Endo Flashcards
Causes of panhypopituitarism
Tumors Trauma Radiation Hemochromatosis Sarcoidosis Histocytosis X Infection: TB, fungus, parasite Autoimmune infiltration
Amenorrhea Decrease libido Decreased secondary sex characteristics Erectile dysfunction Decreased muscle mass
LH/FSH deficiency
Pediatric short stature
GH deficiency
Central Obesity
Increased LDL and cholesterol
Reduced lean muscle mass
GH deficiency
Diagnosing secondary hypothyroidism?
Initial: low TSH & fT4
Diagnostic: TRH stim- fails to increase TSH
Diagnosing hypogonadotropic hypogonadism?
Measure LH/FSH (low) and testosterone (low)
Hypogonadotropic hypogonadism
Anosmia
50% renal agenesis
Kallman Syndrome
Diagnosing growth hormone deficiency?
Initial: Measure Igf-1 (somatostatin)
Diagnostic:
No response to arginine infusion (should stimulate GH)
No response to GHRH
Metyrapone test
Inhibits 11-beta-hydroxylase to decrease adrenal output.
Normally cause increase in ACTH levels.
Insulin stimulation test
Decrease in glucose should stim GH.
Central DI Etiology
50% idiopathic
trauma, stroke, tumor
infiltration from sarcoidosis/infection
Nephrogenic DI Etiology
Lithium Hypercalcemia Hypokalemia Chronic pyelonephritis Amyloidosis Myeloma Sickle Cell Disease
High volume urine
Excessive thirst
Hypernatremia: neuro symptoms
DI
Diagnose DI
Water deprivation test:
Restrict water and measure Urine Osm every hour until normalize.
Administer desmopression and remeasure urine Osm in 1 hour
Central DI treatment
Long term vasopressin
Nephrogenic DI
Treat underlying cause or remove causative agent
Use thiazide diuretic, amiloride, or NSAIDs
Acromegaly Etiology
ALWAYS pituitary adenoma
Diagnose acromegaly
Elevated glucose
Hyperlipidemia
Test prolactin-cosecretion
Measure IGF-1
Glucose supression test
MRI
Treatment of acromegaly
Transphenoidal resection
Cabergoline-dopamine inhibit GH
Octreotide/lanreotide- somatostatin inhibit GH
Pegvisomant- GH receptor antagonist
Hyperprolactinemia etiology
Cosecreted with GH Hypothyroidism- Increase TRH stim prolactin Pregnancy Intense exercise Nipple stim Pituitary adenoma Renal insufficiency Antipsychotics Methyldopa Metoclopramide TCA Opioids Verapamil
Diagnose hyperprolactinemia
Thyroid function
Pregnancy test
BUN/Cr
Liver function
If all normal: MRI
Treat prolactinoma
Dopamine agonist- Cabergoline/bromocriptine
Transphenoidal resection
Hypothyroidism eitology
Almost always Hashimoto’s thyroiditis burnout
Bradycardia Constipation Weight gain Fatigue, lethargy, coma Decreased reflexes Cold intolerance Hypothermia Hair loss Edema
Hypothyroidism
Hypothyroid diagnosis
- Measure TSH
- Measure fT4
If TSH double normal- treat
If TSH elevated, but less than double- anti-TPO Ab
Tachycardia, palpitations, a.fib Diarrhea Weight loss Anxiety Hyperreflexia Heat intolerance Fever
Hyperthyroid
Hyperthyroid + eye and skin changes
Graves Disease
Hyperthyroid + tender thyroid
Subacute thyroiditis
Hyperthyroid + normal exam
Painless thyroiditis
Hyperthyroid + involuted non-palpable gland
Exogenous thyroid hormone use
Hyperthyroid + elevated TSH
Pituitary adenoma
High TSH
RAIU- elevated
Graves Disease
Low TSH
RAIU- decreased
Subacute thyroidits, painless thyroiditis, exogenous thyroid hormone
**correlate with exam
Graves treatment
Radioactive iodine
Subacute thyroiditis treatment
Aspirin
Painless thyroiditis
No treatment
Treatment for acute hyperthyroidism
- Propanolol-blocks target organ, prevents peripheral conversion
- Thiourea- blocks hormone production
- Iodinated contrast material- block peripheral conversion, blocks hormone release
- Hydrocortisone
- Radioactive iodine
Treatment for Graves opthalmopathy
First line: steroids
Radiation for non-responders
Decompressive surgery last resort
Hypercalcemia etiology
***Primary hyperparathyroidism Osteolytic cancer Hypercalcemia of malignancy Vit D intoxication Sarcoidosis Thiazide diuretics Hyperthyroidism
Confusion Stupor Constipation Short QT syndrome HTN Osteoporosis Nephrolithiasis DI Renal insufficiency
Hypercalcemia
Treat acute hypercalcemia
- IVF
- Bisphosphonates
- Calcitonin
(If sarcoid treat with steroids)
Hyperparathyroid etiology
Solitary adenoma
Hyperplasia
Malignancy
Diagnose hyperparathyroidism
High Ca High PTH Low Phos Urine Ca > 250 High Cl ECG- short QT
Surgical candidates for parathyroidectomy
Symptomatic Asx and: - Ca at least 1 above upper limit - Age less than 50 - Bone density < T -2.5 - Reduced renal function
Treatment for hyperparathyroidism and not surgical candidate
Cinacalet
Hypocalcemia etiology
Thyroidectomy Hypomagnesemia Renal failure Vit D deficiency DiGeorge syndrome Fat Malabsorption Low albumin (not symptomatic!!)
Chvostek sign Carpopedal spasm Perioral numbness Mental irritability Seizures Trousseau sign
Hypocalcemia
Diagnose hypocalcemia
EKG- long QT
Slit lamp- cataracts
Etiology of Cushing syndrome
Pituitary overproduction
ACTH production from carcinoid/cancer
Overproduction of cortisol from adrenals
Iatrogenic
Striae Easy bruising Decreased wound healing Osteoporosis HTN Menstrual disorder Erectile dysfunction Cognitive disturbance Polyuria
Hypercortisolism
Lab findings in hypercortisolism
Hyperglycemia Hyperlipidemia Hypokalemia Metabolic alkalosis Leukocytosis
Establish presence of hypercortisolism
Best initial test: 24-hour urine coritsol (more specific)
1mg overnight dexamethasone suppression test- false positives:
depression, alcoholism, obesity
Establish cause of hypertcortisolism
Measure ACTH
ACTH elevated- pituitary or ectopic
ACTH depressed- adrenal
Establish source of ACTH
High dose dexamethasone suppression test
Evaluate adrenal incidentaloma
- measure urine metanephrines- rule out pheo
- Measure renin and aldosterone
- 1mg overnight dexamethasone suppression test
Etiology of Addison’s disease
**Autoimmune destruction
**TB
Adrenoleukodystrophy
Cancer to adrenals
Weakness Fatigue Altered mental status N/V Anorexia Hypotension Hyponatremia Hyperkalemia
Hypoadrenalism
Profound hypertension
Fever
Confusion
Coma
Acute adrenal crisis
Lab findings in hypoadrenalism
Hypoglycemia Hyperkalemia Hyponatremia Metabolic acidosis High BUN
Diagnose hypoadrenalism
Cosyntropin (synthetic ACTH) stim test
Treatment of Addision’s
Replace steroid with hydrocortisone
