Endo Flashcards
Thyroglobulin
Precursor of T4 T3, can only be produced by thyroid (or ectopic), test for ca recurrence
Neonatal thyrotoxicosis
MOC w Graves, 3rd tri antiTSH receptor Ab crosses the placenta, resolves ~3mo, tx methimazole and Bb
Thyroid storm
Pt w subclinical hyperthyroid, surgery/trauma/infx, order thyroid studies, tx Bb, iodine, glucocorticoid, PTU
Thyroid nodules (malig)
U/S + TSH (unless >2cm FNA) –> if TSH low ONLY radionucleotide uptake, MC papillary (psammoma, LN), follicular (capsule/vascular invasion, hard, cold, hem spread), medullary (MEN2B, calcitonin)
Congenital hypothyroidism
OK for a few months, then apathy, hypotonia, macroglossia, umbilical hernia
Primary adrenal insufficiency
dark skin, GI, fatigue/wt loss/weakness, hypoNa, hyperK, hypotension, w/u 8AM cortisol + ACTH + ACTH stim=low cortisol (<5) high ACTH (central has nl aldo/skin/lytes maybe hypoNa)
MEN syndromes
MEN1 PTH, pituitary, pancreas
MEN2A PTH, pheo, medullary thyroid
MEN2B (RET) medullary thyroid, mucosal neuromas, pheo MARFANOID HABITUS
Cushing syndrome
Proximal muscle weakness 2/2 atrophy, easy bruising (nl plt)*** w/u late night salivary cortisol or 24h urine or low-dose dex supp –> ACTH (high=ectopic ACTH or pituitary –> high dose dex supp, low=exogenous or primary adrenal less common)
Primary hyperaldosteronism
U/l (aldosteronoma), b/l (hyperplasia), hypoK muscle pain/weakness, worse w/ diuretics, screen ald/ren>20, dx CT, tx spironolactone
Acute hypoCa
Trousseau (BP)/Chvostek (cheek), chelation (citrate tfusion +liver probs, lactate sepsis)
PKU
musty urine, phenylalanine
Anti-thyroid Rx
methimazole (agranulocytosis BOTH, terat 1st tri), propylthiouracil (hep FAILURE), radioiodine (exophthalmos)
Cirrhosis
Hyperestrogenism=hypothalamic hypogonadism, euthyroid
Exophthalmos
GRAVES ONLY, anti-TSHr Ab=prolif of orbital tissue
Carcinoid
Flushing, diarrhea, tricuspid regurg, GI sometimes liver, inc tryptophan–>SE (5-HIAA) leads to niacin def
Endo causes of myopathy
Cushing, hypothyroid, lytes
Glycemic control in DM
Microvascular (retinopathy, nephropathy)
Hyperthyroid bone disease
inc osteoclast act (bone resorption, dec density, hyperCa)
Secondary amenorrhea w/u
UPT –> TSH, FSH, prolactin
Gaucher disease
Bone pain, HSM, anemia/thrombocytopenia, delayed puberty
Milk alkali syndrome
HyperCa, met alk, AKI, usually pt taking some kind of OTC supplement (Ca carbonate)
HyperCa workup
Albumin, ionized Ca –> PTH (primary, familial, Li) –> PTHrp (cancer), vit D
Osteomalacia
D deficiency (Ricketts kids), PTH high phos low Ca nl-low, cortical thinning dec density
DM nephropathy
Control HTN, A1C<7
Hyperprolactinemia
Non-functioning pit adenoma (prolactin slightly high, TSH, LH low), prolactinoma (>200), Rx TSH nl
Glucagonoma
Mild DM, necrolytic migratory erythema, GI, wt loss, anemia glucagon >500
DM peripheral neuropathy
Large fibers proprioception/numbness/hyporeflexia, small fibers pain/paresthesias
Hyperandrogenism
Rapid virilization c/f androgen-secreting tumor, measure testosterone (ovarian), DHEAS (adrenal)
Subacute thyroiditis
Viral illness, Bb + NSAID
Hypothyroidism metabolic abnormalities
Hyperlipidemia, CK, LFTs, hypoNa
Acromegaly
Concentric LV hypertrophy, LV dilation, hypokinesis
Graves tx
Anti-thyroid + Bb first, then radio-iodine or surg
Thyrotoxicosis
inc myocardial contractility + HR –> hyperdynamic circulation, HTN
Pheochromocytoma
Makes you NRVous (NF1 RET/MEN2 VHL) NOT CARCINOID is only flushing and diarrhea
Panhypopit
Aldosterone is nl
Ca + pH
High pH —> more Ca-alb = less ionized Ca nl labs but sx hypoCa
Medullary thyroid cancer
Parafollicular cells make calcitonin, measure for prog + f/u for recurrence (MEN2)
Painless thyroiditis
Have Abs, transient/self-limiting 3w, small or no nodule no uptake release of pre-formed
Hyperglycemia
A1C 8-10 post-prandial, >10 hyperglyc all the time
Dawn phenomenon=HYPER in the AM cortisol
