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Online Med Ed > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

what is secreted from hypothalamus?

A

GnRH
TRH
CRH
CHRH

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2
Q

where does GnRH act

A

anterior pituitary -> FSH/LH

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3
Q

where does TRH act

A

anterior pituitary -> TSH

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4
Q

where does CRH act

A

anterior pituitary -> ACTH

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5
Q

where does GHRH act

A

anterior pituitary -> GH

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6
Q

where does FSH/LH act

A

ovaries -> estrogen, progesterone, ovulation

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7
Q

where does TSH act

A

thyroid -> T3, T4, metabolism

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8
Q

where does ACTH act

A

adrenals -> cortisol, stress

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9
Q

where does GH act

A

liver -> IGF-1, growth

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10
Q

prolactinoma path

A

autonomously secreting prolactin

most common pituitary lesion

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11
Q

prolactinoma pt

A

women: galactorrhea, amenorrhea, micro adenoma, no vision change
men: decreased libido, gynecomastia, macro adenomas, vision changes

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12
Q

prolactinoma dx

A

1st: TSH/fT4
then: prolactin levels
best: MRI

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13
Q

prolactinoma tx

A

bromocriptine or cabergoline

surgery

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14
Q

prolactinoma f/u

A

surgery is NOT first line therapy for prolactinomas

- it is for all other secreting pituitary tumors and macroadenomas

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15
Q

acromegaly path

A

growth hormone = things that grow
child = long bones (gigantism)
adult = visceral organs

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16
Q

acromegaly pt

A 
cardiomegaly -> DIA heart failure
diabetes
wide-spaced teeth
hat/ring/shoe size increases
coarse features, carpal tunnel
big hands
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17
Q

acromegaly dx

A

IGF-I
glucose suppression test
MRI

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18
Q

acromegaly tx

A

surgery first

octreotide or cabergoline (adjunct)

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19
Q

acromegaly f/u

A

glucose suppression test = give glucose, test is positive (abnormal) if the GH does not change

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20
Q

acromegaly wait

A

carpal tunnel is more associated with RA than acromegaly, don’t be tricked

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21
Q

acute pan hypopituitarism path

A

infection, infarction, surgery, rads

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22
Q

acute pan hypopituitarism pt

A

TSH: lethargy, coma
ACTH: hypotension, tachycardia
GH/LH/FSH: irrelevant

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23
Q

acute pan hypopituitarism dx

A

clinical

hormone (cortisol and T4)

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24
Q

acute pan hypopituitarism tx

A

replace end hormones

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25
Q

acute pan hypopituitarism f/u

A

Sheehan’s: pregnancy, bloody delivery

Apoplexy: tumor outgrows blood supply and dies, necrosis

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26
Q

chronic pan hypopituitarism path

A

autoimmune, deposition, cancer

GH/FSH/LH sacrificed so that TSH and ACTH can persist

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27
Q

chronic pan hypopituitarism pt

A

decrease libido, changes in menstruation

decrease growth

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28
Q

chronic pan hypopituitarism dx

A

insulin stimulation test
- growth hormone fails to rise
MRI

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29
Q

chronic pan hypopituitarism tx

A

reverse underlying cause

replace hormones prn

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30
Q

empty sella syndrome path

A

normal variant

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31
Q

empty sella syndrome pt

A

asymptomatic

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32
Q

empty sella syndrome dx

A

MRI

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33
Q

empty sella syndrome tx

A

reassurance

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34
Q

SIADH path

A

too much ADH = too much water = patient becomes hypotonic
brain lesion = increase ADH
lung lesion = increase ADH (small cell, PNA)

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35
Q

SIADH pt

A

hyponatremia

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36
Q

SIADH dx

A

UNa increase
Uosm increase
Sosm decrease

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37
Q

SIADH tx

A

water restriction
demeclocycline
reverse underlying disease

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38
Q

central diabetes insipidus path

A

central: no ADH production

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39
Q

central diabetes insipidus pt

A

polydipsia
polyuria
normal blood glucose

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40
Q

central DI dx

A

water deprivation test

- corrects with ADH = central DI

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41
Q

central DI tx

A

intranasal desmopressin (DDAVP)

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42
Q

nephrogenic DI path

A

dysfunctional ADH receptor

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43
Q

nephrogenic DI pt

A

polydipsia
polyuria
normal blood glucose

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44
Q

nephrogenic DI dx

A

water deprivation test

-FAILS to correct

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45
Q

nephrogenic DI tx

A

gentle diuresis

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46
Q

psychogenic polydipsia path

A

excess free water intake causes medullary wash out

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47
Q

psychogenic polydipsia pt

A

polyuria
polydipsia
normal blood glucose

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48
Q

psychogenic polydipsia dx

A

water deprivation test

- corrects with water restriction

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49
Q

psychogenic polydipsia tx

A

stop drinking so much

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50
Q

when to use FNA for thyroid nodule

A

best test except excisions biopsy

if any doubt - get an FNA

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51
Q

when to use TSH for thyroid nodule

A

nodule suspected of being hot/active

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52
Q

when to use RAIU for thyroid nodule

A

if not sure, either before or after FNA to push one way or the other

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53
Q

when to use U/S for thyroid nodule

A

assess nodule before FNA, identify good sites for biopsy. confirm index of suspicion

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54
Q

papillary thyroid cancer need to knows

A

most common
associated with XRT
orphan-annie nuclei and psammoma bodies
papillary architecture (FNA), h/o head and neck cancer
positive prognosis (slow growing) -> resection

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55
Q

follicular thyroid cancer need to knows

A

tumor difficult to dx on bx, looks normal
spreads hematogenously
tx resection and I2 ablation

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56
Q

medullary thyroid cancer need to knows

A

C-cells producing calcitonin -> hypo-Ca

part of MEN2a and MEN2b genetics

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57
Q

anaplastic thyroid cancer need to knows

A

found in elderly patients
grows locally and quickly
dismal px correlates to degree of anaplasia

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58
Q

MEN1 path

A

autosomal dominant MEN1

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59
Q

MEN1 pt

A

pancreas -> gastrinoma, insulinoma
pituitary -> any pituitary
parathyroid -> hyper-Ca

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60
Q

MEN2A path

A

RET

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61
Q

MEN2A pt

A

pheochromocytoma
thyroid
parathyroid

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62
Q

MEN2B path

A

RET

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63
Q

MEN2B pt

A

pheochromocytoma
thyroid
neuronal

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64
Q

hyperthyroidism symptoms

A 
tachycardia
diarrhea
increase DTR
heat intolerance
weight loss
AFib
65
Q

hypothyroidism symptoms

A 
bradycardia
constipation
decrease DTR
cold intolerance
weight gain
66
Q

grave’s disease path

A

autoimmune

thyroid stimulation antibodies bind to and activate thyroid

67
Q

grave’s disease pt

A

exophthalmos
pre-tibial myxedema
hyperthyroidism

68
Q

grave’s disease dx

A

TSH decrease
T4 increase
RAIU: diffuse uptake throughout
thyroglobulin: increase

69
Q

grave’s disease tx

A

medications: PTU or methimazole
surgery: thyroidectomy
radiation: RAIU

70
Q

thyroiditis path

A

release of preformed T4 with inflammation of the thyroid

71
Q

thyroiditis pt

A

hyperthyroidism

72
Q

thyroiditis dx

A

TSH decrease
T4 increase
RAIU: no uptake
thyroglobulin: increase

73
Q

thyroiditis tx

A

ß-blockers for symptom control

74
Q

thyroiditis f/u

A

Hashimoto’s: painless, then hypothyroidism
DeQuervain’s: painful, recovery
Lymphocytic: painless, recovery

75
Q

multinodular goiter/toxic adenoma path

A

autonomous secretion of T4

76
Q

multinodular goiter/toxic adenoma pt

A

hyperthyroidism

nodules

77
Q

multinodular goiter/toxic adenoma dx

A

TSH decrease
T4 increase
RAIU: uptake in goiter/adenoma only
thyroglobulin: increase

78
Q

multinodular goiter/toxic adenoma tx

A

resection

79
Q

struma ovarii/factitious path

A 
struma = ovarian production of T4
factitious = exogenous intake
80
Q

struma ovarii/factitious pt

A

woman, healthcare field

81
Q

struma ovarii/factitious dx

A 
TSH decrease
T4 increase
RAIU: NO UPTAKE
struma ovarii - thyroglobulin: increase
factitious - thyroglobulin: decrease
82
Q

struma ovarii/factitious tx

A

resection

confrontation

83
Q

thyroid storm path

A

excess thyroid hormone to the point of shock and life-threatening emergency

84
Q

thyroid storm pt

A

shock, fever, delirium

85
Q

thyroid storm dx

A

T4 increase, TSH undetectable

86
Q

thyroid storm tx

A
  1. propranolol (control rate)
  2. PTU/methimazole (decrease fT4)
  3. IV steroids (decrease fT4->fT3)
87
Q

thyroid storm tx2

A

radioactive iodine

surgery

88
Q

hypothyroidism path

A

iatrogenic (most common)

Hashimoto’s (most common non-iatrogenic)

89
Q

hypothyroidism pt

A

hypothyroidism

90
Q

hypothyroidism dx

A

TSH increase

T4 decrease

91
Q

hypothyroidism tx

A

levothyroxine

92
Q

hypothyroidism f/u

A

TSH in 3mo from start, track TSH

asx + TSH <10 = subclinical = no treat

93
Q

myxedema coma path

A

too little T4

94
Q

myxedema coma pt

A

shock, freezing, coma, pericardial effusion

95
Q

myxedema coma dx

A

TSH very increased

fT4 decreased

96
Q

myxedema coma tx

A

IVF (warmed)
blankets
T4 IV

97
Q

Cushing’s syndrome path

A 
cortisol excess
ACTH dependent
- pituitary tumor (Cushing's disease)
- lung tumor
ACTH independent
- exogenous ingestion
- adrenal tumor
98
Q

Cushing’s syndrome pt

A 
HTN, diabetes
central/truncal obesity
moon face
purple striae
buffalo hump
99
Q

Cushing’s syndrome dx

A
  1. low dose dexa suppression test, then 24hr urinary cortisol
  2. ACTH
  3. high-dose dexa suppression test
  4. MRI brain OR CT chest/abd/pelvis
  5. inferior petrosal sinus sampling
100
Q

Cushing’s syndrome tx

A

resection

101
Q

Addison’s path

A

deficient cortisol = adrenal
- TB worldwide
- autoimmune US
deficient ACTH = pituitary

102
Q

Addison’s pt

A

hypotension/orthostatics
decrease Na, increase K = adrenal deficiency
hyperpigmentation = adrenal deficiency

103
Q

Addison’s dx

A

1st: AM cortisol
then: cosyntropin stim test
- if increase cortisol -> MRI
- if no change cortisol -> CT abdomen

104
Q

Addison’s tx

A

adrenal gland = cortisol + fludrocortisone

pituitary = cortisone alone

105
Q

pheochromocytoma path

A

catecholamine producing tumor

106
Q

pheochromocytoma pt

A 
paroxysm
pain
palpitations
pressure
perspiration
107
Q

pheochromocytoma dx

A

24h urinary VMA, metanephrine
CT/MRI abd
adrenal vein sampling

108
Q

pheochromocytoma tx

A

α-blockade
ß-blockade
resection

109
Q

Conn’s syndrome

A

primary hyperaldosteronism

110
Q

Conn’s syndrome path

A

primary adrenal tumor = primary hyperAldo

111
Q

Conn’s syndrome pt

A

HTN + HypoK

112
Q

Conn’s syndrome dx

A

1st: Aldo/Renin ratio >20
then: salt suppression test
then: CT/MRI
best: adrenal vein sampling

113
Q

Conn’s syndrome tx

A

resection

114
Q

secondary hyperaldosteronism path

A

young woman, fibromuscular dysplasia

old man, renal artery stenosis

115
Q

secondary hyperaldosteronism pt

A

HTN + HypoK

116
Q

secondary hyperaldosteronism dx

A

Aldo/Renin < 10

angiogram

117
Q

secondary hyperaldosteronism tx

A

RAS: medically manage, no stent
FMD: stent

118
Q

incidentaloma path

A

asx, non-active, ‘thing’ on the adrenal

119
Q

incidentaloma pt

A

asx, incidentally found on a scan for something else

120
Q

incidentaloma dx

A

r/o hyper-functioning adenoma

  1. Renin:Aldo (Conn’s)
  2. Low dose dexa (Cushing’s)
  3. Urine VMA, Meta (pheo)
121
Q

incidentaloma tx

A

ignore it, once testing is negative

122
Q

diagnosing diabetes by bG

A

random (needs 1)
>/= 200 = diabetes
< 200 = ???

Fasting (needs 2)
>/= 125 = diabetes
100-124 = glucose intolerance
< 100 = normal

2hr post-prandial glucose tolerance test
2hrs >/= 200 = diabetes

123
Q

diagnosing diabetes by A1c

A

normal < 5.7
prediabetes 5.7-6.4
diabetes >/= 6.5

124
Q

sulfonylureas

A

glyburide

glipizide

125
Q

sulfonylureas mechanism

A

increase insulin secretion

126
Q

biguanides

A

metformin

127
Q

biguanides mechanism

A

decrease glucose made in liver

increase insulin sensitivity

128
Q

thiazolidinediones

A

pioglitazone

rosiglitazone

129
Q

thiazolidinediones mechanism

A

increase insulin sensitivity

130
Q

DPP-4-i

A

(gliptins)
sitagliptin
saxagliptin

131
Q

DPP-4-i mechanism

A

DPP-4-i increase GLP-1

132
Q

GLP-1 analogs

A

eventide

liraglutide

133
Q

GLP-1 analogs mechanism

A

increase GLP-1 -> increase incretin

134
Q

Lantus, Levemir class

A

long acting insulin

135
Q

Humalog, nova log class

A

rapid acting insulin combo

136
Q

humulin, novolin class

A

medium acting insulin combo

137
Q

NPH class

A

cheap version of ‘Lin’

138
Q

regular class

A

cheap version of ‘log’

139
Q

somogyi effect

A

too much insulin at night -> high AM bG

140
Q

dawn phenomena

A

too little insulin at night -> high AM bG

141
Q

how to tell difference of somogyi effect and dawn phenomena?

A

check early AM bG to tell the difference

142
Q

T1DM path

A

autoimmune
no islet cells
no insulin

143
Q

T1DM pt

A 
DKA
increase bG
increase ketones
increase acid
polydipsia
polyphagia
polyuria, weight decrease
onset childhood
144
Q

T1DM dx

A

A1c, bG

anti-GAD ab

145
Q

T1DM tx

A

insulin only

146
Q

T2DM path

A

obesity
insulin insensitivity
pancreas burns out

147
Q

T2DM pt

A 
obese
complications of
- diabetes
- neuropath
- retinopathy
- nephropathy
HHS = HHNK
148
Q

T2DM tx

A

2 oral anti-glycemics THEN insulin

149
Q

primary care in diabetes: nephropathy

A

U/A -> microalbuminuria q1y

if retinopathy & CKD, presume diabetic nephropathy

150
Q

primary care in diabetes: retinopathy

A

retina exam q1y

laser treatments

151
Q

primary care in diabetes: neuropathy

A

monofilament wire to foot q1y
gabapentin, pregabalin
soft shoes, frequent foot checks

152
Q

DKA path

A

Type 1, insulin dependent DM (IDDM)

153
Q

DKA pt

A

+ diabetic coma
+ ketones
+ acidosis

154
Q

DKA dx

A

bG 300-500
U/A: + ketones
ABG: + acidosis
BMP: + gap

155
Q

DKA tx

A

replete K
IVF - bolus a lot
IV insulin
follow the gap

156
Q

HHNKC/HHS path

A

Type II, non-insulin dependent DM (NIDDM)

157
Q

HHNKC/HHS pt

A

+ diabetic coma

  • ketones
  • acidosis
158
Q

HHNKC/HHS dx

A

bG 800-1000
U/A - no ketones
ABG - no acidosis
BMP - no gap

159
Q

HHNKC/HHS tx

A

replete K
IVF - bolus a lot
IV insulin
follow the symptomatic improvement

Online Med Ed (18 decks)

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