UW3 (08 Endo) Flashcards by M S

HyperCalcemia

Lab tests? 3
Treatment? 2
When to add thiazide?

Repeat test
PTH
PTHrp + Vit D
Calciferol / Calcitriol
Calcium

• If U-Ca ↓ + PTH ↑ Add Thiazide

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Anabolic steroid

Symptoms? 3
Withdrawal symptoms? 2
Labs? 6

Testicular atrophy
Acne
Gynecomastia
Libido ↓
Erectile dysfunction
FSH ↓ + LH ↓
LDL ↑ + HDL ↓
Hb ↑ / RBC ↑

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Thiazolidinedione
Pioglitazone (actos)
Rosiglitazone (Avandia)

Effects? 2

↑ Na reabsorption @ kidney

* ↑ Fluid retention

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Subclinical HypoThryoid (Hashimoto Thyroiditis)

Diagnostic lab?
Treatment indication based on TSH?
Treatment indication based on TPO Ab?

• TSH↑, T4 n, TPO Ab ⊕

TSH > 10
TSH 7-10 + Age < 70
TSH 7-10 + Age > 70 + Symptoms
TSH < 7 + Age < 70 + Symptoms
TPO Ab ⊝ with:
Goiter
Pregnancy
Cholesterol ↑
Ovulatory dysfunction
Infertility
Symptomatic

• TPO Ab ⊕

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Euthyroid Sick Syndrome
Lab results

Early / Mid
Late / Severe?

T4 n + T3 ↓ + TSH n

* T4 ↓ + T3 ↓ + TSH ↓

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HyperThyroidism @ pregnancy (treatment)

PTU @ T1 (MM = teratogen)

* MM @ T2-3 (PUT ↑ liver failure)

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DM2

Starting insulin treatment indication? 2

Failed 2 oral agent

* A1c > 9%

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SulfonylUrea toxicity

2 medication therapy?

Glucose / Dextrose

* Octreotide (↓ insulin)

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Pheochromocytoma

3 classic symptoms?
Diagnosis? 6
Treatment? 3
4 surgery complications + management?

• Headache, Sweating, HR ↑

24h U-metanephrine
24h U-catecholamine
Plasma Metanephrine
CT / MRI
MIBG
Octreotide scan
Wide body MRI
PET
Alpha blocker
Beta blocker
Resection
BP ↑ (Nitroprusside, Phentolamine, Nicardipine)
BP ↓ (NS, Vasopressor)
Gluc ↓ (Dextrose)
HR ↑ / Arrhythmia (Lidocaine, Esmolol)

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Rapid thyroid enlargement
Arm raise causes: Facial Plethora, Neck vein engorgement

Diagnosis?

Thyroid Lymphoma

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CanaGliflozin / DapaGliflozin

Mediation class?
5 side effects?

• SGLT-2 inhibitor

UTI
Vaginal candida
K ↑ / Lipid ↑
KetoAcidosis

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HyperParaThyroidism

Causes? 2 major
Labs? 3
Surgery indication? 3
Surgery complications? 3

Parathyroid Adenoma / Carcinoma
MEN 1, 2A
Ca ↑, PTH n↑, U-Ca ↑
Age < 50, Symptomatic, U-Ca > 400
Osteoporosis, Kidney stone, CKD

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Bilateral Tempral Hemiagnosia & HyperPigmentation – after L+R adenomectomy

Diagnosis?
Management?

Nelson’s syndrome
Pituitary adenoma development after bilateral adenoectomy for cushing syndrome
If ACTH ↑↑ –> MRI brain
Surgery / Radiation

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PostPartum Thyroiditis

PE?
Labs?
Study findings?

Non-tender goiter
T4 ↑ / TSH ↓ / TPO Ab ⊕
RAIU ⊝

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1° hyperthyroidism pituitary adenoma

Labs? 4
Treatment? 2

TSH n↑
T3 ↑ / T4 ↑
α-sub ↑
Somatostatin
Surgery

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Thyroid Nodule

Evaluation / Diagnostic?

1) US
a. US suspicious / Cancer risk –> FNA
b. No US finding / No cancer risk –> TSH

2) TSH
a. If TSH n↑ –> FNA
b. If TSH ↓ –> I123 Scintigraph

3) Iodine Scintigraph
a. Cold –> FNA
b. Hot –> Treat hyperthyroidism

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Differentiated thyroid cancer

What types are differentiated? 2
Initial diagnostic? Why?
When to do thyrodetomy? 4
When to do neck dissection?
When to do thyroid lobectomy?

Papillary & Follicular
US neck / Lymph (to stage cancer)
Large papillary thyroid cancer
Extra thyroid tumor extension
Distant metastasis
History of radiation @ neck / head
Involvement of adjacent neck structure or regional lymph nodes.
Papillary cancer < 1cm + No lymph node involvement

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Patient has Weight ↓, Weakness, HyperPigmentation
Suspicious for adrenal failure

Lab tests & results? 4
Diagnostic test? 3

Eosinophil ↑
K ↑
Na ↓
Gluc ↓
Cortisol
Consyntropin
CT

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Class of mediation? Side effects?

1) SulfonylUrea, Glyburide, Glipizide, Glimepiride
2) Maglitnide, Nataglinide, Repaglinide,
3) Metformin
4) Pioglitazone, Rosiglitazone
5) Exenatide, Liraglutide
6) Sitagliptin, Saxagliptin
7) Acabose, Miglitol
8) Canaflifloxin, Dapagliflozin

1) Insulin ↑ (Weight↑, Avoid @ CKD)
2) Insulin ↑ (Gluc ↓)
3) Biguanides (LA, Diarrhea, Avoid @ Liver / CKD / CHF)
4) Thiazolidindones (Weight ↑, Fluid retention)
5) GLP-1 (Weight ↓, Pancreatitis)
6) DDP4-I (Weight ∅, NasoPharyngitis)
7) α-gluc-I (Diarrhea, Flatulence)
8) SGLT2-I (Gluc ∅, DKA , UTI, BP ↓)

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Amiodarone effects @ thyroid

Which is more common, Hypo or Hyper?
Frequency of monitoring?

HypoThyroidism more common than HyperThyroidism

Monitor TSH q3m

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Amiodarone effects @ thyroid

What effect can it have it on conversion?
What effect can it have on thyroid hormone production?
What effect can it have on thyroid gland?

Lab test & treatment for each type?

Conversion [T4–>T3] ↓
TSH n↑/ T4 ↑ / T3 ↓
Euthyroid, No treatment
High I2 causes Thyroid hormone production ↓
TSH ↑ / T4 ↓
LevoThyroxine
High I2 casues Thyroid hormone production ↑
TSH ↓ / T4 ↑ / T3 ↑ / RAIU ↑ / US = vascularity ↑
PTU / MMI
Thyroid gland destruction
TSH ↓ / T4 ↑ / T3 ↑ / RAIU ∅ / US = vascularity ↓
Steroids

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Thyroid binding globulin

What can cause high TBG? 2
What can cause low TBG? 3

Associated labs & management?

Estrogen (OCP, Pregnancy, HRT) / Hepatitis
T4 ↓ / T3 ↓ / TSH ↑
↑ Thyroid med
Androgen, Steroids, Protein ↓ (Nephrotic, Starvation), Liver disease
T4 ↑ / T3 ↑ / TSH ↓
↓ Thyroid med

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Estrogen induced thyrotoxicosis

Mechanism?
Study finding? Labs?

T4 ↑ / T3 ↑ –> TSH ↓

RAIU ⊝ / T-Ig↓

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Definition of
Vitamin D insufficiency
Vitamin D deficiency

Treatment?

Insufficiency = Vit D 20-30
Deficiency = Vit D < 20
Calciferol 50ku/w x8w –> Vit D > 30
Calcitriol 2ku/d (3-6ku/d @ malabsorption)

Incidental adrenal mass Evaluation? 3 Surgery indication? 3

* Electrolyte * DexaMethason Suppression * 24h urine (Catecholamine, Metanephrine, VMA, 17-keto steroid) * Functional tumor * Malignancy / Heterogenous * Size > 4cm

TSH ↓ / T3 n / T4 n Diagnosis? Initial management? Treatment indication?

SubClinical HyperThyroid Repeat test @ 6-8w TSH < 0.1 TSH > 0.5 + (Age > 65, Heart disease, OsteoPorosis, Nodular Thyroid)

1° Ovarian Insufficiency Labs? 3 Treatment?

Estrogen ↓ FSH ↑ / LH ↑ Estrogen + Progestin

Statin High medication? 2 Moderate medication? 5

AtorvaStatin 40-80mg RousuvaStatin 20-40mg ``` AtorvaStatin 10-20mg RousuvaStatin 5-10mg Simvastatin 20-40mg Prvastatin 40-80mg Lovastatin 40mg ```

Statin therapy indication High statin indication? Moderate statin indication?

* Age < 75 + (ACS / Angina / CABG / TIA / CVA) * LDL > 190 * Age > 40 + DM + ASCVD risk > 20% * Age > 75 + (ACS / Angina / CABG / TIA / CVA) * Age > 40 + DM + ASCVD risk < 20% * ASVCD risk 7.5-20%

Patient has mood swings, hypertension, osteoporosis Diagnosed with cushing syndrome Associated lab results? 3

* Gluc ↑ * K ↓ * Aklalosis / HCO3 ↑

Male in puberty Breast mass < 4cm Diagnosis? Management? Course?

* GynecoMastia * Reassess / Observe * Resolve < 1y

GDM cause? | When to screen?

* Human placental lactogen increase | * Screen @ GA 24-28w

CAH types 1) Hypertension? 2) Hypotension? 3) Low potassium? 4) High potassium? 5) Ambiguous genitalia @ F 6) Ambiguous genitalia @ M 7) Low sodium & low glucose?

1) 11b-OH, 17a-OH 2) 21-OH 3) 11b-OH, 17a-OH 4) 21-OH 5) 11b-OH, 21-OH 6) 17a-OH 7) 21-OH

Exercised induced amenorrhea Labs? 3 PE? Complications? 2

* LH ↓ --> Estrogen ↓ / Cholesterol ↑ * Atrophy @ breast / vagina * Osteopenia / Osteoporosis / Infertility

Vitamin B12 deficiency Treatment effects? Follow up?

* ↑ K cellular use * ↓ K @ serum • Monitor K within 48h

Patient with fatigue, weight loss, myalgia, hyperpigmentation Diagnosed with Addisons (adrenal insufficiency) Lab results? 4

* Na ↓ * K ↑ * Cl ↑ * Metabolic Acidosis

HypoCalcemia Lab findings 1) Normal PTH 2) Normal Vit D 3) Vitamin D deficiency 4) Hypo-parathyroidism 5) Pseudo-Hypot-parathyroidim 6) Hyper-phosphatemia

HypoCalcemia Differential 1) PO4 ↓ + Ca ↑ 2) Ca ↑ + PO4 ↑ 3) Ca ↓ + PO4 ↓ --> PTH ↑ 4) PTH ↓ --> Ca ↓ + PO4 ↑ 5) Ca ↓ + PO4 ↑--> PTH ↑ 6) PO4 ↑ + PTH ↑

Precocious Puberty (evaluation) 1) Normal bone age + pubic hair 2) Normal bone age + breast 3) Older bone age + LH ↑ 4) Older bone age + LH ↓

• Precocious Puberty (evaluation) * Premature adrenarche * Premature thelarche * Central precocious puberty * Peripheral precocious puberty

Fever, Neck pain, Tender thyroid, suspicious for subacute thyroiditis Lab test? 4 Study resuts?

* TSH ↓ / T4 ↑ * ESR ↑ * TPO Ab ⊕ * RAIU ↓

Diseases of MEN 1 MEN 2a MEN 2b

* Pituitary * HyperParaThyroid * Pancreatic * Medullary Thyroid Cancer * PheoChromoCytoma * HyperParaThryoid * Medullary Thyroid Cancer * PheoChromoCytoma * Neuroma / Marfanoid

Congenital Hypothyroidism Management? 3

* LevoThyroxine * US thyroid * Endocrine referra

Glucagonoma (pancreatic tumor) Endocrine manifest? Skin manifest? At risk for what cancer?

* Diabetes * Necrotic Migratory Erythema * Liver malignancy

* Erythematous / Scaly * Itchy / Painful * Central clearing * Borders elevated & crusty

Necrotic migratory erythema

Prolactinoma Pre-menopausal symptoms? 5 Post-menopausal symptoms? 2 Symptoms at male? Diagnostic? 5 Treatment? 2

* Amenorrhea * Infertility * Galactorrhea * Hot flashes * Osteoporosis * Headache * Vision changes * Impotence * Gynecomastia * Infertility * Libido ↓ * Prolactin > 200 * Check: Cr / TSH / T4 * MRI brain * Dopamine Agonist (cabergoline) * TransSphenoid surgery

Thyroiditis Diffuse goiter Hypo symptoms 3 types, 2 labs Small / Non-tender goiter Mild & short – Hyper symptoms Spontaneous recovery 2 labs Post viral / Fever Painful & tender goiter 3 labs, 3 treatment?

* Chronic / AutoImmune / Hashimoto * TPO Ab ⊕, RAIU ⊕ / ⊝ * Painless / Silent * TPO Ab ⊕, RAIU ⊝ * SubAcute / deQuervain * ESR ↑ / CRP ↑ / RAIU ⊝ * Propranolol / Atenolol, NSAID, Steroid

Diabetic neuropathy SSRI (2 med, 2 use, 3 avoid) TCA (3 med, 3 use, 5 avoid) Gaba (2 med, 3 use, 3 avoid)

* Duloxetine / Venltafaxine * Depression / Anxiety * Restless leg / Sexual dysfunction / Glaucoma * AmiTryptyline / Nortryptyline / Desipramine * Depression / Anxiety / Insomnia * QT ↑ / Ortho BP ↓ / Sexual dysfunction / Urinary retention / Glaucoma * Gabapentin / Pregabalin * Restless leg / Tremor / Insomnia * Substance abuse / Peripheral edema / COPD

Lithium induced Hypothyroidism Mechanism? Treatment? 2

• ↓ T3 & T4 synthesis & release * Continue Lithium * Add Levothyroxine

Breast development = n No pubic or axillary hair 1° Amenorrhea > 15y Diagnosis? Additional PE findings? 2 Imaging study finding? Lab finding?

• Androgen Insensitivity * Blind vaginal pouch * CyrptoOrchitism * US vagina = No uterus * Testosterone = n @ male

Diagnosis? Cortisol low ACTH ↑ ACTH test = minimal response Cortisol low ACTH ↓ ACTH test = minimal response

* 1° = Adrenal gland | * Central = Pituitary

Central adrenal insufficiency Lab & diagnostic? Associated condition & lab?

* Na ↓ / ACTH ↓ * ACTH test = minimal response * MRI brain * Hypothyroidism * TSH ↓ / T4 ↓ / T3 ↓

HyperThyroidism (complications) Cardiac? 2 Endocrine? 1

* Arrhythmia * CardioMyopathy • Osteoporosis

Bisphosphonate | 4 indications ?

* History of fracture * Osteoporosis (T < -2.5) * Osteopenia (T -1 to -2.5) * + Fracture risk > 20% * + Hip fracture risk > 3%

HypoAldosterone / Conn (lab check)

* HTN + K ↓ | * Aldosterone : Renin > 30

Delayed Puberty @ boys PE? 2 Diagnostics tests? 6

* No testicle size ↑ by 14y * Delayed growth spurt * Bone age * FSH / LH * TSH * Testosterone * Prolactin

How do these affect thyroid medication? * Cholestramine * Iron / Calcium / Aluminum * PPI / Sucralfate * Estrogen * Tamoxifen * Androgen * Steroids * Rifampin * Phenytoin * Carbamazepine

* ↓ Levothyroxine absorption - increase thyroid med * ↑ TBG - increase thyroid med * ↓ TBG - decrease thyroid med * ↑ Thyroid hormone metabolism - increase thyroid med

Menopausal HRT Benefits? 5 Risks? 5

* Symptoms ↓ * Bone ↑ / Fracture ↓ * Colon cancer ↓ * DM2 ↓ * Mortality ↓ < 60y * VTE * Breast cancer * CAD > 60y * CVA * Gall bladder disease

* Pubic & Axillary hair ⊕ * Acne * Girls = hirsutism / Oligomenorrhea * Boys = normal testis Diagnosis?

Precocious puberty / Non classical CAH

Grave’s Disease (management) * 3 Medication indication? What medication? * What to do radiation treatment? * Thyroidectomy indication? 6 * Follow up?

* Propranolol * Mild symptoms * Old age * Pregnancy • Moderate / Severe * Large goiter * Thyroid cancer suspicion * Opthmalopathy * Obstructive symptoms * Medication intolerance @ pregnancy * 1° HyperParathyroidism • T3 / T4 check @ 4-6w --> q3m

Metformin Contraindications? 3

* Alcohol abuse * Sepsis * CHF