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Endocrinology > MTB 1 > Flashcards

MTB 1 Flashcards

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1
Q

Presentation of PRL deficiency in men? Women?

A

Men - ASX

Women - No lactation after birth

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2
Q

Presentation of LH and FSH deficiency in men? Women?

A

Both - Decreased libido, decreased axillary, public, body hair
Men - ED, decreased muscle mass ( do not make testosterone or sperm)
Women - Amenorrhea

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3
Q

Presentation of GH deficiency in children? Adults?

A 
Children - short stature, dwarfism
Adults - mostly ASX, subtle findings:
- Central obesity
- Increased LDL and cholesterol 
- Reduced lean muscle mass
- Accelerated Atherosclerosis
- Fine wrinkles
- Hypoglycemia
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4
Q

Presentation of Kallman syndrome

A 
Anosmia
Amenorrhea
Absent 2 sexual characteristics -breasts, pubic hair
Renal Agenesis
Normal female internal repro organs
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5
Q

Role of cortisol on ACTH

A

Cortisol is feedback inhibition on pituitary for ACTH

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6
Q

Effect of insulin on GH

A

Insulin decreases glucose ->
GH rises
Failure to rise = pituitary insufficiency

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7
Q

Kidney dz’s that cause NDI

A

Chronic pyelonephritis
Myeloma
Amyloidosis
Sickle cell

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8
Q

Electrolyte changes that inhibit ADH’s effect on kidney

A

Hypercalcemia

Hypokalemia

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9
Q

Presentation of DI

A

Extremely High-volume urine output
Excessive thirst
Volume depletion
Hypernatremia

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10
Q

Drugs that cause NDI

A

Lithium
Demeclocycline
Colchicine

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11
Q

Dx tests for DI

A

Urine osmolality LOW
Urine Sodium LOW
Serum osmolality HIGH

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12
Q

DDX of CDI and NDI

A

Vasopressin response

  • CDI = urine volume decreases, urine osmolality increases
  • NDI = no chagne
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13
Q

Tx for CDI

A

Vasoporessin

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14
Q

Tx for NDI

A

Correct underlying problem
HCTZ
Amiloride
PG inhibitors = NSAIDS, Indomethacin

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15
Q

MCC Acromegaly

A

Pituitary Adenoma

aka Somatotroph Adenoma

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16
Q

Acromegaly Presentation

A 
Increased hat, ring, shoe size
Carpal tunnel
Body odor
Coarsening facial features
Deep voice, macroglossia
Colonic polyps
Arthralgias
HTN
Cardiomegaly, CHF 
DM 2
ED
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17
Q

MCC Death Acromegaly

A

Cardiomegaly, CHF

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18
Q

DDX for Bilateral Carpal Tunnel

A

Acromegaly

Hypothyroidism

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19
Q

Presentation of Constitutional Growth Delay

A 
Delayed growth spurt
Delayed puberty
Delayed bone age
Normal birth wt and ht 
Growth slows b/t 6 mos and 3 yrs
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20
Q

Lab tests Acromegaly

A

Glucose intolerance

Hyperlipidemia

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21
Q

Best initial test Acromegaly

A

IGF-1

insulinlike = somatomedins

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22
Q

Most accurate test Acromegaly

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A

Glucose suppression test

23
Q

When is MRI done in Acromegaly

Study These Flashcards
A

ONLY after lab Id

Localize tumor for surgery

24
Q

Tx for Acromegaly

Study These Flashcards
A
  1. Transphenoidal resection
  2. Octreotide = somatostatin inhibits GH release
    Cabergoline, Bromocriptine = tumors have Da receptors
    Pegvisomant = GH receptor antagonist
  3. Radiotherapy
25
AE of octreotide
Cholestasis --> Cholecystitis
26
Why are PRL levels tested in Acromegaly
Bc cosecreted with GH
27
Presentation of Prolactinoma
Aka Lactotroph Adenoma Women: Galactorrhea, amenorrhea, infertility Men: ED, decreased libido
28
Effect of thyroid levels on PRL
Hypothyroidism leads to hyperprolactinemia b/c extremely high TRH levels stimulate PRL secretion
29
Relationship of Dopamine and PRL
Dopamine inhibits PRL release
30
Drugs that cause hyperprolactinemia
``` Antipsychotics - Risperidone, Phenothiazine Methyldopa Metoclopromide Opiods TCAs SSRIs Cocaine Narcotics ```
31
Which endocrine dz do we do MRI first
None.
32
Dx test for high PRL
1. TFTs 2. Pregnancy test 3. BUN/Cr - kidney dz elevates PRL 4. LFTs = cirrhosis elevates PRL
33
What is empty sella syndrome? Presentation? Tx?
Meninges comes in and pushes pituitary to side Incidental CT finding, trauma, radiation Obese, multiparous women w HA Tx: resection
34
Tx for hyperprolactinemia
1. Dopamine Agonists - Cabergoline 2. Transphenoidal surgery 3. Radiation
35
Carpal Tunnel Syndrome in hypothyroid | Pathophys
Deposits of mucopolysaccarhide protein complexes w/in perineum and endoneurium of Median Nerve, tendons, synovial sheath BL, severe sx's
36
Hashimoto thyroiditis abs
Anti TPO | Antimicrosomal
37
What is pituitary apoplexy | Presentation
Hemorrhage of preexisting pituitary adenoma | Presents like meningitis, HA, AMS
38
Presentation of Sheehan syndrome
Postpartum gland necrosis Inability to lactate Can be years post partum
39
Best initial test thyroid disorders
TSH | Then T4
40
Tx of hypothyroid? | What if left untreated?
Thyroxine | If untreated = rapid bone loss b/c of increased osteoclastic bone resorption
41
Hypothyroidism during Pregnancy When? Why?
Usually 1st trimester | Increased requirement
42
Labs in Hypothyroidism during Pregnancy
High TBG => High T4, T3
43
Management for Hypothyroidism during Pregnancy
Check TSH q 3 mo's | Increase dose of levothyroxine
44
What is sub-clinical hypothyroidism and tx
TSH > 10 Tx: L-thyroxine Hypercholesterolemia = very high LDL
45
Sick Euthyroid syndrome
"Low T3 syndrome" | Abnormal TFTs with sick, acute, severe illness from caloric deprivation and increased cytokines (IL1,6)
46
Labs in Sick Euthyroid syndrome
Decreased total and free T3 | Normal TSH, T4
47
Lab findings in Graves
Low TSH | High RAIU
48
Tx for Graves
RAI
49
Tx for acute hyperthyroidism and Thyroid storm
1. Propranolol = inhbits T4-> T3 2. Thiourea drugs = methimazole, PTU 3. Iodinated contrast 4. Steroids 5. RAI
50
AE of Methimazole and PTU
Agranulocytosis
51
When do we discontinue PTU/Methimazole
Pt with fever and sore throat | Measure WBC, if < 1,000
52
Best initial tx for Graves opthalmopathy
Steroids
53
When is RAI CI
Graves w severe exophthalmus

Endocrinology (2 decks)

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