Endo Fun Flashcards
What hormones are produced by the posterior pituitary?
ADH, oxytocin
What hormones are produced by the anterior pituitary?
TSH, prolactin, FSH, LH, GH, ACTH
If you think there is an excess of an hormone order what test?
Suppression
If you think there is a lack or decrease of a hormone order what test?
Stimulation
What stimulates synthesis of thyroid hormones and is inhibited by T3 and T4?
TSH
What hormone prepares for breast feeding?
Prolactin
What inhibits prolactin?
Dopamine
What stimulates ovulation and sperm genesis?
FSH
What inhibits FSH
Inhibin
What develops the corpus leuteum, releases oocyte and produces estrogen?
LH
What inhibits LH?
Testosterone
What stuns bone growth and protein synthesis?
GH
What inhibits GH?
Somatostatin
What synthesizes secretion of adrenal cortical hormones?
ACTH
What inhibits ACTH?
Cortisol
What increases water resorption by kidneys?
ADH
What is hyperparathyroidism?
Excess secretion of PTH causing increased absorption of calcium from bones, kidneys, GI
What is the patient complaints of hyperparathyroidism?
Bones, stones, groans, moans.
Primary hyperparathyroidism?
Middle aged woman, hyper functioning benign parathyroid adenoma 85%
Secondary causes of hyperparathyroidism?
Chronic renal dz, METASTATIC dz, multiple myeloma, sarcoidosis.
Clinical presentation of hyperparathyroidism?
Anorexia, N,v,constipation, fatigue, weakness, confusion. Polyuria, polydipsia, bone pain, kidney stones, abdominal pain
Causes of hypoparathyroidism?
Follows thyroid surgery, autoimmune, congenital
Acute and chronic sx of hypoparathyroidism?
Acute: circumoral tingling, tetany, muscle cramps, irritability
Chronic: lethargy, personality changes, blurry vision, mental retardation
Hypoparathyroidism on physical exam.
Positive chvosteks sign, pos trousseaus test, prolonged QT on EKG
Chvosteks test?
Tap face and get facial muscle spasm, hypoparathyroidism
Trousseaus test.
Carpal spasm with BP cuff, hypoparathyroidism
Treatment for hypoparathyroidism?
Calcium, vit D if tetany then IV calcium gluconate
Hyperthyroid disease 2?
Thyroiditis, graves dz (+ on grave)
Decreased TSH, increased T4
Hypothyroid disease 2?
Thyroiditis, hashimotos
Increased TSH, decreased T4
MC cause of hyperthyroidism?
Graves dz, autoimmune causes 90%, increased T4 and decreases TSH
Hyperthyroidism on exam?
Exophthalmos, per tibial myxedema, goiter WITH bruit
Goiter with bruit,
Graves dz
MC drug causing graves dz hyperthyroidism.
Amiodarone
What are the signs and symptoms of graves dz?
Increase in: appetite, exertional SOB, diarrhea, fatigue, hA, heat intolerance, weight loss, irritability, nervousness, palpitations, sweating, tremor, weakness
Graves dz tx?
Methimazole or propythiouracil to inhibit hormone synthesis
PTU in pregnancy
Radioactive iodine
Beta blocker for sx
Give s/s for thyroid crisis / thyroid storm.
This is life threatening hyperthyroidism. High ver, tachycardia, vomiting, diarrhea, dehydration, delirium, congestive heart failure.
What causes thyroid storm?
Stress, infections, surgery or trauma
How can you treat thyroid storm?
Treat underlying cause. PTU, propranolol which only tx sx
AVOID ASA
Most common cause of hypothyroidism?
Hashimotos, autoimmune
Painless goiter?
Hashimoto’s thyroiditis
Sx of Hashimoto’s thyroiditis?
Cold intolerance, decrease appetite, weight gain, constipation, depression, dry skin, fatigue, lethargy, paresthesias, muscle cramps
PE of Hashimoto’s ?
Dry skin, thinning of lateral eyebrows, slow DTR, bradycardia, thin nails, thinning hair
Tx for hypothyroidism?
Synthroid, start low in elderly/CAD. Check TSH every 6 wks till euthyroid then 2/yr.
Describe subacute thyroiditis?
Woman in 40’s with acute painful glandular enlargement with dysphagia. Gland is hard and tender.
Tx with ASA for pain and inflammation and BBlocker for thyroid sx.
Describe suppurative thyroiditis.
Rare, caused by pyogenic bacteria. Very painful tender, red, asymmetric swelling go thyroid. Tx. Abx and surgical drainage.
Patient presents to clinic with a painless single hard mass on thyroid, dysphagia and hoarseness
Thyroid cancer.
Thyroid cancer is liked to what other disease?
MEN IIa and IIb
Adrenal gland outer most layer?
Zona glumerulosa produces aldosterone, controlled by renin
Adrenal middle layer?
Zona fasiculate producing cortisol and controlled by ACTH
Adrenal innermost layer?
Zona reticularis producing DEHA controlled by androgen stim factor
Lab test to checkm for adrenal hypo function?
ACTH stimulation test
Lab test to check for adrenal hyper function?
Dexamethasone suppression test
What is Cushing syndrome and its causes?
Too much cortisol! From excess steroid use, pituitary hypothalamus dys, adenoma, adrenal neoplasia
What does Cushing syndrome present with?
Apple obesity, buffalo hump, thin skin, acne, hirsutism, amenorrhea, fatigue, proximal muscle meekness, pigmented striae, HTN.
What Is the #1 test for Cushing syndrome?
Increase free cortisol in urine over 125/24 hrs
Tx for Cushing syndrome?
Transphenoidal resection and replacement therapy if tumor. Radiation therapy. Meds not OK alone:ketoconazole, metyrapone
What is Addison’s disease?
Primary corticoadrenal insufficiency.
MC cause of Addison’s dz?
Autoimmune inflammation of the adrenal cortex, TB infection, trauma, mets
Patient presents to clinic with weakness, easy fatigue ability, ortho static hypotension, anorexia, n,v, diarrhea, wt loss, hyper pigmentation?
Addison’s disease
Screening test for Addison’s disease?
Plasma cortisol 30-60 min after cosyntropin IM or IV
If screening lab for Addison’s produces high ACTH?
Primary dz
If screening lab for Addison’s produces low ACTH?
Secondary dz
Treatment for Addison’s dz?
Oral cortisone and mineral cortocoid. IV if crisis.
What is a pheochromocytoma?
Rare tumor rising for the chromaffin cells of sympathetic nervous system. Can cause HTN.
Presentation of pheochromocytoma?
HA, sweating, palpitations, anxiety, tremor, abdominal pain, HTN.
What labs should you order if you suspect pheochromocytoma?
Urine catecholamines, plasma catecholamines, MRI/CT for adrenal tumor
Treatment for pheochromocytoma?!
Treatment is surgery BUT remember to give alpha blocker FiRST before beta blocker or blood pressure will rise more
What is insufficientroduction of thyroid hormone at birth?
Congenital hypothyroidism or creatinism
Signs and symptoms of congenital hypothyroidism?
Sluggish, constipation, large tongue, umbilical hernia, hypothermia, bradycardia, enlarged fontanelle, jaundice, scaly dry skin, brittle hair, inability to feed.
How do children present with Cushing syndrome.
Growth arrest, obesity, precocious puberty, easy bruising, and difficulty standing for a crouch.
What is the leading cause of death in diabetes?
Myocardial infarction
Cause of primary hyperthyroidism?
Thyroid making too much hormone
Cause of secondary hyperthyroidism?
Pituitary making too much TSH
A patient presents with amenorrhea and galactorrhea in the absence of pregnancy?
Pituitary adenoma
Number one treatment of pituitary adenoma?
Dopamine agonist, carbegoline or bromocriptine
Nerve damaged during thyroidectomy causing hoarseness.
Recurrent laryngeal nerve
Risk of pituitary surgery?
Diabetes insipidus. Treat with desmopressin
Hungry bone syndrome.
When hyperthyroidism is corrected surgically the patient needs extra calcium because the damaged bone be absorbs it quickly.
What do most pituitary adenomas secrete?
Prolactin
How dose primary hyper aldosteronism present.
HTN, polyuria, polydipsia, muscle weakness, fatigue, NO edema.
Treatment for primary hyper aldosteronism?
Spironolactone (blocks aldosterone) and surgery of tumor.
What is acromegaly?
Excess GH from anterior pituitary. Usually fo
Rom an GH secreting pituitary macro adenoma.
Clinical presentation of increase on glove and hat size, space between teeth, DM, kidney stones, HA?
Acromegaly
Screening test for acromegaly?
Increase in insulin like GF and confirm with oral glucose suppression test and MRI
Describe familial short stature.
Growth curves at or below 5% by age 2, healthy and normal PE, normal bone age and puberty.
Describe constitutional delay of growth.
At or below 5%, delay in puberty! skeletal imaturation, likely to be expected height
What is achondroplasia?
Dwarfism, short limbs, long torso, big head, prominent brow, delayed milestones (motor), normal intelligence, bowing of legs, frequent ear infections
What is diabetes insipidus and the causes?
Decrease of ADH. Central: decreased production of vasopressin from post pituitary from tumor, surgery, basal skull fx
Nephrogenic: decreased renal response to vasopressin from chronic renal dz
Sx are polyuria, polydipsia, polyphagia?
Diabetes insipidus
Treatment of DI?
Central: desmopressin
Nephrogenic: thiazides , monitor sodium levels
What are some causes of hyperprolactinemia?
Exercise, pregnancy, suckling, seizure, Meds, pituitary adenoma
Clinical presentation in men/women with hyperprolactinemia?
Men: ED, gynecomastia, decreased libido
Women: oligomenorrhea, amenorrhea, galactorrhea, infertility
If prolactin over 100 think?
Pituitary adenoma
Treatment for hyperprolactinemia?
Stop Meds. Surgery and dopamine agonists (bromocriptine.)
Meds than can cause hyperprolactinemia?
Risperidone and SSRI
What is hypopitutiarism?
Partial or complete loss of anterior pituitary
Causes of hypoputiaryism?
Pituitary adenoma, infarction of the pituitary, inflammatory dx, vascular dz (Sheehan postpartum necrosis)
What is DM type 1?
Cause by insulin deficient, autoimmune dz, little or no endogenous insulin
What are the sx of DM type 1?
Polyuria, polydipsia, polyphagia, blurry vision, fatigue, eight loss
Positive labs for DM?
Fasting glucose over 126 and random glucose over 200.
Treatment measure for DM type I?
Cholesterol less than 300 per day, less protein, less saturated fat, less sodium
What is diabetic ketoacidosis?
Ketones as a result from fat metabolism. From infection, inadequate insulin tx, MI, trauma
Patient present to clinic with abdominal pain, N, V, decreased appetite, thirst tachycardia, fruity Oder to breath…..?
DKA
What is the treatment for DKA?
Regular insulin. IV fluids. Treat potassium is less than 5.5. Tx underlying cause.
Describe what happens in DM type II.
Tissues are resistant to insulin, there is NO deficiency.
Lab results confirming DMt2?
Fasting glucose over 126, random glucose over 200, elevated HA1C.
Treatment for DM type 2?
Metformin: decreases hepatic glucose production, decreases body weight, improves lipids. Hold if oral contrast.
Sulfonylureas: glyburide and glipizide
Monitoring parameters for DM type 2?
HA1C less than 7%, microalbumin, BP target 130/85, lifestyle modification
Complications of diabetes?
Cataracts, retinopathy, glaucoma, diabetic neuropathy in stocking glove pattern, gastropsresis, impotence
What is the honeymoon period in DM?
Ketoacidosis followed by a sx free period , no tx required
Describe the somogyi effect.
Hypoglycemic at night and body’s response overshoots leading to hyperglycemia in the morning
What is the dawn phenomena?
Early morning rise in glucose requiring increased amounts of insulin to maintain balance
If rise in early morning blood sugar check the 3 am glucose and if…. Increased?
Dawn phenomonon and increase pm insulin dose
If early morning blood sugar is increased check 3 am glucose… If it is decreased…..
Somogyi effect and decrease pm insulin.
What are the signs and symptoms of hypoglycemia?
Sweating, palpitations, hunger, tremor, weakness, lightheaded ness, headache, confusion
Hypoglycemia is a glucose below what? And what is the treatment?
55, dextrose
High LDL increases the risk of?
Atherosclerotic dz, less than 100 is optimal
High HDL is associated with?
Decreased fish of atherosclerotic dz, 40-60
Increased triglycerides is associated with?
Increased risk of atherosclerotic dz in women and diabetics, keep under 125
Hyperlinked is on exam?
Xanthomas, lipemic blood sample, abdominal pain, Hepatomegaly,
Metabolic syndrome clinical features?
Must have 3: Abdominal obesity men >40 in women > 35 in Triglycerides over 150 HDL m<50 BP greater than 130/85 Fasting glucose over 110
Treatment for metabolic syndrome?
Reduce underlying cause
