ITE Endocrinology Flashcards
(70 cards)
What is the full dose for levothyroxine initiation? What does would you start in someone who is older, or has heart disease?
A) 100 micrograms/d (1.6 micrograms/kg lean body)
B) 25-50 microgram/d
What is the treatment regimen for opioid-related hypogonadism?
STOP opioids; consider testosterone replacement in hypogonadism secondary to chronic opioid abuse
Overt presentation of what common endocrinology condition can cause hyperprolactinemia?
Hypothyroidism
How to treat hyperprolactinemia and hypothyroidism?
treat hypothyroidism first to see if hyperprolactinemia resolves
Screening for pheochromocytoma is initiated if the unenhanced attenuation of an adrenal mass is greater than what?
10 Hounsfield units
When is adrenalectomy indicated?
1) functioning tumors - Pheo, aldosterone producing tumor, hypercortisol, or suspicion for adrenal carcinoma
2) Suspicious tumor - 4cm greater, 60% or less contrast washout at 10 minutes, 10 hounsfield units
Markedly elevated DHEAS and mildly elevated serum testosterone suggests what in someone with signs including deep voice, facial hair, frontal hair loss
adrenal source; consider CT Scan when DHEAS is above 700
If testosterone levels exceed above 150 in a patient with hyperandrogenism, consider what imaging modality?
pelvic ultrasound
Patients with Type I diabetes mellitus and gastrointestinal manifestations should be screened for what?
Celiac disease (esp if rash appears) by way of IgA tissue transglutaminase antibody
What condition can develop with people who have pituitary surgery?
SIADH (low sodium); manipulation of posterior pituitary gland causes increase release of ADH
What is the treatment/management of thyroid storm?
Transferred to ICU; treat with IV beta-blockers (esmolol); thionamides, typically propylthiouracil, transitioning to methimazole when more stable; IV high-dose glucocorticoids and potassium iodide.
What lab should be monitor in a transgender male undergoing masculinizing testosterone therapy?
H/H; screening for erythrocytosis; PSA should be monitored and genetic males taking testosterone therapy to treat hypogonadism because testosterone therapy can accelerate prostate cancer cell growth.
What condition is associated with suppressed parathyroid hormone level, hypercalcemia, a high/high normal serum phosphorus level, and an elevated 1, 25 dihydroxy vitamin D level?
Vitamin D dependent hypercalcemia which can be seen in sarcoidosis, fungal infection, tuberculosis, and lymphoma.
The combination of neurologic findings and anemia in a patient taking metformin for several years is consistent with what?
Vitamin B12 deficiency
Prolonged metformin use can cause a deficiency and what vitamin?
B12
What endocrinology condition is characterized by diffuse signs and symptoms of skeletal disease, as well as, a progressive rise in total alkaline phosphatase preceding overt hypercalcemia or hyperphosphatemia?
Osteomalacia
Osteonecrosis typically occurs in what areas of the body? How to differentiate from osteomalacia?
Osteonecrosis typically occurs in the shoulders, knees, and hips. Is often bilateral but is not a diffuse disease as reflected in a whole-body bone scan
With drug is typically related to drug-induced hyperprolactinemia? What are the signs and symptoms of hyperprolactinemia?
Risperidone, metoclopramide and phenothiazines; amenorrhea and some cases galactorrhea
What is the treatment of drug-induced hyperprolactinemia?
stop the drug if possible; if not, estrogen-progesterone supplementation is necessary to avoid estrogen deficiency
Patient is receiving anabolic therapy for osteoporosis, what must be started within 1 month to complete the course of antibiotic treatment to prevent the loss of newly formed bone?
Bisphosphonate, alendronate
Generally speaking, how long should a course of teriparatide and other anabolic agents last? What are the procedure risk?
Approximately 24 months; most concerning adverse effect of teriparatide therapy is a theoretical increase in bone osteosarcoma rates
What test are used to confirm diagnosis of Cushing syndrome? What follow-up tests will be necessary once diagnosis has been confirmed?
Overnight low-dose dexamethasone suppression test, 24-hour urine free cortisol measurement, and late-night salivary cortisol measurement
Once diagnosis is made, ACTH is measured; if ACTH dependent then you would get a a milligram dexamethasone suppression test
How to differentiate between ACTH dependent Cushing’s syndrome?
High-dose dexamethasone suppression test; if ACTH is suppressed, location of hormone is likely pituitary by way of negative feedback loop; if high-dose dexamethasone suppression test fails, ACTH is likely coming from an ectopic source
In otherwise healthy, young adults, a low energy fracture is not an indication for bone mineral density measurement. What would be the appropriate management?
Lifestyle modifications
