosemide: only after hydration has been given
- if those two don't work, can try calcitonin
3. Bisphosphonate (pamidronate) - chronic management

48

Clinical findings in severe Hypocalcemia

Seizures
Neural twitching
Arrhythmia prolonged QT

49

Diagnosis of Cushing syndrome

1. 1 mg dexamethasone suppression test
- if this fails to suppress:
2. 24 hour urine cortisol test

50

You find a pt to have high cortisol, high ACTH level that suppresses to high dose dexamethasone test. You suspect pituitary adenoma but MRI does not show any lesions. What should you do next?

Inferior petrosal sinus sampling

51

CF of Addison Disease

Fatigue, anorexia, weakness, weight loss, hypotension
Thin pt with hyperpigmented skin
Concomitant autoimmune disorders

52

Lab findings in Addison's disease

Hyperkalemia with metabolic acidosis
Hyponatremia
Hypoglycemia
Neutropenia
Peripheral eosinophillia

53

Most accurate diagnostic test

Cosyntropin (ACTH) stimulation test
- give ACTH , should have increase in cortisol, if no increase then you have adrenal insufficiency

54

Tx. Addison's disease

1. Acute crisis (ie hypotensive) - give hydrocortisone or dexamethasone (doesn't interfere with cortisol measurement) and IVF
2. Chronic - prednisone
3. If still hypotensive despite steroid replacement, give fludrocortisone

55

CF in hyperaldosteronism

Hypertension
Hypokalemia with metabolic alkalosis
Weakness
Nephrogenic DI from Hypokalemia (polyuria and polydipsia)

56

Diagnostic findings in hyperaldosteronism

Low renin
Hypertension
Elevated aldosterone level despite salt loading with normal saline

57

Tx. Hyperaldosteronism

Solitary adenoma - surgery
Hyperplasia - spironolactone

58

Best initial tests for pheochromocytoma

High plasma and urinary catecholamine levels
Plasma free metanephrine and VMA levels

59

Most accurate test for pheochromocytoma

CT or MRI of the adrenal glands

60

When do you do a MIBG scan for pheochromocytoma

If >5 cm in size and suspicion of extra renal disease
Positive hormone levels but negative imaging

61

Tx. Hypertensive crisis in pheochromocytoma

IV nitroprusside
Phentolamine
Nocardipine

62

Tx. Hypotensive crisis in pheo

Normal saline bolus
Pressors if no response

63

Tx. Hypoglycemia in pheo

IV dextrose infusion

64

Cardiac tachyarrhythmias

IV lidocaine or esmolol

65

Medical prep prior to surgery for pheo

Phenoxybenzamine for 10-14 days
Propranolol before surgery (1-2d)

66

Features of all types of CAH

Low aldosterone and cortisol
High ACTH levels
Tx. Prednisone

67

Most accurate test for prolactinoma

MRI of the brain

68

Best initial therapy for prolactinoma

DA agonists - bromocriptine, cabergoline

69

Best initial test for acromegaly

IGF1 level

70

Most accurate test for acromegaly

OGTT
- normally, GH is suppressed by glucose
Suppression of GH by glucose excluded acromegaly

71

Tx. Acromegaly

Surgical removal - transsphenoidal resection
Octreotide, cabergoline, bromocriptine - prevent release of GH

72

Pegvisomant

GH receptor antagonist

73

Testicular feminization - features

Female, who does not menstruate
Breasts present
Exam: vagina ends in blind pouch, no cervix, uterus or ovaries
Genetically, XY

74

CF of Klinefelters

Tall men, small testicles
XXY karyotype
Insensitivity to FSH and LH on their testicles (high levels but no testosterone is produced)

75

Tx. Klinefelters

Testosterone

76

Kallmans syndrome

Anosmia
Hypogonadism - low LH, FSH, GnRH

77

Pituitary apoplexy

Sudden hemorrhage into pituitary gland causing obtundation due to a rapid drop in cortisol level and hypotension that fails to respond to IVF

78

Tx. Pituitary apoplexy

Stabilized with high dose steroids and IVF. Give fludrocortisone

79

In what situation should you not use Ringers lactate solution

Hyperkalemia - it contains K+

80

Insulin dosing prior to surgery

Admin of 1/3 usual insulin dose