Endocrinology Flashcards
(159 cards)
1
Q
what is secreted from hypothalamus?
A
GnRH
TRH
CRH
CHRH
2
Q
where does GnRH act
A
anterior pituitary -> FSH/LH
3
Q
where does TRH act
A
anterior pituitary -> TSH
4
Q
where does CRH act
A
anterior pituitary -> ACTH
5
Q
where does GHRH act
A
anterior pituitary -> GH
6
Q
where does FSH/LH act
A
ovaries -> estrogen, progesterone, ovulation
7
Q
where does TSH act
A
thyroid -> T3, T4, metabolism
8
Q
where does ACTH act
A
adrenals -> cortisol, stress
9
Q
where does GH act
A
liver -> IGF-1, growth
10
Q
prolactinoma path
A
autonomously secreting prolactin
most common pituitary lesion
11
Q
prolactinoma pt
A
women: galactorrhea, amenorrhea, micro adenoma, no vision change
men: decreased libido, gynecomastia, macro adenomas, vision changes
12
Q
prolactinoma dx
A
1st: TSH/fT4
then: prolactin levels
best: MRI
13
Q
prolactinoma tx
A
bromocriptine or cabergoline
surgery
14
Q
prolactinoma f/u
A
surgery is NOT first line therapy for prolactinomas
- it is for all other secreting pituitary tumors and macroadenomas
15
Q
acromegaly path
A
growth hormone = things that grow
child = long bones (gigantism)
adult = visceral organs
16
Q
acromegaly pt
A
cardiomegaly -> DIA heart failure diabetes wide-spaced teeth hat/ring/shoe size increases coarse features, carpal tunnel big hands
17
Q
acromegaly dx
A
IGF-I
glucose suppression test
MRI
18
Q
acromegaly tx
A
surgery first
octreotide or cabergoline (adjunct)
19
Q
acromegaly f/u
A
glucose suppression test = give glucose, test is positive (abnormal) if the GH does not change
20
Q
acromegaly wait
A
carpal tunnel is more associated with RA than acromegaly, don’t be tricked
21
Q
acute pan hypopituitarism path
A
infection, infarction, surgery, rads
22
Q
acute pan hypopituitarism pt
A
TSH: lethargy, coma
ACTH: hypotension, tachycardia
GH/LH/FSH: irrelevant
23
Q
acute pan hypopituitarism dx
A
clinical
hormone (cortisol and T4)
24
Q
acute pan hypopituitarism tx
A
replace end hormones
25
acute pan hypopituitarism f/u
Sheehan's: pregnancy, bloody delivery
| Apoplexy: tumor outgrows blood supply and dies, necrosis
26
chronic pan hypopituitarism path
autoimmune, deposition, cancer
| GH/FSH/LH sacrificed so that TSH and ACTH can persist
27
chronic pan hypopituitarism pt
decrease libido, changes in menstruation
| decrease growth
28
chronic pan hypopituitarism dx
insulin stimulation test
- growth hormone fails to rise
MRI
29
chronic pan hypopituitarism tx
reverse underlying cause
| replace hormones prn
30
empty sella syndrome path
normal variant
31
empty sella syndrome pt
asymptomatic
32
empty sella syndrome dx
MRI
33
empty sella syndrome tx
reassurance
34
SIADH path
too much ADH = too much water = patient becomes hypotonic
brain lesion = increase ADH
lung lesion = increase ADH (small cell, PNA)
35
SIADH pt
hyponatremia
36
SIADH dx
UNa increase
Uosm increase
Sosm decrease
37
SIADH tx
water restriction
demeclocycline
reverse underlying disease
38
central diabetes insipidus path
central: no ADH production
39
central diabetes insipidus pt
polydipsia
polyuria
normal blood glucose
40
central DI dx
water deprivation test
| - corrects with ADH = central DI
41
central DI tx
intranasal desmopressin (DDAVP)
42
nephrogenic DI path
dysfunctional ADH receptor
43
nephrogenic DI pt
polydipsia
polyuria
normal blood glucose
44
nephrogenic DI dx
water deprivation test
| -FAILS to correct
45
nephrogenic DI tx
gentle diuresis
46
psychogenic polydipsia path
excess free water intake causes medullary wash out
47
psychogenic polydipsia pt
polyuria
polydipsia
normal blood glucose
48
psychogenic polydipsia dx
water deprivation test
| - corrects with water restriction
49
psychogenic polydipsia tx
stop drinking so much
50
when to use FNA for thyroid nodule
best test except excisions biopsy
| if any doubt - get an FNA
51
when to use TSH for thyroid nodule
nodule suspected of being hot/active
52
when to use RAIU for thyroid nodule
if not sure, either before or after FNA to push one way or the other
53
when to use U/S for thyroid nodule
assess nodule before FNA, identify good sites for biopsy. confirm index of suspicion
54
papillary thyroid cancer need to knows
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
55
follicular thyroid cancer need to knows
tumor difficult to dx on bx, looks normal
spreads hematogenously
tx resection and I2 ablation
56
medullary thyroid cancer need to knows
C-cells producing calcitonin -> hypo-Ca
| part of MEN2a and MEN2b genetics
57
anaplastic thyroid cancer need to knows
found in elderly patients
grows locally and quickly
dismal px correlates to degree of anaplasia
58
MEN1 path
autosomal dominant MEN1
59
MEN1 pt
pancreas -> gastrinoma, insulinoma
pituitary -> any pituitary
parathyroid -> hyper-Ca
60
MEN2A path
RET
61
MEN2A pt
pheochromocytoma
thyroid
parathyroid
62
MEN2B path
RET
63
MEN2B pt
pheochromocytoma
thyroid
neuronal
64
hyperthyroidism symptoms
```
tachycardia
diarrhea
increase DTR
heat intolerance
weight loss
AFib
```
65
hypothyroidism symptoms
```
bradycardia
constipation
decrease DTR
cold intolerance
weight gain
```
66
grave's disease path
autoimmune
| thyroid stimulation antibodies bind to and activate thyroid
67
grave's disease pt
exophthalmos
pre-tibial myxedema
hyperthyroidism
68
grave's disease dx
TSH decrease
T4 increase
RAIU: diffuse uptake throughout
thyroglobulin: increase
69
grave's disease tx
medications: PTU or methimazole
surgery: thyroidectomy
radiation: RAIU
70
thyroiditis path
release of preformed T4 with inflammation of the thyroid
71
thyroiditis pt
hyperthyroidism
72
thyroiditis dx
TSH decrease
T4 increase
RAIU: no uptake
thyroglobulin: increase
73
thyroiditis tx
ß-blockers for symptom control
74
thyroiditis f/u
Hashimoto's: painless, then hypothyroidism
DeQuervain's: painful, recovery
Lymphocytic: painless, recovery
75
multinodular goiter/toxic adenoma path
autonomous secretion of T4
76
multinodular goiter/toxic adenoma pt
hyperthyroidism
| nodules
77
multinodular goiter/toxic adenoma dx
TSH decrease
T4 increase
RAIU: uptake in goiter/adenoma only
thyroglobulin: increase
78
multinodular goiter/toxic adenoma tx
resection
79
struma ovarii/factitious path
```
struma = ovarian production of T4
factitious = exogenous intake
```
80
struma ovarii/factitious pt
woman, healthcare field
81
struma ovarii/factitious dx
```
TSH decrease
T4 increase
RAIU: NO UPTAKE
struma ovarii - thyroglobulin: increase
factitious - thyroglobulin: decrease
```
82
struma ovarii/factitious tx
resection
| confrontation
83
thyroid storm path
excess thyroid hormone to the point of shock and life-threatening emergency
84
thyroid storm pt
shock, fever, delirium
85
thyroid storm dx
T4 increase, TSH undetectable
86
thyroid storm tx
1. propranolol (control rate)
2. PTU/methimazole (decrease fT4)
3. IV steroids (decrease fT4->fT3)
87
thyroid storm tx2
radioactive iodine
| surgery
88
hypothyroidism path
iatrogenic (most common)
| Hashimoto's (most common non-iatrogenic)
89
hypothyroidism pt
hypothyroidism
90
hypothyroidism dx
TSH increase
| T4 decrease
91
hypothyroidism tx
levothyroxine
92
hypothyroidism f/u
TSH in 3mo from start, track TSH
| asx + TSH <10 = subclinical = no treat
93
myxedema coma path
too little T4
94
myxedema coma pt
shock, freezing, coma, pericardial effusion
95
myxedema coma dx
TSH very increased
| fT4 decreased
96
myxedema coma tx
IVF (warmed)
blankets
T4 IV
97
Cushing's syndrome path
```
cortisol excess
ACTH dependent
- pituitary tumor (Cushing's disease)
- lung tumor
ACTH independent
- exogenous ingestion
- adrenal tumor
```
98
Cushing's syndrome pt
```
HTN, diabetes
central/truncal obesity
moon face
purple striae
buffalo hump
```
99
Cushing's syndrome dx
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
Cushing's syndrome tx
resection
101
Addison's path
deficient cortisol = adrenal
- TB worldwide
- autoimmune US
deficient ACTH = pituitary
102
Addison's pt
hypotension/orthostatics
decrease Na, increase K = adrenal deficiency
hyperpigmentation = adrenal deficiency
103
Addison's dx
1st: AM cortisol
then: cosyntropin stim test
- if increase cortisol -> MRI
- if no change cortisol -> CT abdomen
104
Addison's tx
adrenal gland = cortisol + fludrocortisone
| pituitary = cortisone alone
105
pheochromocytoma path
catecholamine producing tumor
106
pheochromocytoma pt
```
paroxysm
pain
palpitations
pressure
perspiration
```
107
pheochromocytoma dx
24h urinary VMA, metanephrine
CT/MRI abd
adrenal vein sampling
108
pheochromocytoma tx
α-blockade
ß-blockade
resection
109
Conn's syndrome
primary hyperaldosteronism
110
Conn's syndrome path
primary adrenal tumor = primary hyperAldo
111
Conn's syndrome pt
HTN + HypoK
112
Conn's syndrome dx
1st: Aldo/Renin ratio >20
then: salt suppression test
then: CT/MRI
best: adrenal vein sampling
113
Conn's syndrome tx
resection
114
secondary hyperaldosteronism path
young woman, fibromuscular dysplasia
| old man, renal artery stenosis
115
secondary hyperaldosteronism pt
HTN + HypoK
116
secondary hyperaldosteronism dx
Aldo/Renin < 10
| angiogram
117
secondary hyperaldosteronism tx
RAS: medically manage, no stent
FMD: stent
118
incidentaloma path
asx, non-active, 'thing' on the adrenal
119
incidentaloma pt
asx, incidentally found on a scan for something else
120
incidentaloma dx
r/o hyper-functioning adenoma
1. Renin:Aldo (Conn's)
2. Low dose dexa (Cushing's)
3. Urine VMA, Meta (pheo)
121
incidentaloma tx
ignore it, once testing is negative
122
diagnosing diabetes by bG
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
diagnosing diabetes by A1c
normal < 5.7
prediabetes 5.7-6.4
diabetes >/= 6.5
124
sulfonylureas
glyburide
| glipizide
125
sulfonylureas mechanism
increase insulin secretion
126
biguanides
metformin
127
biguanides mechanism
decrease glucose made in liver
| increase insulin sensitivity
128
thiazolidinediones
pioglitazone
| rosiglitazone
129
thiazolidinediones mechanism
increase insulin sensitivity
130
DPP-4-i
(gliptins)
sitagliptin
saxagliptin
131
DPP-4-i mechanism
DPP-4-i increase GLP-1
132
GLP-1 analogs
eventide
| liraglutide
133
GLP-1 analogs mechanism
increase GLP-1 -> increase incretin
134
Lantus, Levemir class
long acting insulin
135
Humalog, nova log class
rapid acting insulin combo
136
humulin, novolin class
medium acting insulin combo
137
NPH class
cheap version of 'Lin'
138
regular class
cheap version of 'log'
139
somogyi effect
too much insulin at night -> high AM bG
140
dawn phenomena
too little insulin at night -> high AM bG
141
how to tell difference of somogyi effect and dawn phenomena?
check early AM bG to tell the difference
142
T1DM path
autoimmune
no islet cells
no insulin
143
T1DM pt
```
DKA
increase bG
increase ketones
increase acid
polydipsia
polyphagia
polyuria, weight decrease
onset childhood
```
144
T1DM dx
A1c, bG
| anti-GAD ab
145
T1DM tx
insulin only
146
T2DM path
obesity
insulin insensitivity
pancreas burns out
147
T2DM pt
```
obese
complications of
- diabetes
- neuropath
- retinopathy
- nephropathy
HHS = HHNK
```
148
T2DM tx
2 oral anti-glycemics THEN insulin
149
primary care in diabetes: nephropathy
U/A -> microalbuminuria q1y
| if retinopathy & CKD, presume diabetic nephropathy
150
primary care in diabetes: retinopathy
retina exam q1y
| laser treatments
151
primary care in diabetes: neuropathy
monofilament wire to foot q1y
gabapentin, pregabalin
soft shoes, frequent foot checks
152
DKA path
Type 1, insulin dependent DM (IDDM)
153
DKA pt
+ diabetic coma
+ ketones
+ acidosis
154
DKA dx
bG 300-500
U/A: + ketones
ABG: + acidosis
BMP: + gap
155
DKA tx
replete K
IVF - bolus a lot
IV insulin
follow the gap
156
HHNKC/HHS path
Type II, non-insulin dependent DM (NIDDM)
157
HHNKC/HHS pt
+ diabetic coma
- ketones
- acidosis
158
HHNKC/HHS dx
bG 800-1000
U/A - no ketones
ABG - no acidosis
BMP - no gap
159
HHNKC/HHS tx
replete K
IVF - bolus a lot
IV insulin
follow the symptomatic improvement
