Endo Flashcards
Nutritonal deficiencies associated with gastric bypass
copper deficiency, B12, folate, vtiamin D, iron
Myeloneuropathy, normocytic anemia, leukopenai in the setting of history of gastric bypass
Copper deficiency. PResents similar to B12 deficiency as far as symptoms (ataxis, spasticity with weakness, Romberg, dorsal column disease) but then anemia is normocytic
Increased intake of what can exacerbate copper deficiecny
Zinc. It competes with copper absorption in the GI tract
Failure of anti-diabetic therapy after an initial good response
Progressive insulin deficiency is usually the cause. If gaining weight could be insulin resistance
Hungry bone syndrome
Low calcium, low phosphorous, low magnesium, normal to high PTH. Acute withdrawal of PTH post parathyroidectomy leads to a net influx of calcium into the bone (phos and mag resorbed with Ca)
Thyrotoxicosis and hypercalcemia
Typically hyperthryoid symptoms. Thyroid hormone acts on osteoclasts to increase bone turnoober. Labs demonstrate hypercalciuria, mild hypercalcemia, suppressed PTH –> renal calcium wasting. Low 1,25 hydroxvitamin D.
Antiresoprtive therpay is indivated for postmeonpausal women with:
osteoporosis on DEXA (t score < or = -2.5), low trauma hip or vertebral fracture, osteopenia and a 10 year probability of hip fracture > or = 3% ormajor osteoporotic fracure > or = 20%
Osteoporosis medication first line choice.
First line choice oral or IV bisphosphonate. These are not recommended when CrCl < 30-35.
Osteoporosis medication choice when renal insufficient
Denosumab, need to monitor for hypocalcemia
Failed or can’t tolerate bisphosphonates osteoporosis medications
Teriparatide
Next step in thyroid nodule with clinical or subclinical hyperthryoidism
Thyroid scintigraphy to determine “hot” versus “cold” nodule
Hot thyroid nodule
Manage as hyperthyroid - does not need an FNA
High risk cold thryoid nodule characteristics
microcalcifications, increased vascularity, hypoechoic, elongated, ireregular margins. FNA when >1cm
Low risk cold thyroid nodule characteristics
isoechoic, hyperechoic, partially cystic, spongiform. Biopsy if grew >1.5-2cm
Hypercalcium with suppressed PTH and high PTHrP
solid tumor or malignancy
Hypercalcemia with suppressed PTH and elevated 1,25(OH)D
lymphoma vs sarcoid
Hypercalcemia with suppressed PTH and elevated 25(OH)D
vitamin D toxicity
Hypercalcemia with suppressed PTH and normal PTHrp, 25(OH)D, and 1,25(OH)D
hyperthyroid, mulitple myeloma, adrenal tumor, acromegaly, vitamin A toxicity, immobilization, milk-alkali syndrome
What should be screened for in all patients newly diagnosed with dyslipidemia?
Hypothryoidism. TSH is a common cause of dyslipidemia. And untreated hypothyroidism increases risk of statin-induced myopathy
Cushing syndrome diagnosis
Clinical presentation (weight gain, HTN, hirsutism, hypoK, hyperglycemia, proximal weakness, easy bruising) and then 2 different first-line screening tests: low dose overnight dexamethasone suppression test, late night salivary cortisol, 24 hour free cortisol urine
Causes of false positives in overnight dexamethasone suppression tests
increased cortisol binding globulin (estrogens aka OCPs), medications that increase dexamethasone metabolism (Anticonvulsants, rifampicin, rifapentine, pioglitazone), depression, alcoholism
Things that can increase 24 hour urinary free cortisol
carbamazepine, fenofibrate, synthetic glucocorticoids, licorice
False positive salivary cortisol
men > 60 years old, erratic sleep wake cycles
Hereditary hemochromatosis presentation
31% have cardiac conduction abnormalities (most commonly sick sinus syndrome), and about 45% have secondary hypogonadism (due to iron accumulation in pituitary gonadotrophs). OFten nonspecific fatigue, arthralgia, loss of libido. Classic presentation of bronze diabetes, cirrhosis LATE presentation and <25% of cases
