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Endocrinology Flashcards

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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
Only _______ Disease has TSH receptor antibodies?
Graves
26
Which non-cancerous thyroid disorder has elevated radioactive iodine uptake?
Graves
27
What medication treats thyroid storm?
Methimazole
28
What's the next step in evaluation of a thyroid nodule felt on physical exam?
T4 and TSH levels
29
Which type of thyroid cancer shows elevated calcitonin?
Medullary carcinoma
30
If there's an indeterminate biopsy, do you have to take an entire thyroid nodule out?
Yes
31
What's the most common cause of hypercalcemia?
Hyperparathyroidism
32
``` What can the following all cause?: Cancer Vit D intox Sarcoidosis/granulomatous Thiazide diuretics Hyperthyroidism Mets to the bone Multiple Myeloma ```
Hypercalcemia
33
What does EKG show with hypercalcemia?
Short QT
34
How is acute hypercalcemia treated?
1. Saline hydration at high volume 2. Bisphosphonates 3. Calcitonin (works faster)
35
What are the calcium and PTH levels in hyperparathyroidism?
High calcium | High PTH
36
What are the chloride and phosphate levels in hyperparathyroidism?
Chloride: high Phosphate: low
37
What's the medicine you can give a patient with hyperparathyroidism if they can't have surgery?
Cinacalcet
38
Other than prior neck surgery, what else can cause hypocalcemia (3)?
1. Hypomagnesemia 2. Renal failure 3. Vit D deficiency
39
What are the phosphate levels in vit D deficiency?
Low phosphate
40
What are the childhood and adult diseases caused by low vitamin D?
Rickets/Osteomalacia
41
Can hypocalcemia cause a prolonged QT?
Yes
42
``` What are the following signs of:? Chvostek sign Carpopedal spasm Perioral numbness Mental irritability Seizures Tetany ```
Hypocalcemia
43
In which disease are osteoclasts and osteoblasts working out of sync, deforming the bone. It also has elevated alk phos and normal GGTP.
Paget disease
44
What's the most accurate test for Paget disease?
Nuclear technetium bone scan finding patchy areas of osteoblastic activity
45
What cancer can Paget disease turn into?
Osteosarcoma
46
If Paget is painful, what tx is used?
Bisphosphonates
47
If Paget is painless, what tx is used?
None!
48
If Paget has bone pain not relieved by NSAIDs, what med do you use?
Calcitonin
49
What's the difference between Cushing syndrome vs Cushing disease?
Cushing syndrome is the umbrella term for hypercortisolism; Cushing disease is a term used for specifically pituitary overproduction of ACTH
50
What are the 2 best initial tests for hypercortisolism?
1. 24-hour urine cortisol | 2. Dexamethasone suppression test
51
How do you interpret the dexamethasone suppression test?
Dexamethasone should normally suppress the morning cortisol level. If the morning cortisol is high, hypercortisolism is the dx
52
What's the best test for establishing the cause of hypercortisolism?
ACTH testing
53
How do you interpret an ACTH test?
Decreased ACTH = adrenal source Elevated ACTH = pituitary or ectopic
54
How do you differentiate between pituitary vs ectopic when there's elevated cortisol and ACTH?
High dose dexamethasone suppresses pituitary, but does not suppress ectopic
55
If high dose dexamethasone does not suppress, do you still need a brain MRI?
Yes
56
What lab value is elevated in hypercortisolism that rhymes with deukocytosis?
Leukocytosis
57
What size of adrenal mass is suspicious for malignancy?
>4cm
58
What is Addison disease?
Hypoadrenalism caused by autoimmune destruction of the gland
59
How is Addison disease treated?
Hydrocortisone
60
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?
Primary hyperaldosteronism
61
High BP + hypokalemia = ______ _____________?
Primary hypoaldosteronism
62
What's the best test for primary hyperaldosteronism?
Plasma aldo : plasma renin ratio.
63
How does primary hyperaldosteronism present on labs?
Elevated aldo | Normal renin
64
Where in the adrenal gland is a pheochromocytoma?
Medulla
65
What's the best initial test for suspected pheochromocytoma?
Plasma free metanephrines
66
What's the best initial tx for pheochromocytoma before surgery?
Phenoxybenzamine
67
What does hypoglycemia plus high insulin level (high C peptide) mean?
Insulinoma
68
How do you treat a glucagonoma?
Octreotide and surgery
69
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?
VIPoma
70
How do you treat a VIPoma?
Octreotide and surgery
71
``` What condition has issues with: -Parathyroid -Anterior pituitary -Pancreas islet cells ? ```
MEN1
72
``` What condition has issues with: -Parathyroid -Medullary thyroid -Pheochromocytoma ? ```
MEN 2A
73
``` What condition has issues with: -Mucosal neuroma -Medullary thyroid -Pheochromocytoma -Marfanoid ? ```
MEN 2B
74
What are the criteria for diabetes diagnosis?
- Single random glucose >200 with sx - 2 fasting glucoses >125 - A1c >6.5%
75
Why are sulfonylureas not great as first line tx for T2DM?
They increase insulin release from the pancreas and increase obesity
76
In whom is Metformin contraindicated?
Those with renal dysfunction
77
What's the peak action time of lispro, aspart, and glulisine?
1 hour
78
What's the peak action time of regular insulin?
2 hours
79
What's the peak action time for NPH?
6-7 hours
80
What's the peak action time for glargine?
None, just a steady 24 hour release
81
When do you replace potassium during DKA?
When it comes down to a level approaching normal
82
What's the most accurate test of the severity of DKA?
Bicarb (anion gap)
83
All patients with DM should receive which vaccine?
Pneumococcal
84
What's the BP cutoff for diabetic patients to take ACEi/ARBs?
140/90
85
What side effect can minoxidil, valproic acid, and phenytoin all cause in women?
Male-pattern hair growth
86
What drug can you give for PCOS?
Metformin

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