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Endocrinology Flashcards

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1
Q

Panhypopituitarism

A

Compression or damage of the pituitary gland.

Caused by tumors, cancers, adenomas, cysts, meningiomas, craniopharyngionas, or lymphoma

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2
Q

Panhypopituitarism causes

A 
hemochromatosis
sarcoidosis
histiocytosis X
infection with fungi, TB, parasites
Autoimmune and lymphocytic  infiltration damages gland
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3
Q

Prolactin def presentation

A

male: no symptoms
female: patient cannot lactate normally after childbirth

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4
Q

LH and FSH deficiency presentation

A

decreased libido, decreased axillary, pubic, body hair

men: no testosterone or sperm & erectile dysfunction
women: unable to ovulate or menstruate normally and become amenorrheric

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5
Q

GH deficiency presentation

A

children: dwarfism

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6
Q

Kallman syndrome

A

decreased FSH, LH, GnRH

and anosmia

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7
Q

Diabetes Insipidus

A

decreased in the amount of ADH from pituitary (central DI) or its effect on kidney (nephrogenic DI)

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8
Q

Central Diabetes Insipidus

A

Damage to the brain

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9
Q

Nephrogenic Diabetes Insipidus

A 
Chronic pyelonephritis
Amyloidosis
Myeloma
Sickle cell disease
Lithium
Hypercalcemia or hypokalemia inhibits ADH effects
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10
Q

Central DI Tx

A

Vasopressin

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11
Q

Nephrogenic DI Tx

A

Correct the cause (hypokalemia or hypercalcemia)

HCTZ, NSAIDs, amiloride

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12
Q

Acromegaly

A

soft tissue overgrowth throughout the body

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13
Q 
increased hat, ring, and shoe size
carpal tunnel
body odor
deep voice
colonic polyps
arthralgias
hypertension
Cardiomegaly, CHF,  erectile dysfunction
A

Acromegaly
pts are hyperglycemic, glucose intolerant, hyperlipidemia

Best initial test: IGF
Most accurate test: glucose suppression test
MIR: after lab values

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14
Q

Acromegaly treatment

A

transphenoidal resection of pituitary
Meds:
cabergoline (dopamine agonists inhibit GH release)
octreotide or lanreotide (somatostatins inhibit GH)
Pevisomant

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15
Q

Hyperprolactinemia

A

pregnancy, chest wall stimulation, cutting pituitary stalk, antipsych, TCA, SSRI, methyldopa, metoclopromide, opioids,
Cosecretion with GH, hypothyroidism with pathologically high TRH levels

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16
Q

Hyperpolactinemia tests

A

Thyroid function tests
Pregnancy tests
BUN/creatinine
Liver function tests

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17
Q

Hyperprolactinemia treatment

A

Dopamine agonists

cabergoline is better than bromocriptine

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18
Q

Hypothyroidism

A

Bradycardia, constipation, weight gain, fatigue lethargy, coma, decreased reflexes, cold intolerance, hypothermia (hair loss, edema)

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19
Q

Hyperthyroidism

A

Tachycardia, palpitations, arrhythmia, diarrhea, weight loss, anxiety, nervousness, restlessness, hyperreflexia, heat intolerance, fever

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20
Q

Hypothyroid tests

treatment?

A

T4 and TSH

synthroid

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21
Q

Hyperthyroidism all have

A

elevated T4 levels

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22
Q

TSH level in hyperthyroidism is

A

elevated in pituitary adenoma

inhibited in other forms

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23
Q

Graves Ophthalmopathy

A

Tx: with steroids

decompressive surgery

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24
Q

Subacture thyroiditis tx

A

painful nodular

treat with aspirin

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25
Pitutary adenoma | tx
surgery
26
Thyroid storm
``` Propanolol Thiourea drugs Iodinated contrast material Steroids Radioactive iodine ```
27
Normal TSH/T4 levels but thyroid nodule is present
FNA
28
Hypercalcemia causes
``` Vitamin D intox Sarcoidosis and other granulmatous disease thiazide diuretics hyperthyroidism metastases to bone and multiple myeloma ```
29
Hypercalcemia most common cause
Primary Hyperparathyroidism
30
confusion, stupor, lethargy, SHORT QT | constipation
Hypercalcemia
31
Hypercalcemia Treatment
- saline hydration at high volume - bisphosponates: pamidronate, zoledronic acid - calcitonin
32
Primary hyperparathyroidism
solitary adenoma most common hyperplasia of all 4 glands parathyroid malignancy
33
Low phosphate short QT on EKG elevated BUN and creatinine Alk phos elevated from effect of PTH on bone
Hyperparathyroidism | high calcium and high PTH
34
Hypocalcemia presentation
twitchy, hyperexcitable
35
Hypercalcemia presentation
lethargic, slow
36
Neural hyper excitability is found in
``` hypocalcemia chvostek sign carpopedal spasm perioral numbness mental irritability seizures trousseau sign ```
37
Hypocalcemia EKG
prolonged QT | may cause ventricular tachycardia
38
Cushing disease
pituitary overproduction of ACTH
39
Cushing syndrome
ectopic production of ACTH
40
Moon face, truncal obesity, buffalo hump, thin extremities, increased abdominal fat, striae, easy bruising, decreased wound dealing, increased sodium reabsorption in kidney
Hypercortisolism
41
Before you get a CT in hypercortisol you need to
establish where the source is
42
Cortisol is an anti-insulin stress hormone which means you will find what on lab?
hyperglycemia | hyperlipidemia
43
Adrenal incidentaloma found now what?
metanephrines of blood/urine to exclude pheo renin and aldosterone levels to exclude hyperaldosteronism 1 mg overnight dexamethasone suppression test
44
Addison's disease
``` chronic hypoadrenalism Autoimmune destruction infection Adrenoleukodystrophy metastatic cancer to adrenal gland ```
45
Adrenal crisis
acute adrenal insufficiency
46
weakness, fatigue, altered mental status, nausea, vomiting, anorexia, hypotension, hyperpigmentation from chronic adrenal insufficiency
Hypoadrenalism presentation acute hypoadrenalism also shows hypotension, fever, confusion, and coma
47
hypoadrenalism | labs
hypoglycemia, hyperkalemia, metabolic acidosis, hyponatremia, high BUN eosinophilia is common in hypoadrenalism
48
Hypoadrenalism Treatment
replace Steroids with hydrocortisone | fludrocortisone (high in aldosterone like effect)
49
Primary hyperaldosteronism | presentation/labs/cause
High BP and low K | usually caused by solitary adenoma
50
primary hyperaldosterone treatment
laproscopic if unilateral | eplerenone or spironolactone if bilateral
51
Pheochromocytoma definition
Autonomous overproduction of catecholamines despite high BP
52
Pheochromocytoma presentation
episodic HTN headache sweating palpitations and tremors
53
Pheochromocytoma best test?
Plasma catecholamines confirm with 24 hr urine metanephrines and catecholamines (more accurate than VMA level)
54
Pheochromocytoma Tx?
phenoxybenzamine propranolol Calcium channel blocker laproscopic removal
55
Diabetes mellitus
persistently increased fasting blood glucose levels> 125 on at least 2 separate occasions
56
Type 1 DM | What the bananas is this?
the pancreas is broken return to sender. momma gave you a terrible pancreas NO INSULIN FOR YOU!
57
Type 2 DM | What the bananas is this?
your tissues have issues and don't wanna take the insulin.
58
Polyuria, polyphagia, polydipsia
DM Type 1 is thin people Type 2 is obese individuals
59
Diagnostic test for DM | NAME THEM
2 FBG >125 mg/dL one reading of >200 mg/dL abnormal oral glucose tolerance testing hemoglobin A1C >6.5%
60
Name your diabetes drugs
``` metformin, sulfonylureas DPPI Glitazones Nateglinide and repaglinide Incretins ```
61
Metformin
blocks gluconeogenesis
62
Sulfonylureas
increase insulin release from pancrease and causes weight gain
63
Dipeptidyl peptidase inhibitors sitagliptin, saxagliptin, linagliptin
increase insulin | decrease glucagon
64
Thiazoladinediones Rosiglitazone, pioglitazone
increase fluid overload
65
Nateglinide and repaglinide
stimulates insulin release | similar to sulfonylreas
66
Incretins Exenatide liraglutide
raise insulin decrease glucagon levels decreased gatric motility
67
Alpha glucosidase inhibitors acarbose, miglitol
block glucose absorption in bowel | cause flatus, diarrhea, and abdominal pain
68
Pramlitide
decreases gastric emptying decreases glucagon levels decreases appetitie
69
Diabetic Ketoacidosis occurs more frequently in who?
type 1 diabetics
70
``` Hyperventilation altered mental status metabolic acidosis with increased anion gap hyperkalemia in blood increased anion gap on blood testing serum positive for ketones ```
DKA see a high glucose level too! when bicarb corrects they can leave the ICU
71
Treatment of DKA
Saline and insulin replace potassium correct the underlying issue: noncompliance with medications, infection, any serious illness
72
All diabetics should?
feet check proteins in urine (+) give ARB/ACEi BP
73
Gastroparesis Tx:
metoclopramide or erythromycin
74
Non-proliferative retinopathy treatment
tighter control of glucose
75
Proliferative retinopathy treatment
treat with photocoagulation
76
Neuropathy treatment
gabapentin pregabalin TCA

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