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Endocrinology Flashcards

1
Q

If a pituitary incidentaloma is less than 1cm, what 2 things should be done yearly?

A
  1. Prolactin level

2. MRI

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2
Q

How do you manage asymptomatic empty sella syndrome (2 tests)?

A

Check thyroid and adrenal function

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3
Q

Are there any sx in men who present with prolactin deficiency?

A

No

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4
Q

What’s the difference between Kallman and Klinefelter syndrome?

A

Kallman is a KAL-1 mutation and results in decreased FSH and LH from decreased GnRH. Klinefelter is a 47XXY karyotype and is an androgen deficiency through insensitivity to FSH and LH despite HIGH levels.

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5
Q

What’s the tx for both Kallman and Klinefelter?

A

Testosterone replacement

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6
Q

What’s the other name for ADH deficiency and ADH insensitivity?

A

Diabetes Insipidus

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7
Q

What’s Central DI?

A

Pituitary produces less ADH

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8
Q

What’s Nephrogenic DI?

A

ADH has less effect on the kidney

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9
Q

What 2 electrolytes can inhibit ADH’s effect on the kidney?

A

Hypercalcemia

Hypokalemia

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10
Q

What disease presents with extremely high-volume urine and thirst, resulting in severe hypernatremia?

A

Diabetes Insipidus

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11
Q

What’s the first diagnostic test for Diabetes Insipidus?

A

Desmopressin stimulation test

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12
Q

How do you determine the difference between central and nephrogenic DI?

A

In central DI: urine volume will decrease and urine osmolal will increase in response to Desmopressin

In nephrogenic DI: no effect on urine volume or osmolality with Desmopressin

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13
Q

How do you treat central DI?

A

Long-term Desmopressin (vasopressin/ADH)

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14
Q

How do you treat nephrogenic DI?

A

Correct the underlying cause with HCTZ, amiloride, NSAIDs

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15
Q

What disorder causes enlargement of soft tissue and bone, deepening of voice, colonic polyps, and coarsening facial features?

A

Acromegaly

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16
Q

What’s the best initial test for acromegaly?

A

IGF-1 (insulinlike growth factor 1)

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17
Q

What’s the most accurate test for acromegaly?

A

Glucose suppression test

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18
Q 
What do the following drugs raise?:
Antipsychotics
Methyldopa
Metoclopramide
Opioids
TCAs
Verapamil
A

Prolactin

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19
Q

After finding high prolactin, what labs should you do?

A

Thyroid
Pregnancy
BUN/Creatinine
Liver function

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20
Q

What’s a medication used to treat prolactinoma that is better tolerated than Bromocriptine?

A

Cabergoline

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21
Q

What are TSH and T4 levels in hypothyroidism?

A

High TSH
Low T4
Low/normal T3

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22
Q

When TSH is 2x normal and T4 is normal, do you treat?

A

Yes

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23
Q

When TSH is high but less than 2x normal and T4 is normal, do you treat?

A

Only if Antithyroid peroxidase/antithyroglobulin Ab’s are positive

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24
Q

What are the TSH and T4 levels in hyperthyroidism?

A

Low TSH
High T4
High T3

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25
Q

Only _______ Disease has TSH receptor antibodies?

A

Graves

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26
Q

Which non-cancerous thyroid disorder has elevated radioactive iodine uptake?

A

Graves

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27
Q

What medication treats thyroid storm?

A

Methimazole

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28
Q

What’s the next step in evaluation of a thyroid nodule felt on physical exam?

A

T4 and TSH levels

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29
Q

Which type of thyroid cancer shows elevated calcitonin?

A

Medullary carcinoma

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30
Q

If there’s an indeterminate biopsy, do you have to take an entire thyroid nodule out?

A

Yes

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31
Q

What’s the most common cause of hypercalcemia?

A

Hyperparathyroidism

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32
Q 
What can the following all cause?:
Cancer
Vit D intox
Sarcoidosis/granulomatous
Thiazide diuretics
Hyperthyroidism
Mets to the bone
Multiple Myeloma
A

Hypercalcemia

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33
Q

What does EKG show with hypercalcemia?

A

Short QT

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34
Q

How is acute hypercalcemia treated?

A
  1. Saline hydration at high volume
  2. Bisphosphonates
  3. Calcitonin (works faster)
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35
Q

What are the calcium and PTH levels in hyperparathyroidism?

A

High calcium

High PTH

36
Q

What are the chloride and phosphate levels in hyperparathyroidism?

A

Chloride: high
Phosphate: low

37
Q

What’s the medicine you can give a patient with hyperparathyroidism if they can’t have surgery?

A

Cinacalcet

38
Q

Other than prior neck surgery, what else can cause hypocalcemia (3)?

A
  1. Hypomagnesemia
  2. Renal failure
  3. Vit D deficiency
39
Q

What are the phosphate levels in vit D deficiency?

A

Low phosphate

40
Q

What are the childhood and adult diseases caused by low vitamin D?

A

Rickets/Osteomalacia

41
Q

Can hypocalcemia cause a prolonged QT?

42
Q 
What are the following signs of:?
Chvostek sign
Carpopedal spasm
Perioral numbness
Mental irritability
Seizures
Tetany
A

Hypocalcemia

43
Q

In which disease are osteoclasts and osteoblasts working out of sync, deforming the bone. It also has elevated alk phos and normal GGTP.

A

Paget disease

44
Q

What’s the most accurate test for Paget disease?

A

Nuclear technetium bone scan finding patchy areas of osteoblastic activity

45
Q

What cancer can Paget disease turn into?

A

Osteosarcoma

46
Q

If Paget is painful, what tx is used?

A

Bisphosphonates

47
Q

If Paget is painless, what tx is used?

48
Q

If Paget has bone pain not relieved by NSAIDs, what med do you use?

A

Calcitonin

49
Q

What’s the difference between Cushing syndrome vs Cushing disease?

A

Cushing syndrome is the umbrella term for hypercortisolism; Cushing disease is a term used for specifically pituitary overproduction of ACTH

50
Q

What are the 2 best initial tests for hypercortisolism?

A
  1. 24-hour urine cortisol

2. Dexamethasone suppression test

51
Q

How do you interpret the dexamethasone suppression test?

A

Dexamethasone should normally suppress the morning cortisol level. If the morning cortisol is high, hypercortisolism is the dx

52
Q

What’s the best test for establishing the cause of hypercortisolism?

A

ACTH testing

53
Q

How do you interpret an ACTH test?

A

Decreased ACTH = adrenal source

Elevated ACTH = pituitary or ectopic

54
Q

How do you differentiate between pituitary vs ectopic when there’s elevated cortisol and ACTH?

A

High dose dexamethasone suppresses pituitary, but does not suppress ectopic

55
Q

If high dose dexamethasone does not suppress, do you still need a brain MRI?

56
Q

What lab value is elevated in hypercortisolism that rhymes with deukocytosis?

A

Leukocytosis

57
Q

What size of adrenal mass is suspicious for malignancy?

58
Q

What is Addison disease?

A

Hypoadrenalism caused by autoimmune destruction of the gland

59
Q

How is Addison disease treated?

A

Hydrocortisone

60
Q

What is the name of the condition in which there is autonomous overproduction of aldosterone despite high BP and low renin, most often caused by adenoma?

A

Primary hyperaldosteronism

61
Q

High BP + hypokalemia = ______ _____________?

A

Primary hypoaldosteronism

62
Q

What’s the best test for primary hyperaldosteronism?

A

Plasma aldo : plasma renin ratio.

63
Q

How does primary hyperaldosteronism present on labs?

A

Elevated aldo

Normal renin

64
Q

Where in the adrenal gland is a pheochromocytoma?

65
Q

What’s the best initial test for suspected pheochromocytoma?

A

Plasma free metanephrines

66
Q

What’s the best initial tx for pheochromocytoma before surgery?

A

Phenoxybenzamine

67
Q

What does hypoglycemia plus high insulin level (high C peptide) mean?

A

Insulinoma

68
Q

How do you treat a glucagonoma?

A

Octreotide and surgery

69
Q

What could be the cause of high volume watery diarrhea, hypokalemia, low osmotic gap in stool, and high vasoactive intestinal peptide levels + a pancreas lesion?

70
Q

How do you treat a VIPoma?

A

Octreotide and surgery

71
Q 
What condition has issues with: 
-Parathyroid
-Anterior pituitary
-Pancreas islet cells
?
72
Q 
What condition has issues with: 
-Parathyroid
-Medullary thyroid
-Pheochromocytoma
?
73
Q 
What condition has issues with: 
-Mucosal neuroma
-Medullary thyroid
-Pheochromocytoma
-Marfanoid
?
74
Q

What are the criteria for diabetes diagnosis?

A
  • Single random glucose >200 with sx
  • 2 fasting glucoses >125
  • A1c >6.5%
75
Q

Why are sulfonylureas not great as first line tx for T2DM?

A

They increase insulin release from the pancreas and increase obesity

76
Q

In whom is Metformin contraindicated?

A

Those with renal dysfunction

77
Q

What’s the peak action time of lispro, aspart, and glulisine?

78
Q

What’s the peak action time of regular insulin?

79
Q

What’s the peak action time for NPH?

80
Q

What’s the peak action time for glargine?

A

None, just a steady 24 hour release

81
Q

When do you replace potassium during DKA?

A

When it comes down to a level approaching normal

82
Q

What’s the most accurate test of the severity of DKA?

A

Bicarb (anion gap)

83
Q

All patients with DM should receive which vaccine?

A

Pneumococcal

84
Q

What’s the BP cutoff for diabetic patients to take ACEi/ARBs?

85
Q

What side effect can minoxidil, valproic acid, and phenytoin all cause in women?

A

Male-pattern hair growth

86
Q

What drug can you give for PCOS?

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