Endo Flashcards
Which CN affected in pituitary apoplexy?
acute pituitary hemorrhage. will cause severe HA, bitemporal visual defects, likely adrenal insuff and CN3 paresis.
initial tests for suspecting Cushing
Pick any:
- overnight dexamethasone suppression test
- 24 hour urinary free cortisol assay
- late-night salivary cortisol measurement
tx for hyperecalcemia from granulomatous dz
- decrease calcium/oxalate intake
- avoid sun exposure
- volume expansion
- low dose steroids
T/F: Bisphophonates are safe in CKD
FAlse! Don’t use if CrCl <30
Can use denosumab in renal insuff (monitor for hypocalcemia)
acromegaly testing
Step 1: Measure IGF-1 levels (note: GH fluctuates diurnal so not used)
Step 2: confirmatory testing with oral glucose suppression test (75g glucose). + = GH >2
Step 3: brain MRI (pituitary mass found in 70%)
T/F: statins can worsen hypothyroid myopathy
true and vice versa
Mgmt of pituitary incidentaloma
<10mm: prolactin levels or targeted hormone testing if any sxs
>10mm: check pituitary hormonal functions, consider surgery (can also follow,and prolactinomas respond well to medical therapy)
T/F: Hyperprolactinemia is common in CKD
true. does not respond to HD, can normalize with dopamine agonists however sexual dysfunction often persists due to multifactorial
Difference in presentation of hyperparathyroidism and hypercalcemia of malignancy
HyperPTH: Insidious onset, often asx/mild, Ca elevated mild (<11)
Malignancy: acute onset, significant sxs and severe hyperCa (>13)
Osteoporosis in men should prompt screening for:
Screen for hypogonadism with an early-morning serum testosterone assay
initial eval in hyperthyroid patient without features of Graves
Radioactive iodine uptake (RAIU)
High RAIU scan
Diffuse uptake pattern: Graves
Nodular uptake: Toxic adenoma, Multinodular goiter
Low RAIU
Measure Tg
- decreased: exogenous hormone
- elevated: thyroiditis, iodide exposure, extraglandular production
why is cosyntropin test needed prior to levothyroxine in central hypothyroidism?
This is an ACTH stimulation test. Levothyroxine can precipitate adrenal crisis in patients with concurrent adrenal insufficiency.
Anti-tpo (thyroperoxidase)
chronic lymphocytic thyroiditis aka Hashimoto (PRIMARY HYPOTHYROIDISM WITH ELEVATED TSH)
T/F: Risk of malignancy of thyroid nodule is independent of TSH
False.
Elevated TSH = higher risk malignancy.
Suppressed TSH suggests hyperfunctioning nodule, which is typically benign.
Other descriptors which increase risk of malignancy = >1cm, hypoechoic, vascular, microcalcifications
Hormonal testing after adrenal incidentaloma
All incidental tumors need at least hormone testing.
Must eval for:
- excess cortisol (i.e. overnight dexamethasone suppression test)
- pheo: urinary fractionated catecholamines and metanephrines
If hypertension: plasma aldosterone and aldosterone:renin activity ratio
T/F: Patients with type 2 diabetes and obesity commonly have hypogonadotropic hypogonadism
True. If it is borderline low (200-300), do not routinely need pituitary imaging.
If markedly low (<200) or signs of other pituitary hormone abnormalities, pituitary MRI to eval for mass
Testing in all patients with medullary thyroid cancer
RET mutation genetic testing.
- also eval for co-existing tumors (i.e. metanephrines for pheo) and for mets
- calcium for hyperparathyroidism
- MTC is seen in MEN 2A and 2B
T/F: Hereditary hemochromatosis causes secondary hypogonadism
True. Look for a patient with sick sinus syndrome. Iron deposits in the pituitary gonadotrophs.
Next step when RAIU shows toxic adenoma (mildly elevated, high-normal RAIU) or multinodular goiter with over hyperthyroidism (low TSH, high T4)
Radioactive iodine ablation (definitive tx)….or surgical thyroidectomy
side effects of SGLT2 inhibitors
UTI, hypotension, vaginal candidiasis
**use cautiously if hx of PVD/diabetic ulcer/neuropathy b/c increased risk of LE amputation
**inc in DKA (euglycemic)
**they decrease glucose reab in kidney - osmotic diuresis = hypotension. reduce doses of diuretics
(note, they don’t cause wt loss)
Which DM med causes wt loss
GLP-1 (liraglutide, exenatide, dulaglutide), low risk of hypoglycemia, good add on to metformin . AE = pancreatitis, GI side effects (n/v/d), wt loss
T/F: Hypogonadism is common in men with obesity and diabetes
True, HPA axis dysfunction. If other features are present (loss of body hair, gynecomastia, hot flashes, osteoporosis), should prompt workup for androgen def