Endo Diagnosis Flashcards
Elevated plasma LDL
Elevated plasma triglyceride
Premature atherosclerosis, thus elevated cardiovascular morbidity
Mild obesity (inc fat mass)
GH deficiency
Excessive & sustained GH release even in daytime
acromegaly
When GH is in excess in children of growing ages what occurs?
gigantism
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
If acromegaly is due to enlarged anterior pituitary what sx would you expect to see?
HA, peripheral vision loss and double vision
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
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)
K+ depletion
Na+ retention
Hypertension
Hyperaldosteronism
What is conn symdrome
primary aldosteronism
excess secretion of aldosterone due to adrenal disease
What is Secondary hyperaldosteronism- renin dependent?
High plasma renin activity often due to cirrhosis, heart failure or nephrosis
What happens to cortisol, CRH and ACTH when a patient has Primary (adrenal) excess?
Cortisol: ↑
CRH: ↓
ACTH: ↓
What happens to cortisol, CRH and ACTH when a patient has Secondary (pituitary) excess?
Cortisol: ↑
CRH: ↓
ACTH: ↑
What happens to cortisol, CRH and ACTH when a patient has Primary (adrenal) deficiency?
Cortisol: ↓
CRH: ↑
ACTH: ↑
What happens to cortisol, CRH and ACTH when a patient has Secondary deficiency?
Cortisol: ↓
CRH: ↑
ACTH: ↓
Hypersecretion of epinephrine and norepinephrine
Pheochromocytoma
Effect of Pheochromocytoma
sustained HTN
glycosuria
increased urinary excretion of catecholamine metabolites
What type of thyroid cancer has the best outcome?
Papillary thyroid cancers
95% 10 yr survival
What is the best test for Cushing’s?
24 hr urine or midnight salivary cortisol
How do you test for adrenal crisis?
ACTH stim test is the Gold standard
If patient presents with cushings symptoms and ACTH is high what is the most likely cause?
Pituitary (primary) cushings or ectopic cushing’s
Sodium levels with SIADH
low
Sodium levels with central diabetes insipidus
high
high BP and low K+
hyperaldosteronism
episodic HA, tachycardia, sweating, feeling of impending doom
Pheochromocytoma
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
