Endo Diagnosis Flashcards by Julia B

Elevated plasma LDL
Elevated plasma triglyceride
Premature atherosclerosis, thus elevated cardiovascular morbidity
Mild obesity (inc fat mass)

GH deficiency

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Excessive & sustained GH release even in daytime

acromegaly

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When GH is in excess in children of growing ages what occurs?

gigantism

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Frontal bossing
increased base of nose
thickening of naso-labial sulcus and lips
parotid hypertrophy
loss of oval features
thickened tongue and skin, increased skin folds, enlarged visceral organs (can lead to HTN due to cardiomegaly)

acromegaly

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If acromegaly is due to enlarged anterior pituitary what sx would you expect to see?

HA, peripheral vision loss and double vision

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How do you diagnosis acromegaly?

measure IGF-I levels and if elevated test glucose intolerance test and GH measure and if inadequately suppressed then do pituitary MRI to find mass if none then do chest and abd CT to find extrapituitary cayse

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What tests would you use to assess adrenal fn?

Measure urinary hormone or degradation products- 24 hour collection

Dexamethasone suppression test (corsitol levels should decrease if HPA is normal and ectopic ACTH tumors do not respond)

Metyrapone Stimulation Test (inhibits cortisol via inhibition of 11-beta hydroxylase)

CRH Stimulation Test (excessive rise in ACTH in corticotroph tumors but not in ectopic ACTH producing tumors)

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K+ depletion
Na+ retention
Hypertension

Hyperaldosteronism

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What is conn symdrome

primary aldosteronism

excess secretion of aldosterone due to adrenal disease

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What is Secondary hyperaldosteronism- renin dependent?

High plasma renin activity often due to cirrhosis, heart failure or nephrosis

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What happens to cortisol, CRH and ACTH when a patient has Primary (adrenal) excess?

Cortisol: ↑

CRH: ↓

ACTH: ↓

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What happens to cortisol, CRH and ACTH when a patient has Secondary (pituitary) excess?

Cortisol: ↑

CRH: ↓

ACTH: ↑

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What happens to cortisol, CRH and ACTH when a patient has Primary (adrenal) deficiency?

Cortisol: ↓

CRH: ↑

ACTH: ↑

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What happens to cortisol, CRH and ACTH when a patient has Secondary deficiency?

Cortisol: ↓

CRH: ↑

ACTH: ↓

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Hypersecretion of epinephrine and norepinephrine

Pheochromocytoma

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Effect of Pheochromocytoma

sustained HTN
glycosuria
increased urinary excretion of catecholamine metabolites

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What type of thyroid cancer has the best outcome?

Papillary thyroid cancers

95% 10 yr survival

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What is the best test for Cushing’s?

24 hr urine or midnight salivary cortisol

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How do you test for adrenal crisis?

ACTH stim test is the Gold standard

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If patient presents with cushings symptoms and ACTH is high what is the most likely cause?

Pituitary (primary) cushings or ectopic cushing’s

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Sodium levels with SIADH

low

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Sodium levels with central diabetes insipidus

high

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high BP and low K+

hyperaldosteronism

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episodic HA, tachycardia, sweating, feeling of impending doom

Pheochromocytoma

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Best initial screening test for pheochromocytoma?

plasma metanephrines

What test should you order if you suspect hyperaldosteronism?

renin aldosterone levels

Parathyroid adenoma Pituitary adenoma Pancreatic islet cell tumor

MEN type 1

Pheochromocytoma Medullary carcinoma of thyroid Parathyroid hyperplasia

MEN type 2A

Pheychromocytoma Medullary carcinoma of thyroid Marfanoid habitus with mucosal and visceral ganglioneuromas

MEN type 2B

What test do you order if you suspect Hashimodos?

TPO

What antibodies are associated with graves?

TSI and TRAB

Low TSH and high free T4

Graves disease

Patient is unsure if he has type 1 or type 2 diabetes what test should you order?

GAD ab because 90% of type 1 are positive for GAD

What is goal fasting blood sugar level for diabetic patients?

<110-112

What are preprandial blood sugar level goals for diabetic patients?

80-130

Patient has FH of hypoglycemia and thinks she is hypoglycemic as well. What test do you order?

serum glucose test when she is symptomatic because insulin levels will be high even though blood glucose is low

Whipple's triad

hypoglycemia sx, low blood glucose, reversal of sx when blood glucose normalized =hypoglycemic

What is the MC cause of Addison's Disease in the US?

autoimmune adrenalitis- | thyroid disease is MC

What is the MC cause worldwide of primary adrenal insufficiency?

TB or fungal infection

Adrenals enlarged with granulomas and caseation

TB causing primary adrenal insufficiency

ACTH high | Cortisol low

primary adrenal insufficiency

What should you be concerned about in a patient with primary AI who has a major infection and is subjected to major stress?

Adrenal crisis

AM cortisol <3

Adrenal insufficiency

What is the Cosyntropin Stimulation Test?

Inject cosyntropin → measure basal, 30 min and 60 min cortisol Nrml resp: max cortisol >18 ug/dl adresses adrenal reserve but not direct pituitary/hypothal fn

What is MC cause of Secondary Adrenal Insufficiency

exogenous steroid use

ACTH Low | Cortisol Low

Secondary Adrenal Insufficiency

What medications must be avoided when testing a patient for primary aldosteronism?

spironolactone and eplernone

Elevated aldosteronism, normal or elevated renin With hypertension: renal artery stenosis, malignant hypertension, renin-secreting tumor

Secondary hyperaldosteronism with HTN

Decreaseeffectivecentralvascularvolume Hypovolemia, CHF, cirrhosis, nephrotic syndrome

Secondary hyperaldosteronism without HTN

What is the Best Screening Test for Primary Aldosteronism?

Aldosterone and renin

How do you determined if ACTH dependent Cushing's syndrome is primary or ectopic?

High dose dexamethasone suppression test Pituitary will have partial suppression which Ectopic ACTH will have no suppression or CRH stimulation test Ectopic ACTH will not stimulate cortisol while pituitary will

What tumors are MC associated with ectopic ACTH production?

Small cell lung cancer | Bronchial carcinoid

What ate the MC causes of hirsuitism?

PCOS Idiopathic CAH

What is the MC cause of Congenital Adrenal Hyperplasia?

21-hydroxylase deficiency

a dry, waxy type of swelling (nonpitting edema) with abnormal deposits of mucin in the skin (mucinosis) and other tissues, associated with hypothyroidism facial changes are distinctive, with swollen lips and thickened nose

Myxedema

If hypothyroid and thyroid responds to dose of TSH where is the problem?

pituitary or hypothal

If hypothyroid and TSH rises in response to TRH where is the problem?

hypothalamus

TSH increased but TH is declining Thyroid hypertrophies and develops goiter What is the cause?

Iodine deficiency goiter

What is TH resistance?

very rare receptor mutation where thyroid hormone levels are normal but body does not respond because receptor is mutated

Dwarfism Mental retardation Growth retardation Short limbs

Cretinism | congenital iodine deficiency syndrome

What drugs MC cause hypoglycemia?

Insulin | Sulfonylureas

Whipple's Triad

sx consistent with hypoglycemia, documented low blood glucose + sx, prompt relief of sx when blood sugar normalized

Suspected humoral agent with Flushing

Bradykinin, 5- hydroxytryptophan, prostaglandins

Suspected humoral agent with Diarrhea

Serotonin, prostaglandins

Suspected humoral agent with Cardiac lesions

Serotonin

Suspected humoral agent with Bronchospasm

Bradykinin, histamine, prostaglandins

Suspected humoral agent with Skin lesions

Niacin deficiency

If adrenal hyperplasia is due to excess ACTH what zone is affected?

zona fasciculata and | zona reticularis

If adrenal hyperplasia is ACTH independent what zone is affected?

zona glomerulosa

Paraganglioma

Extraadrenal pheochromocytoma

What finding in Neuroblastoma would indicate poor prognosis?

N-myc amplification

What are some major complications of diabetes?

CV dz, renal failure, blindness, amputation, nerve damage

What causes type 1 DM?

Autoimmune destruction of insulin-producing pancreatic β cells

Impaired cellular responses to the physiological effects of insulin

insulin resistance

Impaired cellular responses to the physiological effects of insulin

insulin resistance

MC cause of hypercalcemia

primary hyperparathyroidism due to enlarged adenoma

TSH is normal but free T4 is low what is most likely diagnosis?

central (or secondary) hypothyroidism

Low TSH | Low FT4

central hypothyroidism OR use of T3 product- won't need FT4 or TSH so they will be low

Recent infection AMS, resp failure, carcinogenic shock, CK, defective thermoregulation

Myxedema Coma

nrml FT4 and low TSH

thyroid storm or resolving postpartum thyroiditis

What diagnosis is consistent with US for goiter or possible nodule showing heterogeneous thyroid?

Hashimotos thyroiditis

What diagnosis is consistent with US for goiter or possible nodule showing heterogeneous thyroid?

Hashimotos thyroiditis