Approach to Endocrine Complaints2: Thyroid, Parathyroid, Adrenal Disorders

Question 1

What H is made in the pituitary and what is found in the periphery

Answer 1

T4

T3 - in periphery

Question 2

Thyroid H released by Hypothalamus and AP

Answer 2

TRH

TSH

Question 3

Hypothyroidism causes

Answer 3

I deficiency 
Hashimoto’s Thyroiditis (autoimmune)
Iatrogentic cause (from hyperthyroidism Tx)

Question 4

Hashimoto’s Thyroiditis

Answer 4

Most common in US
Hypothyroidism
If goiter then it will be : irregular and firm

Question 5

Hypothyroidism Sx:

Answer 5

Fatigue,
Dry skin 
COLD
Constipation 
Hair loss
Weight gain 
HYPOrefelx, Edema

Question 6

labs show what in hypothyroidism

Answer 6

High TSH,
LOW T4, = * primary hypothyroidism
* if thyroid peroxidase present : autoimmune

Question 7

3 causes of hyperthyroidism

Answer 7

1. Graves Disease
2. Toxic Multinodular goiter
3. Toxic Adenomas : benign hot nodules

Question 8

Graves Disease what is it

Answer 8

Most common in US
Hyperthyroidism
Autoimmune

Question 9

Graves Disease Sx

Answer 9

Hyperactive, irritability
HOT
Palpitations
Weigh loss
Decrease menses
Tremor 
GOITER (large, firm)
HYOERreflex 
Eyelid retraction + opthalmopathy

Question 10

Labs show what in hyperthyroidism

Answer 10

Low TSH
HIGH T4 or T3 - *primary hyperthyroidism
TX: block with anti-thyroid drug or remove thyroid

Question 11

Parathyroid Glands

Answer 11

Maintain Ca+2 in Blood Stream
Increase bone resorption
Increase intestinal Ca+2 secretion by VIT D
Decrease. Ca+2 excretion in kidney

Question 12

PTH function

Answer 12

Increase CA

Question 13

Primary Hyperparathyroidism

Cause

Answer 13

Autonomously functioning adenomas

Hyperplasia

Question 14

Primary Hyperparathyroidism Sx:

Answer 14

most are asymptomatic
Just elevated CA
Renal Stones, Abnormal bones, ABD pains, psychic groans
Neuromuscular Sx, proximal muscle, weakness, easy fatigability, atrophy

Question 15

Hypercalcemia or malignancy

Answer 15

Can cause Primary hyperparathyroidism only it is symptomatic and has extreme high CA

Question 16

What do labs show for HPT

Answer 16

High PTH= *Primary HPT, due to high CA excreted in urine

Question 17

Sx of Hypoparathyroidism

Answer 17

Painful face spasms 
Pins and needles
HypOtention
Heart failure
CHVOSTEK’S SIGN
TROUSSEAU SIGN

Question 18

Chvosteks sign

Answer 18

Same side contraction of facial muscles when tapping on facial nerve (ant to ear)

Question 19

Trousseau’s Sign

Answer 19

Carpal spasm when sphygmomanometer is inflated to above systolic BP for 3mins

Question 20

What do labs show when you have hypoparathyroidism

Answer 20

LOW PTH, low excretion of CA in urine

Question 21

Mineralcortricoids

Answer 21

Aldosterone

Corticosterone

Question 22

Glucocorticoids

Answer 22

Cortisol

Cortisone

Question 23

Catecholamines

Answer 23

EPIN + NEPIN

Question 24

How is Cortisol excreted
Low cortisol
Excess cortisol

Answer 24

By ACTH signal
Adrenal insufficiency (primary and secondary)
Crushing syndrome

Question 25

How is Aldosterone released and controlled

Answer 25

Low Blood volume or BP ——> low renal P ——> Juxtaglomerulous cells secrete RENIN 1. Angiotensinogen ->Angiotensin 1(by renin) 2. Angiotensin 1-> Angiotensin 2 (by ACE) 3. AT2 receptor activated on adrenal gland = ALDOSTERONE 3. VASOCONTRICTION = increase renal P and release Angiotensiongen

Question 26

Low aldosterone | Excess aldosterone

Answer 26

``` Adrenal insufficiency (primary= CONN’S and secondary) Aldosteronism ```

Question 27

Hypoadrenalism 2 major causes

Answer 27

ADDISON’S DISEASE : Autoimmune destruction of adrenal gland | EXOGENOUS GLUCOCORTICOIDS: suppress HPA axis, hypothalamic failure

Question 28

Adrenal insufficiency Sx: for glucocorticoids

Answer 28

``` Fatigue Weight loss Hypoglycemia Low BP Postural hypotension ```

Question 29

Adrenal insufficiency Sx: for mineralocorticoids

Answer 29

Salt craving Low BP Hyponatremia Hyperkalemia

Question 30

Hyperpigmentation when does this happen

Answer 30

For PRIMARY ADRENAL INSUFFICIENCY

Question 31

Addison’s disease hallmark

Answer 31

You will see hyperpigmentation

Question 32

Adrenal insufficiency what will you see in labs

Answer 32

ACTH stimulation test : measuring cortisol after | If LOW CORTISOL, test levels of ACTH, RENIN, ALDOSTERONE to know secondary vs primary

Question 33

Primary adrenal insufficiency

Answer 33

No cortisol | No aldosterone

Question 34

Secondary adrenal insufficiency

Answer 34

No cortisol

Question 35

Hypercortisolism 3 major types

Answer 35

1. CRUSHING SYNDROME : ACTH dependent, AP adenoma makes excess acth, or adenoma other place causes high acth secreted ion 2. Adrenocortical adenoma or carcinoma : ACTH independent 3. Iatrogenic : Drugs to treat inflammation cause upregulation of cortisol

Question 36

Crushing Syndrome Sx

Answer 36

``` Weight gain around abd Easy bruising, acne weakness Abnormal menses Depression Hirsutism ```

Question 37

What do you see in labs for crushing syndrome

Answer 37

Dexamethasone Suppression Test : suppress cortisol and then measure amount of cortisol Measure midnight or 24hr urine excretion

Question 38

Primary aldosteronism

Answer 38

CONN’S syndrome Adrenal adenoma or hyperplasia 5%-12% with HTN

Question 39

Aldosteronism hallmark

Answer 39

HTN + LOW K Hypokalemic NA is normal

Question 40

What do you see in labs for aldosteronism

Answer 40

Measure renin (low) and aldosterone (high) levels

Question 41

Adrenal Mass benign When to diagnose it EX

Answer 41

Most are inactive for endocrine function If >1cm Phenochromocytoma

Question 42

Phenochromocytoma

Answer 42

Tumor making Catecholamines 1. Palpitations 2. Headache 3. Profuse sweating * episodic HTN

Question 43

Pituitary Tumor

Answer 43

Usually discovered if an imaging is done 1. Headache 2. Vision loss * if non-functional adenoma just monitor no surgery needed