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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

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Dx. nelson's syndrome

MRI - suprasellar extension of pituitary adenoma

labs - very high plasma ACTH levels (since youve taken away the adrenal's products, which usually provide negative feedback)

3

tx. nelsons syndrome

surgery and/or pituitary radiation-- makes sense since you just can't have such a rapidly enlarging pituitary adenoma messing with your vision and pigment

4

lab findings in non-functioning pituitary adenoma

1. hypogonadism - low levels of FSH and LH

2. serum alpha subunit levels are elevated

 

note- the only symptoms the patient gets is from sheer mass effect, or from loss of normal pituitary function. if the adenoma compresses the pituitary too much, it won't be able to make hormones normally

 

alpha subunit + beta subunit present in gonadotropins: hcg, LH, FSH, TSH 

5

preferred therapy for nonfunctioning pituitary adenoma

trans-sphenoidal surgery

6

tx. prolactin-secreting adenomas

DA agonists ex. cabergoline

 

Note- MEN1 patients get prolactinoma

males with prolactinoma will have lower testosterone levels so they may have less libido

women lose their menstrual periods and have incrased breast milk production

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

INTRINSIC DRUG EFFECT:

-blocks thyroid hormone from entering cells

-inhibits 5' deiodinase, so decreased conversion from T4 to T3 = decreased T3 and increased T4 levels

-less T3 binding the T3 receptor

-can cause a destructive thyroiditis

 

IODINE EFFECT:

-cant escape wolff-chaikoff effect

-iodine thyroid autoimmunity

-upregulates hormone production via jod-basedow effect

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diagnoses of DM

1. two FPG > 126 (<110 normal)

2. one random glucose > 200 with symptoms

3. abnormal OGTT > 200 2 hours post-load (<140 normal)

4. HbA1c > 6.5%

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

add sulfonylurea (ex glipizide)

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

liver disease

CHF

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

DPP-IV inhibitors

sitagliptin, saxigliptin - increase insulin release and block glucagon

16

C/I to rosiglitazone/pioglitazone

CHF

17

insulin secretagogues

nateglinide, repaglinide - short acting - cause hypoglycemia

18

GLP analogs

exenatide, liraglutide - decrease gastric motility (increase feeling of fullness)

- increase satiety - promote weight loss

19

s/e exenatide or liraglutide

NV

dyspepsia

sensation of fullness/bloating

20

best test to determine severity of DKA

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

21

effect of glucose on Na levels

high glucose artificially drops Na levels

22

which hyperlipidemia drug is C/I in diabetes

niacin - worsens glucose intolerance

 

"niacin not nice to diabetics"

23

Tx. diabetic neuropathy

gabapentin pregabalin

24

Tx. diabetic gastroparesis

erythromycin (gut motility stimulator and antibiotic) or metoclopramide (reglan- gut motility stimulator)

25

lab findings in TSH secreting adenoma

elevated TSH and T3/T4

increased serum alpha subunit levels

26

s/e of sulfonylrureas

hypoglycemia

SIADH

27

TH resistance syndrome

elevated TSH and T3/T4 symptoms of hypothyroidism

28

increased RAIU

Graves disease

goiter

tsh secreting adenoma

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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

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Tx. Hypotensive crisis in pheo

Normal saline bolus

Pressors if no response

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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

 

Note- dopamine inhibits prolactin release

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 a rapid drop in cortisol level and hypotension that fails to respond to IVF

Patient ends up obtunded

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+

 

think RinKKKKers laKtate

80

Insulin dosing prior to surgery

Admin of 1/3 usual insulin dose