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Flashcards in Endocrinology Deck (145):
1

diagnosis for diabetes made by ONE of the following (4 different ways)

1. 2 FASTING glucose greater than or equal to 126
2. ONE RANDOM glucose greater than or equal to 200 WITH symptoms (polyuria, polydipsia, polyphagia)
3. ABNORMAL GTT (2-hour GTT with 75G glucose load)
4. HbA1c greater than 6.5%

2

STRONGEST indication for screening for diabetes

HTN

3

mechanism for type 2 diabetes

excess fat = insulin deficiency

4

best INITIAL treatment for type 2 diabetes

- DIET
- EXERCISE
- WEIGHT LOSS

5

best INITIAL MEDICAL treatment for type 2 diabetes

metformin (biguanide)

6

metformin MOA

blocks gluconeogenesis

7

main advantages of metformin (2)

- no risk of hypOglycemia
- does NOT increase obesity

8

metformin CONTRAindications (2 main ones)

- renal insufficiency
- use of contrast

9

name the sulfonylureas (3)

- glyburide
- glimepiride
- glipizide

10

sulfonylurea MOA

increase insulin RELEASE from pancreas

11

sulfonylurea ADVERSE EFFECTS (2 main ones)

- hypOglycemia
- SIADH

12

name the dipeptidyl peptidase 4 (DPP-4) inhibitors

- sitaGLIPTIN
- linaGLIPTIN
- aloGLIPTIN
- saxaGLIPTIN

13

dipeptidyl peptidase 4 (DPP-4) inhibitor MOA

block metabolism of INCRETINS

14

mechanism of incretins (GLP and GIP)

(GLP = glucagon-like peptide)
(GIP = glucose insulinotropic peptide)

increase insulin and decrease glucagon secretion from pancreas

15

name the thiazolidinediones

- rosiGLITAZONE
- pioGLITAZONE

16

thiazolidinedione MOA

increase PERIPHERAL insulin sensitivity

17

thiazolidinediones CONTRAindication

CHF

18

name the a-glucosidase inhibitors

- acarbose
- miglitol

19

a-glucosidase inhibitor MOA

block glucose ABSORPTION in intestinal lining

20

name the insulin secretagogues

- nateGLINIDE
- repaGLINIDE

21

secretagogue MOA

increase insulin RELEASE from pancreas

22

name the SGLT inhibitors (sodium-glucose transport)

- canaGLIFLOZIN
- dapaGLIFLOZIN
- empaGLIFLOZIN

23

SGLT inhibitor MOA

inhibits glucose reabsorption in kidneys

24

name the GLP (glucagon insulinotropic peptide) analogs

- exenaTIDE
- liragluTIDE

25

GLP analog MOA

slow gastric emptying and promote weight loss

26

name long-acting insulin

- glargine (daily)
- detemir (daily, or Q12H)
- NPH (Q12H)

27

name short-acting insulin

- aspart
- lispro
- glulisine

28

mechanism for type 1 diabetes

underproduction of insulin d/t destruction of pancreas

29

DKA presentation

- hyperventilation d/t metabolic acidosis
- "fruity" breath from acetone
- confusion from hyperosmolar state

30

best INITIAL tests for DKA

- chemistry
- arterial blood gas
- acetone level

31

marker of ketone production

B-hydroxybutyrate

32

DKA lab findings

- hyperglycemia (> 250)
- hyperkalemia
- low bicarb
- low pH
- elevated AG
- elevated acetone, acetoacetate, and B-hydroxybutyrate
- +/- pseudohyponatremia

33

INITIAL treatment for DKA

NS bolus

34

once DKA is confirmed, next step in management

IV insulin

35

complications of diabetes:

BP goal

less than 140/90

36

complications of diabetes:

LDL goal

diabetes = CAD
less than 100

if BOTH DM AND CAD, less than 70

37

complications of diabetes:

retinopathy

ANNUAL dilated eye exam to detect PROLIFERATIVE RETINOPATHY

38

treatment for proliferative retinopathy in DM

laser photocoagulation

39

complications of diabetes:

nephropathy

microalbumin

40

if ANY protein is found in urine of DM patient, should be treated with

ACEI/ARB

41

complications of diabetes:

neuropathy

ANNUAL foot exam

42

treatment for diabetic neuropathy

gabapentin, or pregabalin

43

complications of diabetes:

erectile dysfunction

no routine screening test: just ask

44

treatment for erectile dysfunction

PDE inhibitor (e.g. sildenafil)

n.b. CI with nitrates

45

complications of diabetes:

"bloating," constipation, abdominal fullness, and diarrhea

gastroparesis

46

treatment for gastroparesis

metoclopramide, or erythromycin

47

hypOthyroidism:

- weight =
- intolerance =
- hair =
- skin =
- mental =
- heart =
- muscle =
- reflexes =
- fatigue? =
- menstrual changes =

- gain
- cold
- coarse
- dry
- depressed
- bradycardia
- WEAK
- diminished
- yes
- yes

48

hypERthyroidism:

- weight =
- intolerance =
- hair =
- skin =
- mental =
- heart =
- muscle =
- reflexes =
- fatigue? =
- menstrual changes =

- loss
- heat
- fine
- anxious
- tachycardia, tachyarrhythmias (e.g. atrial fibrillation)
- WEAK
- N/A
- yes
- yes

49

mechanism of weight gain in hypOthyroidism

low thyroid = decreased metabolic rate (decreased use of glucose and FFA) = weight gain

50

best INITIAL tests for hypothyroidism

- free T4 (decreased)
- TSH (increased)

51

treatment for hypothyroidism

levothyroxine (T4 replacement, which gets converted in tissues to T3)

52

4 forms of hyperthyroid

1. Graves (diffuse toxic goiter)
2. silent thyroiditis
3. subacute
4. pituitary adenoma

53

Graves disease (diffuse toxic goiter):

- physical findings
- RAIU (radioactive iodine uptake)
- treatment

- eye, skin, and nail findings
- elevated
- radioactive iodine ablation (RAI)

54

silent thyroiditis

- physical findings
- RAIU (radioactive iodine uptake)
- treatment

- none
- low
- none

55

subacute thyroiditis

- physical findings
- RAIU (radioactive iodine uptake)
- treatment

- tender thyroid gland
- low
- aspirin

56

pituitary adenoma

- physical findings
- RAIU (radioactive iodine uptake)
- treatment

- none
- elevated
- surgery

57

ophthalmopathy seen in Graves disease

- exophthalmos (eyes are bulging)
- proptosis (eyelids are retracted)

58

dermopathy seen in Graves disease

pretibial myxedema

59

nail finding seen in Graves disease

onycholysis (separation of nail from nailbed)

60

ACUTE treatment for Graves disease

PTU (propylthiouracil), or methimazole

61

definitive treatment for Graves disease

radioactive iodine ablation (RAI)

62

treatment for symptoms in Graves disease (tremor, and palpitations)

propranolol

63

PTU (propylthiouracil) MOA

inhibits thyroid peroxidase:

- iodination of tyrosine residues of thyroglobulin
- coupling of DIT and MIT
- decreases PERIPHERAL conversion of T4 to T3

64

methimazole MOA

inhibits thyroid peroxidase:

- iodination of tyrosine residues of thyroglobulin
- coupling of DIT and MIT

65

silent thyroiditis may have which antibodies?

- thyroid peroxidase Ab
- antithyroglobulin Ab

66

ONLY cause of hyperthyroidism with ELEVATED TSH

pituitary adenoma

67

treatment for pituitary adenoma

- MRI of brain
- surgery

68

- elevated T4
- low TSH
- nonpalpable thyroid d/t atrophy of gland

exogenous thyroid hormone abuse

69

- acute
- SEVERE
- life-threatening hypERthyroidism

thyroid storm

70

treatment for thyroid storm

- iodine (blocks iodine uptake and hormone release)
- PTU, or methimazole (blocks thyroxine production)
- dexamethasone (blocks PERIPHERAL conversion of t$ to T3)
- propranolol (blocks PERIPHERAL EFFECTS)

71

can you determine etiology thyroid function from presence of goiter?

NO, can hypOthyroidism, hypERthyroidism, or normal thyroid

72

next best in management if there is a solitary thyroid nodule

fine needle biopsy (FNA)

73

if solitary thyroid nodule shows cancer, next step in management

surgery

74

MCC of hypercalcemia

PRIMARY hyperparathyroidism

75

other causes of hypercalcemia

- malignancy
- granulomatous disease
- vitamin D toxicity
- thiazide diuretics
- TB
- histoplasmosis
- berylliosis

76

mechanism of PTH (parathyroid hormone) (4 effects)

- reabsorbs Ca++ at DISTAL tubule
- excretes phosphate at PROXIMAL tubule
- activates vitamin D
- reabsorbs Ca++ and phosphate from bone

77

target organ damage from hyperparathyroidism

- kidney stones
- osteoporosis/osteomalacia/fractures
- confusion
- constipation (initially, diarrhea)

78

diagnostic tests for hyperparathyroidism

- PTH (elevated)
- Ca++ (elevated)

79

treatment for hyperparathyroidism

surgery

80

when is surgical removal the answer for hyperparathyroidism?

- symptoms
- renal insufficiency
- markedly elevated 24H URINE Ca++
- serum Ca++ more than 12.5

81

acute, severe hypercalcemia presentation

- confusion
- constipation
- polyuria/polydipsia (from nephrogenic DI)
- short QT syndrome
- renal insufficiency (ATN/kidney stone)

82

treatment for acute, severe hypercalcemia

1. hydration (high volume: 3-4 liters of NS)
2. bisphosphonate (very potent, but slow)
3. furosemide (ONLY AFTER hydration)
4. calcitonin (IF hydration and furosemide do NOT work quickly enough)
5. steroid (IF etiology is granulomatous disease)

83

mechanism of volume depletion in hypercalcemia

- inhibits ADH effect in collecting duct = nephrogenic DI
- high Ca++ filtration promotes osmotic diuresis

84

causes of hypocalcemia

- surgical removal of parathyroid glands
- hypomagnesemia (PTH needs magnesium to work)
- vitamin D deficiency
- acute hyperphosphatemia (binds Ca++)
- fat malabsorption (binds Ca++ in gut)
- PTH resistance (pseudohypoparathyroidism)

85

presentation of severe hypocalcemia

- seizures
- neural twitching (Chvostek's and Trousseau's signs)
- arrhythmia/prolonged QT

86

treatment for hypocalcemia

- replace Ca++
- vitamin D if deficient, or hypoparathyroidism

87

clinical presentation, regardless of cause, of hyperadrenalism AKA hypercortisolism (Cushing syndrome)

- fat REdistribution
- easy bruising and striae
- HTN
- muscle wasting
- hirsutism

88

name the 3 sources of Cushing disease

1. pituitary tumor
2. ectopic ACTH production
3. adrenal adenoma

89

Cushing disease: pituitary tumor

- ACTH level
- effect of high-dose dexamethasone
- specific test for diagnosis
- treatment

- high
- suppression
- MRI, or petrosal vein sampling
- removal

90

Cushing disease: ectopic ACTH production

- ACTH level
- effect of high-dose dexamethasone
- specific test for diagnosis
- treatment

- high
- NO suppression
- scan chest and abdomen
- removal

91

Cushing disease: adrenal adenoma

- ACTH level
- effect of high-dose dexamethasone
- specific test for diagnosis
- treatment

- LOW
- NO suppression
- scan adrenals
- removal

92

lab findings in hypercortisolism

- hyperglycemia
- hyperlipidemia
- osteoporosis
- leukocytosis
- metabolic alkalosis (d/t increased urinary loss of H+)

93

mechanism of metabolic alkalosis in hypercortisolism

cortisol = mineralocorticoid/aldosterone effects

increased H+ excretion at a-intercalated cell of late distal/early collecting duct

94

best INITIAL diagnostic tests

- 1 mg overnight dexamethasone suppression testing
- 24-hour urine cortisol

95

LOW ACTH level

adrenal gland ORIGIN

96

HIGH ACTH level

either pituitary gland or from ECTOPIC production

97

- fatigue
- anorexia
- weight loss
- weakness with hypOtension
- thin patient with hyperpigmented skin
- hypERkalemia, with mild metabolic acidosis
- hyponatremia
- may have hypoglycemia and neutropenia

adrenal insufficiency (Addison disease)

98

MOST ACCURATE test for adrenal insufficiency

- cosyntropin (synthetic ACTH) stimulation test
- CT scan of adrenal glands

99

treatment for ACUTE addisonian (hypoadrenal) CRISIS

- check cortisol level
- IVF and hydrocortisone

100

treatment for STABLE (nonhypotensive) adrenal insufficiency

prednisone

101

treatment for adrenal insufficiency, if patient is STILL hypotensive AFTER prednisone

fludrocortisone

102

- HTN
- hypOkalemia
- metabolic alkalosis

hyperaldosteronism (Conn syndrome)

103

diagnostic tests for hyperaldosteronism

- LOW renin
- HIGH aldosterone
- HTN

104

how do you confirm diagnosis for hyperaldosteronism

CT scan of adrenal glands

105

treatment for hyperaldosteronism: solitary adenoma

surgical resection

106

treatment for hyperaldosteronism: hyperplasia

spironolactone

107

- HA, palpitations, tremors, anxiety, flushing (all nonspecific)
- EPISODIC HYPERTENSION

pheochromocytoma

108

best INITIAL tests for pheochromocytoma

- serum and urinary catecholamine levels (HIGH)
- serum free metanephrine and VMA levels

109

MOST ACCURATE test for pheochromocytoma

CT or MRI of adrenal glands

110

what test is used to detect metastatic disease in pheochromocytoma?

MIGB scan

111

FIRST treatment used for pheochromocytoma

phenoxybenzamine (alpha blockade)

112

treatment for pheochromocytoma AFTER a-blocker

propranolol

113

definitive treatment for pheochromocytoma

surgery

114

ALL forms of congenital adrenal hyperplasia (CAH)

- elevated ACTH
- low aldosterone
- low cortisol
- treatable with prednisone

115

name the 3 kinds of CAH

- 21-hydroxylase deficiency
- 11-hydroxylase deficiency
- 17-hydroxylase deficiency

116

MOST COMMON TYPE of CAH

21-hydroxylase deficiency

117

- hirsutism (virilization)
- HYPOTENSION

21-hydroxylase deficiency

118

diagnostic test for 21-hydroxylase deficiency

increased 17-hydroxyprogesterone level

119

- hirsutism (virilization)
- HYPERTENSION

11-hydroxylase deficiency

120

- HYPERTENSION ONLY
- NO hirsutism (virilization)

17-hydroxylase deficiency

121

MC pituitary tumor

prolactinoma

122

presentation for prolactinoma: men

- impotence
- decreased libido
- gynecomastia
- presents LATE
- MORE LIKELY to have signs of mass effect (HA, and visual disturbance)

123

presentation for prolactinoma: women

- amenorrhea
- galactorrhea in ABSENCE of pregnancy
- presents EARLY

124

MOST ACCURATE test for prolactinoma

MRI of brain

125

best INITIAL treatment for prolactinoma

- dopamine agonist (bromocriptine, or cabergoline)
- surgery, if medicine doesn't work

126

- growth hormone-secreting adenoma in pituitary
- excess production of growth hormone (GH)

acromegaly

127

acromegaly presentation

- enlarged head, fingers, feet, nose, and jaw
- intense sweating (enlarged sweat glands)

128

acromegaly also causes

- joint abnormalities
- amenorrhea
- cardiomegaly
- HTN
- colonic polyps
- DM

129

best INITIAL test for acromegaly

insulinlike growth factor (IGF)

130

which test is NOT done first for acromegaly, and why?

- growth factor
- bc max secretion is in middle of night and has short half-life

131

MOST ACCURATE test for acromegaly

GH suppression with glucose EXCLUDES acromegaly

132

treatment for acromegaly

transsphenoidal resection

133

somatostatin analog that has some effect on inhibiting GH release

octreotide

134

dopamine agonists that inhibit GH

bromocriptine, and cabergoline

135

GH receptor antagonist

pegvisomant

136

primary amenorrhea causes

1. Turner syndrome
2. testicular feminization

137

secondary amenorrhea causes

1. pregnancy (MCC)
2.exercise
3. extreme weight loss
4. hyperprolactinemia
5. polycystic ovary syndrome (PCOS)

138

- short stature
- webbed neck
- wide-spaced nipples
- scant pubic and axillary hair
- XO karyotype

TURNER SYNDROME

139

- genetically male, but looks/acts/feels female
- does not menstruate (no cervix, fallopian tubes, ovaries, or top 1/3 of vagina)

testicular feminization

140

- obesity
- amenorrhea
- hirsutism
- increased adrenal androgens

PCOS

141

treatment for glucose intolerance and DM in PCOS

metformin

142

treatment for virilization in PCOS

spironolactone

143

- tall male
- insensitivity of FSH and LH receptors in testicles
- XXY karyotype
- VERY HIGH FSH and LH levels, BUT NO testosterone is produced from testicles

Klinefelter's syndrome

144

treatment for Klinefelter's syndrome

testosterone

145

- ANOSMIA (key to diagnosis)
- hypogonadism
- LOW GnRH, FSH, and LH

Kallman's syndrome