Endo Flashcards
Treatment for Cushing’s syndrome, which inhibits cortisol synthesis at the level of 11-hydroxylase?
Metyrapone
Treatment for Cushing’s syndrome, which inhibits early steps of steroidogenesis?
Ketoconazole
Treatment for Cushing’s syndrome, which is an adrenolytic agent that is also effective for reducing cortisol in adrenocortical carcinoma?
Mitotane
Treatment for Cushing’s syndrome, which block 11B-hydroxylase, usually used for severe cases of cortisol exscess?
Etomidate
What must be done after successful removal of an ACTH or cortisol producing tumor until HPA axis RESUMES its normal axis?
Physiologic hydrocortisone replacement
OHAs that can increase risk of bladder cancer? (2)
Pioglitazone and Dapagliflozine
Most common cause of Mineralocorticoid excess
Primary hyperaldosteronism
Bilateral (micro nodular) adrenal hyperplasia (60%) > Adrenal (Conn’s) Adenoma (40%)
Clinical hallmark of primary hyper aldosteronism
Hypokalemic hypertension
Others: increase Na retention, aldosterone excess
Diagnostic of Primary aldosteronism
Saline infusion test (IV administration of 2L NSS over 4h:
Positive: failure of aldosterone to suppress below 140pmol/L (5ng/dL)
Screening
Endo wise: ARR (aldosterone-renin ratio) > 750pmol/L + high normal or increase aldosterone
Cardio wise: PA:PRA ratio > 30:1
Treatment for GRA (glucocorticoid-remediable hyperaldosteronism)
Low dose Dexa that controls BP
Adrenal carcinoma-like CT scan characteristics
=/> 4cm
> 20 HU
Benign: </=20 HU
WEISS Score for ACC (atleast 3 elements for suggest ACC)
High Nuclear grade
Atypical mitosis
Diffuse architecture
Mitotic rate (>5/hpf)
<25% clear cells
+ necrosis, venous invasion, invasijb of sinusoid and tumors
What is the Adjuvant treatment given post removal of ACC with high risk recurrence ?
Mitotane >= 2yrs
High risk: tumor size> 8cm, vascular capsule invasion or violation, Ki67 proliferation index >/= 10%
Most common cause of adrenal insufficiency
Autoimmune adrenalitis
Hallmark of Proliferative diabetic retinopathy and what is the ultimate effect of proliferative stage
Neovascularization
Retinal hypoxia
Treatment for adrenal crisis
Rehydration 1L/hr with continuous cardiac monitoring + Hydrocortisone 100mg IV bolus then 200 mg over 24h
Treatment for chronic adrenal insufficiency
Hydrocortisone physiologic doses: HYdrocortisone PO 15-25 mg in2-3 divided doses, half of dose taken in morning
However not preferred for replacement: longacting (prednisolone, dexamethasone)
Assay that can predict both fetal and neonatal thyrotoxicosis
TRAb
Increased Serum Tg in all types of thyrotoxicosis except for:
Thyrotoxicosis factitia
On thyroid scan what characteristics describes a highly malignant nodule?
Hypoechoic, solid, with infiltrative borders, microcalcifications
“Cold nodule”
What medicationcan induce secondary hypothyroidism?
Bexarotene treatment
Amiodarone
Represent end stage of Hashimoto’s thyroiditis, almost completely absent thyroid cells
Atrophic thyroiditis
What condition in hypothyroidism due to increase dermal glycosamoniglycan content which traps water giving rise to non pitting edema
Myxedema
How long would you test TFTs after instituting LT4 treatment
2 months
Subclinical hypothyroidism (High tsh normal t3t4) which patient would you RECOMMEND to treat with LT4
Woman who wishes to conceive or is pregnant
TSH level >10miu/L
Start with low dose of levothyroxine25-50 ug/d
Consideration for treatment OF LT4 in Hypothyroidism
+ suggestive symptoms of hypothyroidism
Positive TPO ab
Any evidence of heart disease
Prior to conception, in hypothyroidism what is the target Tsh on lt4 therapy
<2.5
Elderly patient require __% less thyroxine than young patient
20%
Treatment for myxedema
LT4 administered single IV bolus 200-400mcg loading dose, followed by oral dose of 1.6mcg/kg/day, reduced by 25 % if administered IV.
Since T4 to T3 is impaired there is rationale for adding liothyronin (T3) IV: initial dose 5-20 micrograms followed by 2.5-10mcg every 8 hours .
Parenteral hydrocortisone 50mg IV every 6 hours
Non inflamed indurated plaque with deep pink or purple color abd and orange skin, mimis elephantiasis
Thyroid dermopathy
Form of clubbinf foun in <1% of patient in Graves disease
Thyroid acropachy
LOW TSH normal T4 normal t3
Subclinical hyperthyroidism
How to avoid thyrotoxic crisis before RAI
Pretreatment with antithyrpid drugs for atleast 1 month before RAI
STOP metimazole or carbumaxole 2-3 dats before RAI restart 3-7days after RAI
If with opthalmopathy give prednisone 30mg/dat at the time of RAI tapered over 6-8 weeks
Treatment for thyroid storm
DOC: PTU 500-1000mg loading dose and 250 mg every 4h.
Alt Methimazole 20mgq6
Then SSKI 5 drops q6
Propnaloo 60-80mg PO q4
Others: GC (hydrocortisone 300mg IV bolus then 100mg q8
Treatment of choice of toxic adenoma
RAI ablation
Which thyroid Ca has + Hurthle cell histology
follicular (FTC)
