Final Flashcards by Rachel Schofield

Name 3 conditions of hyperpituitarism in the anterior pituitary.

Increased GH - Pituitary gigantism, acromegaly

Increased ACTH - Cushing Disease

Increased PRL - Hyperprolactinemia

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Name a condition of hyperpituitarism in the posterior pituitary.

Increased ADH - SiADH

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Name a cause of hypopituitarism in the anterior pituitary.

Low GH - Pituitary dwarfism

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Name a cause of hypopituitarism in the posterior pituitary.

Low ADH - Diabetes insipidus

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What is the emergent condition related to hypopituitarism?

Pituitary Apoplexy (hemorrhage or impaired blood supply of the pituitary gland)

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What is the cause of Sheehan Syndrome?

Postpartum pituitary gland necrosis. Ischemic necrosis due to blood loss and hypovolemic shock during childbirth.

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What is the most common pituitary adenoma?

Prolactinoma

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What are the lab values associated with Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

Low serum osmolality

High urine osmolality

Low BUN due to volume expansion

Plasma Na+ < 135

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Compare Diabetes insipidus and Syndrome of Inappropriate Antidiuretic Hormone

DI: Low ADH

Causes: central, nephrogenic, dipsogenic, geestational
↑ urination
↑ thirst
Dehydration
Polyuria, polydipsia
DX: water deprivation testing, desmopressin stimulation test

SIADH: High ADH

Causes: idiopathic, pulmonary disease, cancer, drugs,
↓ Urination
↑ Urine osmolality
↑ ECF fluid > hypo-osmolality, hyponatremia
↑ Intracellular volume > cell swelling (brain) (neurological symptoms: mild > severe/death)
Generalized muscle weakness, myoclonus, tremor, asterixis, hyporeflexia, ataxia, dysarthria

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Compare the SXS of DI and DM.

DI:

Non-sweet pee
Causes: central, nephrogenic, dipsogenic, geestational
↑ urination
↑ thirst
Dehydration
Polyuria, polydipsia

SWEET PEE
Polydipsia
Polyuria
Polyphagia
Weight loss
Blurry vision
Hyperglycemia in the setting of a combination of insulin resistance and imparied insulin secretion

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SXS of hyponatremia (acute and chronic).

N/V

Headache

Seizure

Coma

Respiratory arrest

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What is the cause of congenital adrenal hyperplasia (CAH)?

Rare autosomal recessive disease resulting from mutations in steroidogenic enzymes. Causes low adrenocortical steroids (cortisol always affected). Low cortisol signals ACTH to be released = hyperplasia.

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What emergent condition can congenital adrenal hyperplasia lead to?

Adrenal crisis

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What are the SXS of congenital hyperplasia?

F: Ambiguous genitalia

Decreased BP

Short height

Early puberty

Rapid growth

Pubic hair at early age

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Name 2 medullary tumors.

Pheochromocytoma

Neuroblastoma

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What are the SXS of the 2 medullary tumors?

Pheochromocytoma - Secrete excess catecholamines, often cause severe HTN. Palpitations, tachycardia, headache, profuse sweating, episodes of dramatic BP elevation, insomnia, facial flushing, anxiety.

Neuroblastoma - Tumors of primitive neural crest cells related to chromaffin cells. Can develop in the neck, chest, abdomen, spine. Abdominal distention, abdominal mass, bone pain, dancing feet/eyes. Most common cancer in babies. 90% in <5YO

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What are the causes of primary vs secondary hyperaldosteronism?

Primary - Conn Syndrome, Adrenal hyperplasia, Congenital adrenal hyperplasia.

Secondary - Renal artery stenosis, CHF, cirrhosis, nephrotic syndrome

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What are the differences in lab values in primary vs secondary hyperaldosteronism?

Primary - High aldosterone, regular renin

Secondary - High aldosterone, high renin

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What is the condition associated with primary adrenocortical insufficiency?

Addison Disease

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What are the secondary and tertiary causes of adrenocortical insufficiency?

Secondary - Pituitary pathology or exogenous glucocorticoid therapy

Tertiary - Hypothalamic tumors

What are the SXS of Cushing Disease?

High cortisol, central adiposity, moon facies, purple striae, excess hair,

What is the main cause of Cushing Disease?

Pituitary adenoma

What are the different types of goiters and their symptoms/causes?

Colloid - early iodine deficiency, smooth enlarged thyroid from colloid accumulation
Nodule - iodine deficiency continuation, follicles become cystic and irregularly sized
Toxic goiter: Grave’s Dz/hyperthyroidism

What is the most common cause of hypothyroidism and its etiology?

Hashimoto Thyroiditis; autoimmune

What is a common symptom associated with hypothyroidism? (Not the obvious ones)

Carpal tunnel syndrome

How would lab(s) differ in primary vs central (secondary) hypothyroidism?

Primary - ↑TSH, ↓fT4 Secondary - ↓ TSH, ↓fT4

What is an emergency condition to look out for with hyperthyroid pts? What are sx of this condition?

**_Thyroid storm_**; high fever, severe tachycardia, weight loss, heat intolerance

What is a common autoimmune cause of hyperthyroidism? What would thyroid hormone levels look like in this condition?

Graves disease; ↓ TSH ↑ fT4/T3 ↑ TSIs

What are the common causes/risks for functional hypothalamic amenorrhea?

Female athlete triad: Anorexia, stress, over exercising

How is amenorrhea is diagnosed?

No period by age 15, in the presence of normal secondary sex characteristics OR 13 with absence of secondary sex characteristics Secondary: dx of exclusion ↑ androgen/testosterone

What is a common cause of premature ovarian failure/insufficiency? What lab(s) would be abnormal with this condition?

Turner syndrome ↑ FSH \> 25 ↓ estradiol \<50

What lab(s) would be markers of menopause?

↑ FSH \> 25 ↓ inhibin and AMH

What are the criteria for making a diagnosis of overt diabetes at the initial pregnancy visit?

* Fasting plasma glucose \> 126 * A1C \> 6.5 * Random plasma glucose \> 200 with follow up fasting glucose/A1C

What is the definition of pre-eclampsia?

Pregnancy-induced HTN + proteinuria and/or edema

Sx of preeclampsia?

* Headache that won’t go away/is getting worse * Edema * RUQ pain * Decreased urinary output * Urinary frequency of thimbleful of protein urine * N/V * Malaise * Altered mentation * Asym if mild

Why do thyroid levels need to be monitored for a pregnant pt with hypothyroidism?

Pregnancy causes fluctuations in thyroid hormone; need to use trimester specific reference ranges

Risk factors for postpartum thyroiditis?

Hx of autoimmune, antithyroid antibodies, previous thyroid dysfunction, Fhx

What is the most common cause for primary hypogonadism? What is the cause of this disorder?

Klinefelter syndrome - extra chromosomes in males

What is the primary diagnostic lab in late onset hypogonadism (andropause)?

Low serum total testosterone

Compare Klinefelter syndrome and Late Onset Hypogonadism (andropause).

Klinefelter * Small statue + testicles (hypogonadism + infertility) * Gynecomastia * ↓ Muscle mass * ↓ Body/facial hair * Broader hips, long arms/legs * Learning + reading impairment * Low androgen levels Late onset hypogonadism * Sexual fxn: Low libido, ED * ↓ Bone mineral density (increased fracture risk) * ↓ Muscle mass/strength, ↑ fat mass, central obesity, gynecomastia * Low energy * Depression * Impaired memory * ↓ Testicular size * ↓ Ejaculated sperm density * Low testosterone

What is the difference between type 1 DM and type 2 DM?

Type 1 - autoimmune → absolute insulin deficiency Type 2 - hyperglycemia + insulin resistance → impaired insulin secretion

What is the **emergency** complication you have to look out for in all types of DM but is more common in DM1? What are the sx?

**_Diabetic ketoacidosis (DKA)_** * Results from excess ketone body formation from increased fatty acid catabolism * Rapid breathing * Fruit-like odor breath * Disorientation * Sudden coma

What lab values are diagnostic of DM?

Asymptomatic: Fasting plasma glucose \> 126 mg/dL OR A1C \> 6.5% OR Oral glucose tolerance test (OGTT) 2 concordant lab values on a single sample or 1 value repeated on 2 diff samples. Symptomatic: Random plasma glucose \> 200 mg/dL 4 autoantibodies associated with T1DM: Islet cell antibodies (ICA) – target cytoplasmic proteins in the β cells Glutamic Acid Decarboxylase (GAD-65) antibodies Insulin autoantibodies (IAA) Islet Antigen 2 antibody (IA-2A) – target protein tyrosine phosphatase

What is the difference between LADA and MODY?

**_LADA_**: hyperglycemia and insulin deficiency w/ varying degrees of insulin resistance w/ the presence of autoimmune antibodies **_MODY_**: genetic defects of B-cell function

What is the Chvostek sign and the Trousseau sign?

**_Chvostek_**: Elicited by tapping the facial nerve about 2 cm anterior to the earlobe, just below the zygoma—response is contraction of facial muscles **_Trousseau_**: Elicited by inflating a BP cuff to ~20 mmHg above systolic pressure for 3 minutes—response is carpal spasm

What is the most common cause of hyperparathyroidism and hypoparathyroidism?

Hyper - Adenoma Hypo - Surgery

What are the symptom differences between hypocalcemia and hypercalcemia?

**_Hypocalcemia_**: “CATs go numb” Convulsions, arrhythmias, tetany, numbness/paresthesia **_Hypercalcemia_**: Stones, bones, groans, and moans

How do you diagnose osteoporosis?

Clinical dx can be made in the presence of a fragility fracture OR DEXA T-score ≤ -2.5 standard deviations (SD) at any site based upon bone mineral density (BMD) measurement