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Tests And Stuff Flashcards

1
Q

Primary hyperparathyroidism Labs:

A

Serum Cal: high
iCal: high
iPTH: high
Serum phosphate: low

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2
Q

S/s of congenital adrenal hyperplasia

A

Virulization; salt wasting; ambiguous genitalia

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3
Q

Congenital adrenal hyperplasia is caused by what deficiency

A

21-hydroxylase enzyme (makes cortisol)

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4
Q

DI on physical exam:

A

Hydronephrosis and larger bladder

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5
Q

Hypoparathyroidism s/s

A 
Laryngospasm/bronchospasm
GI
Neuro
Psych
\+chovesteks and trousseau’s sign
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6
Q

Iatrogenic adrenal insufficiency potential causes:

A

Etodimate
Ketoconazole
Adrenalectomy
RU-486

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7
Q

Common s/s post-parathyroidectomy surgery in hyperparathyroidism

A

“Hungry bones” and now pts getting waxing and waning hypocalcemia

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8
Q

adrenal insufficiency is comomonly caused by withdrawal from chronic use w/ these medications

A

Prednisone and dexamethasone (decadron)

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9
Q

Hypoparathyroidism on Labs:

A

Serum Cal: low
iCal: low
iPTH: low
Serum phosphate: high

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10
Q

Pheochromocytoma etiology

A

90% adrenal medulla tumors of chromaffin cells

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11
Q

Adrenal insufficiency workups

A 
renal failure
Low glucose
Hyperkalemia
Hyponatremia
Metabolic acidosis
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12
Q

Adrenal etiologies with cushings and treatment

A

1- adrenal adenoma (MC); tx u/l laparoscopic adrenal resection
2 adrenal carcinoma; tx- open laparotomy with exploration

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13
Q

Hypopituitarism workup:

A

Labs: panhypopituitarism; MRI of pituitary

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14
Q

Hypoparathyroidism etiology

A

Iatrogenic
Autoimmune destruction
Hypomagnesiemia (reversible)

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15
Q

Central DI tx

A

DDAVP- synthetic ADH

Diet

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16
Q

Tx for symptomatic primary hyperparathyroidism

A

Parathyroidectomy

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17
Q

Hypoaldosteronism labs

A

Hyperkalemia
Hypovolemia
Non-metabolic acidosis
However pt. Asymptomatic presentation

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18
Q

Cushings test to localize the source of acth

A

ACTH serum level: elevated—>pituitary or ectopic source
(R/o adrenal autonomous secretion)
CRH serum level: elevated—>pituitary source
(R/o ectopic source)

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19
Q

Adrenal insufficiency CT reveals calcified adrenals:

A

TB

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20
Q

Meds for tx in hyperaldosteronism

A

CCB and alpha blockade

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21
Q

Nephrogenic DI tx

A

Diet
Thiazide
Amiloride

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22
Q

Prolactinoma work-up

A

1- Labs: prolactin, pregnancy test, TSH

2- MRI w/ contrast

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23
Q

Hyporeninemic hypoaldosteronism tx

A

Thiazide and diet w/ low K

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24
Q

Secondary hyperparathyroidism treatment:

A

1- reduce phosphate foods
2- phosphate binders: need to be taken w/ meals
Calcium acetate (Phoslo)- CA
Selevamer (Renvela; Renagel): non-ca
Fosrenol (Lanthanum) non-CA, chewable and crushable (peg-tube pts)
3- Vitamin D agent:
Calcitriol (rocaltrol)- IV/oral (SC w/ HD appointments)
-Active form of vitamin D
Doxercalciferol (hectoral)- IV/oral
- metabolized to active form
Paricalcitol (zemplar)- IV/oral
- synthetic vitamin D analog; binds at receptor in kidney
4- Calcimimetic agent: Cinacalcet (Sensipar)
5- Surgical (as last resort): parathyoidectomy

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25
Hypercalcemia treatment:
Mild (<12) 1- hydrate 2- avoid drugs that worsen (lithium and thiazide) 3- avoidance of factors that worsen (bed rest/immobility) Severe (>12) 1- bisphosphonate IV (zometa) and IV fluids!!
26
Labs in adrenal insufficiency
``` Low glucose Hyperkalemia Renal failure Low sodium Metabolic acidosis ```
27
Cushing’s syndrome test:
``` 1- dexamethasone test 2- salivary cortisol test 3- random urinary free cortisol test 4- ACTH 5- CRH 6- MRI w/ contrast ```
28
Hypoparathyroidism tx
``` 1- IV calcium gluconate—> normal levels Also high oral calcium intake and vitamin D supplements 2- thiazide diuretics 3- recombinant PTH (natpara) —> BBW for osteosarcoma ```
29
Hypocalcemia s/s
Parasthesias (oral and hands/feet) Prolonged QT Sz Tetany/muscle spasms
30
Hyperaldosteronism workup:
- Aldosterone to renin ratio w/ patient standing 2+ hours | - MRI w/ contrast
31
Hypoaldosteronism MC associated with these diseases
Diabetic nephropathy and chronic tubulointerstitial kidney dz
32
Pituitary Metasteses cancers and survival length
Metastasize to the posterior pituitary—> diabetes insipidus ~ 6 months - breast, lung, & GI
33
MC cause of hyperglycemia in outpatients and MC etiology
Primary hyperparathyroidism | Single autonomous parathyroid adenoma
34
Diabetes Insipidus workup:
1- 24h urine collection 2- labs: - ADH - urine specific gravity (>1.005 is +) - plasma & urine osmolality (<200 is +) - serum electrolytes & glucose 3- water deprivation testing to see central vs. nephrogenic
35
Mc cause of Addison’s dz
Auto abs to adrenal
36
Prolactinoma Tx:
Aymptomatic: yearly MRI and observation Symptomatic: Bromocriptine & surgical transphenoidal pituitary adenectomy
37
Tx of hypocalcemia
Mild: (1.0-1.2) PO calcium Calcium gluconate Calcium chloride (only in central line or w/ emergency) Severe- IV calcium (<1.0) W/ symptoms—> 100-300 mg calcium IV over 5-10 minutes w/ continuous infusion at 0.5 mg/kg/hr W/o symptoms—> 0.5 mg/kg/hr IV infusion (not to exceed 3-4 g over 4 hrs) Monitor calcium levels Q4-6hours
38
Cushing’s Dx tests
1- Dexamethasone suppression test- in patient test - 1 mg at 11p and measure serum cortisol @ 8a—> elevated or normal is likely cushings 2- salivary cortisol levels- easy test; at home -saliva specimen at 11p—> high cortisol likely Cushing’s 3- random urinary free cortisol level Cortisol>(3*creatinine) likely Cushing’s
39
Secondary adrenal dz workup
Screening test: serum cortisol levels (<25mg/dL is +) Diagnostic: cosynotropin stimulation test (obtain baseline levels of aldosterone and cortisol; give 0.25 mg ACTH and measure aldosterone and cortisol levels—>low/unchanged is +)
40
MC cause of Diabetes insipidus w/ central etiology:
Idiopathic | - also malignant, surgery, or trauma
41
MC cause of Diabetes Insipidus w/ Nephrogenic etiology:
Meds: LITHIUM | - also, renal dz, pregnant, osmotic diuresis
42
MC cause of adrenal insufficiency
Addison’s dz
43
Primary treatment of cushings:
transphenoidal surgery (high success rate)
44
Secondary adrenal dz presenting differences:
No salt cravings All endocrine hormones affected No hypigmentation
45
Medical tx w/ ectopic cushings
Ketoconazole
46
Hypocalcemia w/u
Labs: PTH, mag, creatinine , phosphate, vitamin D metabolites
47
Secondary hyperparathyroidism Labs picture:
Serum Cal: low iCal: low iPTH: high Serum phosphate: high
48
Ectopic etiologies in cushings:
Carcinoid tumors: lung/GI (MC) | Neuroendocrine: pancreas; pheo; medullary thyroid cancer
49
Etiology of hypercalcemia of malignancy
Tumor release of a hormone-related peptide (PTrH) w/ low PTH; BLT and a Kosher Pickle
50
Dx for pituitary macroadenoma:
1- intitial screening test: random serum IGF-1 (+)—> elevated IGF-1 2- GH supression test: - oral glucose load is given and GH level drawn at 120 min - IGF-1 level>1ng/mL= (+) GH excess 3- thin cuts MRI w/ contrast
51
Tertiary hyperparathyroidism tx
MC w/ total or subtotal parathyroidectomy
52
Hypoituitarism tx:
``` 1- ACTH= hydrocortisone 2- TSH replacement 3- FSH/LH= - fertility—> Men & women: gonadotropins - no fertility—> M: testosterone W: HRT (est and progest) ```
53
Hypercalcemia S/S
Skeletal muscle weakness | Easy fatig
54
Hypoaldosteronism from Primary adrenal deficiency tx
Fludrocortisone (Florinef)
55
Tx of choice for macroadenoma
``` 1- transphenoidal microsurgery 2- pharm: - octreotide/lanteotide (somatostatin analog) - bromocriptine - pegvisomant (GH receptor antagonist) ```
56
W/u of hypercalcemia
1- confirm hypercalcemia (w/albumin test) 2- Check PTH —> high: primary hyperparathyroidism —> low, then require iPTHrP to check malignancy or vitamin D metabolites for granulomatous or vitaminosis
57
Adrenal insufficiency CT reveals enlarged adrenals:
Metastatic dz
58
MC cause of hypercalcemia in hospitalized patients
Hypercalcemia of malignancy
59
Cushings first line Imaging test
MRI w/ contrast
60
Hypercalcemia of malignancy tx
IV bisphosphonate | FLUIDS
61
Hyperaldosteronism labs:
Hypokalemia Hypervolemia Hypernatremia Metabolic alkalosis
62
hyperaldosteronism tx
Adenoma?—> U/L adrenal resection | Hyperplasia?—> aldactone (spironolactone): aldosterone antagonist
63
Tests for adrenal insufficiency
1- serum cortisol levels (<25 mcg=+) | 2- cosyneotropin stimulation test (low or not changing=+)
64
Hyperaldosteronism etiologies:
Mc women 30-50 1- B/L adrenal hyperplasia (MC) 2- aldosterone producing adenoma 3- sometimes adrenal ca
65
Pheochromocytoma Dx test
24 hour creatinine urine test
66
Two pharm treatments for hypothyroidism:
1- levothryoxine (synthroid) | 2- liothyronine (cytomel)
67
Inducers of thyroid pharm tx:
Phenytoin Tegatrol Rifampin Phenobarbital
68
Inhibitors of levothyroxine
Delivery Menopause Oral estrogens GnRH agonists

KC Endocrine (12 decks)

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