Endocrinology from PANCE Pearls

Question 1

What is Hyperthyroidism and what does it do in your body

Answer 1

High T3/T4
Increases Metabolism
Increases glucose absorption from GI
Catabolic effect on muscle mass
Increased CO and RR
Increased Catecholamine levels
Increased Oxygen Consumption

Question 2

What is the most common cause of Hyperthyroidism

Answer 2

Graves
Autoimmune
Antibodies against TSH receptor

Question 3

What is a common cause of Hyperthyroidism in the elderly

Answer 3

Toxic Nodular Goiter

Leads to thyrotoxicosis (Increased T3/T4)

Question 4

Sx of Hyperthyroidism

Answer 4

Anxiety, Emotional Lability, Weight loss, Weakness, Tremor, Palpitations, Heat Intolerance, Warm, Moist Skin, Thin Hair, Tachycardia, Fine Resting Tremor, Hyper-reflexia

Question 5

What is a unique sx seen in Graves

Answer 5

Exophthalmos

Proptosis, Lid Lag, Eyes Bulging

Question 6

Dx of Hyperthyroidism

Answer 6

Low TSH
High T3/T4
If graves, see TSH Ig Antibodies

Question 7

Tx of Hyperthyroidism

Answer 7

Anti-Hormonal Therapy: PTU (propylthiouriacil) or Methimazole Radiactive Iodine destroys gland

Question 8

Which of the tx for Hyperthyroidism can be used during pregnancy

Answer 8

PTU

Question 9

What drugs can you use to curb sx of Hyperthyroidism

Answer 9

Beta Blockers: Propranolol, decreases HR and BP

Glucocorticoids prevent conversion of T4 to T3

Question 10

Dx of TSH secreting pituitary adenoma

Answer 10

High TSH
High T3/T4
MRI to look for pituitary mass

Question 11

Tx of TSH secreting pituitary adenoma

Answer 11

Transphenoidal surgery to remove pituitary tumor

Question 12

What is Hyperparathyroidism

Answer 12

Overactive Parathyroid glands that lead to increased calcium absorption

Question 13

What is primary Hyperparathyroidism and what causes it

Answer 13

Excess inappropriate PTH production

Parathyroid Adenoma is the most common cause

Question 14

What is secondary Hyperparathyroidism and what causes it

Answer 14

Increased PTH due to hypocalcemia or Vitamin D deficiency

Chronic Kidney Failure is the most common cause

Question 15

Sx of Hyperparathyroidism

Answer 15

Bones, Stones, Groans and Psychic Groans

Bone pain, Kidney stones, Abdominal Pain Constipation, Depression and Confusion

Question 16

Dx of Hyperparathyroidism

Answer 16

Increased PTH
Hypercalcemia
Decreased Phosphate
Check 24 hour urine calcium excretion
Osteopenia on bone scan

Question 17

Tx of Hyperparathyroidism

Answer 17

Surgery
Parathyroidectomy
Vitamin D/Calcium supplement if secondary

Question 18

What is Hypoparathyroidism

Answer 18

Due to low PTH or Insensitivity to its action

Question 19

What are the more common causes of Hypoparathyroidism

Answer 19

Accidental damage/removal of parathyroid during neck/thyroid surgery
Autoimmune destruction of parathyroid gland

Question 20

Sx of Hypoparathyroidism

Answer 20

Hypocalcemia: Carpopedal Spasms, Trousseau and Chvostek Sign, Perioral Parasthesias, Increased DTR
Chvostek Sign: Tap on facial nerve and it causes twitching
Trousseau Sign: Blood pressure cuff on arm blocks flow to brachial artery, causes flexion in fingers, extension of wrist

Question 21

Dx of Parathyroidism

Answer 21

Hypocalcemia
Decreased PTH
Increased Phosphate

Question 22

Tx of Parathyroidism

Answer 22

Calcium Supplement and Vitamin D

Vitamin D helps to absorb calcium in gut (Ergocalciferol or Calcitriol)

Question 23

What is Primary Hypothyroidism

Answer 23

Increased TSH

Low T3/T4

Question 24

What is the most common cause of Hypothyroidism in the United States vs. world

Answer 24

United States: Hashimotos (Autoimmune Disorder)

World: Iodine Deficiency

Question 25

Sx of Hypothyroidism

Answer 25

``` Decreased Metabolic Rate Cold intolerance Weight gain Dry, thick skin Goiter Fatigue, depression Constipation, Bradycardia, Decreased CO Menorrhagia Hypoglycemia ```

Question 26

Dx of Hypothyroidism

Answer 26

If Hashimotos, Thyroid antibodies present

Question 27

Tx for Hypothyroidism

Answer 27

Levothyroxine

Question 28

What are risk factors for a thyroid nodule

Answer 28

Extremes of age (very young or very old) | Hx of head or neck irradiation

Question 29

Sx of thyroid nodule

Answer 29

Asymptomatic | Compressive sx: difficulty swallowing or breathing, neck jaw or ear pain, hoarseness

Question 30

Dx of Thyroid Nodule

Answer 30

Benign: Smooth, firm, irregular, sharply outlined Malignant: Rapid growth, fixed, no movement with swallowing Thyroid Function Test (Euthyroid = normal functioning thyroid gland) FNA is best initial test -Benign: Colloid -Malignant: Follicular Radioactive Iodine Uptake Scan, cold is suspicious for malignancy Ultrasound

Question 31

Tx of Thyroid Nodule

Answer 31

Thyroidectomy Observation with ultrasound Suppressive therapy with thyroid hormone in attempt to shrink nodule

Question 32

What are the 4 forms of Thyroid Cancer Which one is the most common Which one is the most aggressive/worst and least aggressive/best

Answer 32

Papillary: Most common and Least Aggressive, Great prognosis Follicular: More aggressive Medullary: More aggressive, low cure rate Anaplastic: Most aggressive, Rapid growth, Poor prognosis

Question 33

What is Pheochromocytoma

Answer 33

Catecholamine Secreting Adrenal Tumor | Secretes Norepinephrine and Epinephrie Autonomously and Intermittently

Question 34

Sx of Pheochromocytoma

Answer 34

HTN Palpitations, Headaches, Excessive Sweating Chest or abdominal pain, weakness, fatigue, weight loss

Question 35

Dx of Pheochromoctyoma

Answer 35

Increased 24 hour urinary catecholamines including metabolites (Metanephrine and Vanillylmadelic Acid) MRI or CT

Question 36

Tx of Pheochromocytoma

Answer 36

Complete Adrenalectomy Preoperative nonselective alpha Blockage (Phenoxybenzamine or Phentolamine for 7-14 days followed by beta blockers Remember: Surgery causes a release of catecholamine release, so you want to block this prior to surgery)

Question 37

What is Cushings Disease

Answer 37

High Cortisol caused by excess ACTH secretion

Question 38

What is Cushings Syndrome

Answer 38

Signs and Sx related to Cortisol

Question 39

Sx of Cushings Disease

Answer 39

``` Central Trunk Obesity Moon Facies Buffalo Hump Superclavicular Fat Pads Wasting Extremities Striae HTN Weight Gain Osteoporosis, Hypokalemia Acanthosis Nigricans Hirtuism ```

Question 40

Dx of Cushings Disease (1st step)

Answer 40

Test to see that you have elevated Cortisol 24 hour urine Salivary Low Dose Dexamethasone

Question 41

What do the results of the Low Dose Dexamethasone tell you

Answer 41

Normal response is Cortisol suppression | No suppression = Cushings Syndrome

Question 42

Dx of Cushings Disease (2nd step)

Answer 42

Measure ACTH If elevated ACTH: Dependent If normal or reduced: Independent If Independent it means the adrena glands are going crazy (adrenal tumor), so scan the adrenals and take out the tumor If Dependent, it means Cortisol is being secreted as a response to high ACTH. Now you need to figure out where its coming from. Could be Pituiatry Tumor or Ectopic Tumor

Question 43

Dx of Cushings Disease (3rd step - Where is the high ACTH coming from)

Answer 43

High dose Dexamethasone If Cortisol is suppressed, it means excess ACTH is coming from Pituiatry tumor (adrenal glands are responding normally to suppression) If cortisol is NOT suppressed, it means ACTH is coming from an ectopic location (mutated cells)

Question 44

Tx of Cushings Disease

Answer 44

Transphenoidal Surgery

Question 45

Tx of Cushings due to Ectopic or Adrenal Tumor

Answer 45

Remove Tumor

Question 46

Tx of Cushings if due to exogenous cause (like excess steroid use)

Answer 46

Withdraw gradually to avoid Addison Crisis