ENDO NEW Flashcards
What imaging would be best to assess for pituitary adenomas?
MRI (study of choice)
A 42-year-old man presents with complaints of enlarged hands and feet, a change in facial features, and joint pain over the past several years. Physical examination reveals coarse facial features, an enlarged tongue, and widened hands with thickened fingers. Laboratory testing shows elevated serum insulin-like growth factor-1 (IGF-1) levels. MRI of the brain reveals a pituitary mass.
Which of the following best explains the pathophysiology of this patient’s condition?
A) Excessive growth hormone secretion beginning after epiphyseal plate closure
B) Excessive growth hormone secretion beginning before epiphyseal plate closure
C) Excessive secretion of growth hormone-releasing hormone (GHRH) from the hypothalamus
D) Primary hypothyroidism causing pituitary hyperplasia
A) Excessive growth hormone secretion beginning after epiphyseal plate closure (Acromegaly )
A 10-year-old boy is brought to the pediatrician for evaluation of rapid growth. His parents report that he is much taller than his classmates and has large hands and feet for his age. On examination, his height and weight are above the 99th percentile. Laboratory tests show elevated growth hormone and insulin-like growth factor-1 (IGF-1) levels. MRI of the brain reveals a pituitary mass.
Which of the following best describes this patient’s condition?
A) Acromegaly caused by excessive growth hormone secretion after epiphyseal plate closure
B) Gigantism caused by excessive growth hormone secretion before epiphyseal plate closure
C) Normal pubertal growth spurtD) Gigantism caused by excessive thyroid-stimulating hormone (TSH) production
B) Gigantism caused by excessive growth hormone secretion before epiphyseal plate closure
What is the primary treatment of acromegaly and gigantism?
pituitary tumor removal
Describe the pathophysiology of addihsons disease
autoimmune destruction of the adrenal cortex resulting in loss of cortisol production
What physical exam findings are consistent with Addisons disease?
Hyperpigmentation
hypotension,
fatigue,
myalgias,
GI complaints,
weight loss
A 34-year-old woman presents with fatigue, weight loss, nausea, and hyperpigmentation of her skin. Blood pressure is 90/60 mmHg. Laboratory results reveal:
Low sodium
High potassium
Low 8 AM cortisol
Elevated ACTH
Low DHEA levels
Which of the following is the most likely diagnosis?
A) Secondary adrenal insufficiency B) Cushing syndrome
C) Addison’s disease (primary adrenal insufficiency)
D) SIADHE) Hyperaldosteronism
C) Addison’s disease (primary adrenal insufficiency)
how is the diagnoses of addisons disease made?
stimulation test via High dose cosyntropin is given IM(synthetic ACTH) normal response is a rise in blood and urine cortisol levels after synthetic ACTH is given. Primary adrenal insufficiency results in little or no increase in cortisol (<20mcg) after ACTH is given
What is the recommmended treatment for addisons disease?
Hydrocortisone/prednisone PO daily
32-year-old woman who comes to the clinic because of new skin markings on her abdomen. Physical exam shows a round face, large purple striae over the abdomen, and several ecchymoses over her trunk, arms, and legs. She describes easy bruising, as well as a significant weakness when she tries to stand up from sitting on the ground. Her 24-hour urine free cortisol is 3 x the upper limit, her late-night serum cortisol is elevated and her plasma ACTH level is < 5 pg/mL. What is the most likely cause of this patients symptoms ?
Cushing’s syndrome
What is the most common cause of cushings disease?
pituitary adenoma
What are some hallmark physical exam features of cushings disease ?
buffalo hump, moon facies, supraclavicular pads, pigmented striae , Proximal muscle weakness,
What test is used to confirm cushings disease ?
24-hour urinary free cortisol, late night serum cortison, and/or low dose dexamethasone suppression test
A 35-year-old woman presents with weight gain, muscle weakness, and new-onset hypertension. Laboratory evaluation reveals elevated 24-hour urinary free cortisol. To determine the source of hypercortisolism, plasma ACTH level is obtained and found to be elevated.
What is the next best step in the management of this patient?
A) High-dose dexamethasone suppression test
B) MRI of the brain
C) CT scan of the adrenal glands
D) Low-dose dexamethasone suppression test
B) MRI of the brain
How does the low dose dexamethasone suppression test work?
Give a steroid (dexamethasone ) failure of the steroid to decrease cortisol level is diagnostic
What is the treatment of chocie for cushing disease
transsphenoidal selective resection of pituitary tumor cures 75-90%
What is diabetes insipidius (DI)
caused by a deficiency or resistance to vasopressin (ADH), which decreases the kidneys ability to reabsorbs water, resulting in massive polyuria
What is central diabetes insipidus?
Deficiency of ADH from posterior pituitary/ hypothalamus
-No ADH production most common type: idiopathic, autoimmune destruction of posterior pituitary from head trauma, brain tumor, infection, or sarcoidosis
What is Nephrogenic diabetes insipidus ?
Lack of reaction to ADH
caused by drugs (Lithium, Amphoterrible), hypercalcemia and hypokalemia affect the kidney’s ability to concentrate urine, acute tubular necrosis
What test can be used to diagnose diabetes inspidius
Water deprivation test , simplest/most reliable method- continued production dilute urine despite deprivation
and desmopression stimulation test
What lab value would help diagnose diabetes insipidus?
High Serum Osmolality ( unable to stop secretion of water into the kidneys so blood becomes more concentreated ). while
&
urine osmolality is low because its so dilute
A 30-year-old man presents with excessive thirst and urination. His serum sodium is elevated, and his urine is dilute. A water deprivation test is inconclusive, so a desmopressin stimulation test is performed. After administration, his urine osmolality significantly increases and his urine output decreases.
Which of the following is the most likely diagnosis?
A) Nephrogenic diabetes insipidus
B) Primary polydipsia
C) Central diabetes insipidus
D) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
In central DI, giving desmopressin (synthetic ADH) corrects the problem — urine becomes concentrated.In nephrogenic DI, the kidneys do not respond to desmopressin.
A 45-year-old man with a history of chronic lithium use presents with excessive thirst and frequent urination. Laboratory results reveal hypernatremia and dilute urine. A water deprivation test shows no significant change in urine osmolality. After administration of desmopressin, there is minimal increase in urine osmolality, and he continues to produce large volumes of dilute urine.
Which of the following is the most likely diagnosis?
A) Central diabetes insipidus
B) Nephrogenic diabetes insipidus
C) Psychogenic polydipsia
D) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
B) Nephrogenic diabetes insipidus
Name the treatment of Central diabetes inspidius
desmopressin/DDAVP
Name the treatment for nephrogenic diabetes inspidius
sodium and protein restriction, HCTZ, indomethacin
What is the typical presentation of a patient with type 1 diabetes mellitus ?
Children
Polyuria, polydipsia, polyphagia, fatigue, and weight loss
Often first recognized as diabetic ketoacidosis:Symptoms: Fruity breath, nausea, vomiting, dehydration
Treatment: IV regular insulin
What is the Dawn Phenomenon?
Morning Hyperglycemia
- increase in the nocturnal secretion of GH at (dawn)
What is the somogyi effects
high dose of insulin too close to bed time causes the body to crash and go into hypoglycemic state , a surge of hormone is relased to counterregulate this crash leading to rebound hyperglycemia
- treat by decreasing nightime NPH dose or give bedtime snack
How should dawn phenomenon be treated?
Treat with bedtime injection of NPH to blunt morning hyperglycemia, avoiding carbohydrate snack late at night
What is the treatment of chocie for DKA patients?
TREAT WITH FLUIDS! Patients with DKA are always dehydrated and need large-volume IV fluid resuscitation, usually isotonic fluids such as normal salin
How can the diagnose of DM be made?
Hemoglobin A1c of > 6.5%
Random blood glucose level of
> 200 mg/dL + diabetic symptoms
2 seperate fasting (8 hours levels ) >126
2- hour plasma glucose of >200 on an oral glucose tolerance test
treatment goal for diabete mellitus type 1 patients is A1c < _____%
finger stick specifically is
< 130 mg/dL fasting and < 180 mg/dL peak postprandial
7.0
This medication decreases hepatic glucose production and peripheral glucose utilization, decreases intestinal glucose absorption (these are reasons it leads to weight loss)
Metformin
What monitoring parameters should be considered with patients on metformin?
CI if eGFR <30
not recommended if GFR 30-45
Discontinue 24 hours before contrast and resume 48 hours after
STOP if creatinine >1.5
A 62-year-old woman with type 2 diabetes mellitus is scheduled for a contrast-enhanced CT scan to evaluate for possible pulmonary embolism. Her current medications include metformin, insulin glargine, and lisinopril. Which of the following is the most appropriate management regarding her metformin use in the setting of contrast administration?
A) Continue metformin throughout the procedure without interruption
B) Discontinue metformin 24 hours before contrast administration and resume 48 hours later after confirming stable renal function
C) Discontinue metformin 12 hours before contrast and restart immediately after the procedure
D) Hold metformin on the morning of the scan only and resume that evening regardless of renal status
B) Discontinue metformin 24 hours before contrast administration and resume 48 hours later after confirming stable renal function
What diabetes medication stimulates pancreatic beta-cell insulin release ?
Sulfonylureas
(Glyburide, Glipizide,Glimepiride)
What are thiazolidinediones ?
Diabetes medications which increase insulin sensitivity in peripheral receptor site adipose and muscle, they have no efect on pancreatic beta cells
- Pioglitazone, Rosiglitazone
Name one CI to thiazolidinediones
CHF
What class of diabetes medication delays intestinal glucose absorption?
Alpha glucosidase inhibitors
Name examples of Alpha glucosidase inhibitors
Acarbose, Miglitol
Meglitinides stimulate pancreatic beta cell insulin relase, name examples if these medications
Repaglinide and Nateglinide
Name examples of GLP-1 Agonist
Exenatide, Dulaglutide, Semaglutide, liraglutide
What is MOA of GLP-1 Agonist?
lowers blood sugar by mimicking incretin - causes insulin secretion and decreased glucagon and delays gastric emptying
What is the MOA of (dipeptidyl peptidase inhibitors) DPP-4 inhibitors?
inhibits degradation of GLP-1 so more circulating GLP-1
Name examples of DPP-4 Inhibitors
Sitagliptin , Saxagliptin
What is the MOA of SGLT2 inhibitors in managment ofType 2 DM
inhibition lowers renal glucose threshold which results in increased urinary glucose excretion
Name example SGLT2 Inhibitors
Canagliflozin
What medication is shown to reduce cardiovascular mortality in type 2 DM patients with established CVD
Canagliflozin = SGLT2
what is the diagnostic criteria for prediabetes ?
A1C 5.7 - 6.4
Fadting glucose 100-125
2hr oral glucose tolerance test 140-199
A 55-year-old woman with a history of type 2 diabetes mellitus presents for a routine health maintenance visit. She does not smoke, exercises regularly, and has no history of cardiovascular disease. Her labs reveal an LDL-C of 120 mg/dL. According to current guidelines, which of the following is the best next step in management?
A) No intervention is needed; continue lifestyle modification alone
B) Recommend initiating a moderate- to high-intensity statin therapy
C) Recommend aspirin 81 mg daily without starting a statin
D) Repeat lipid panel in 6 months before deciding on treatment
B) Recommend initiating a moderate- to high-intensity statin therapy
Guidelines recommend statin therapy for patients with diabetes aged 40-75 years and LDL 70-189 mg/dL, even if they have no clinical ASCVD.
serum total calcium of what value is consider Hypercalcemia?
10.5
what is the typical presentation of a patient with hypercalcemia
“Stones, Bones, abdominal groans, psychiatric moans,”
EKG: shortened QT interval.
62-year-old woman presents to her primary care provider complaining of fatigue, constipation, and mild confusion over the past several weeks. She also reports new onset of muscle weakness. Vital signs are stable. Laboratory tests reveal a calcium level of 12.2 mg/dL (normal: 8.5-10.5 mg/dL) and a parathyroid hormone (PTH) level that is elevated.
Which of the following is the most likely cause of her hypercalcemia?
B) Primary hyperparathyroidism
Primary hyperparathyroidism is the most common cause of outpatient hypercalcemia, typically due to a parathyroid adenoma. It leads to elevated calcium and elevated PTH levels. Symptoms often include “stones, bones, groans, thrones, and psychiatric overtones” — referring to kidney stones, bone pain, abdominal symptoms, polyuria, and neuropsychiatric symptoms.In contrast, hypercalcemia of malignancy often presents with low PTH due to suppression by high calcium levels.
Define Hypernatremia
sodium of > 145 mmol/L
increased BUN/CR ratio > 20:1
Decrease circulating volume = decrease of flow to kidneys means more bound urea in the blood, which means ↑ BUN
A 55-year-old woman is diagnosed with primary hyperparathyroidism after lab work reveals hypercalcemia. Which of the following changes in her lab values would most likely also be seen?
A) Increased phosphorus, increased PTHB) Decreased phosphorus, increased PTHC) Increased phosphorus, decreased PTHD) Decreased phosphorus, decreased PTH
B) Decreased phosphorus, increased PTH
In primary hyperparathyroidism, PTH is elevated, leading to increased calcium levels and decreased phosphorus levels.PTH causes the kidneys to excrete more phosphate and reabsorb more calcium, resulting in hypercalcemia and hypophosphatemia.
Describe primary hyperparathyrodism
increased PTH usually due to PTH secreting parathyroid adenoma
Describe secondary hyperparathyrodism
Increased PTH due to physiological response to hypocalcemia or vitamin D deficiency
(CKD!!!)
What is the most common cause of secondary hyperparathyroidism?
Chronic kidney disease
Describe signs and symptoms and laboratory findings consistent with hyperparathyroid
Presentation: weakness, fatigue, constipation ⇒ Stones, bones, abdominal groans, psych moans, and fatigue overtones
What is the recommended treat for primary hyperparthyroidism
(think of mcc)
surgical correction to remove the overactive parathyroid gland ⇒ If all 4, remove 3.5 glands
recommended treat for secondary hyperparthyroidism
(think of mcc)
replace cause (vitamin D/Ca supplementation) manage CKD
What are signs of hyperthyrodism ?
nervousness, heat intolerance,rapid heartbeat with increased sweating, and weight loss despite an increase in appetite.
What is the treatment recommended for hyperthyroid ?
Beta Blockers (symptomatic), methimazole/propylthiouracil
radioactive iodine
thyroidectomy
What hyperthyroid medication can be given in the first trimerster of pregancy?
Hint P for Pregancy (safe in first trimester)
propylthiouracil
After the first trimester of pregancy what thyroid medication can be used( safe for nursing etc)
hint: M for Mother (after first trimester and once baby is born)
Methimazole
This term is the general term that refers to inflammation of the thyroid gland. this includes a group of individual disorders causing thyroidal inflammation but presenting in different ways
Thyroditis
A 31-year-old woman returns to your clinic after being seen for a viral upper respiratory infection three weeks ago. She reports initial improvement, followed by the development of a painful neck, fatigue, and weight gain. She also mentions experiencing dry skin and cold intolerance. On examination, you note mild, diffuse tenderness over the thyroid gland. What is the most likely diagnosis?
Subacute thyroiditis
often follows a viral upper respiratory infection. It is characterized by a painful, tender thyroid, and can initially present with symptoms of hyperthyroidism (such as palpitations), followed by symptoms of hypothyroidism (such as fatigue, weight gain, dry skin, and cold intolerance). T
What is the typical presentation of a patient with hasimotos thyroidits?
often follows a viral upper respiratory infection. It is characterized by a painful, tender thyroid, and can initially present with symptoms of hyperthyroidism (such as palpitations), followed by symptoms of hypothyroidism (such as fatigue, weight gain, dry skin, and cold intolerance).
describe the typical presenations of hashimotos thyroiditis
Diffusely enlarged, painless, nodular goiter
What serum level of calicum indicates hypocalcemia ?
< 8.4 mg/dL
What the most common cause of cause of hypocalcemia ?
Hypoparathyroidism
A 69-year-old woman is admitted for management of a sternotomy wound infection. During her hospitalization, she develops muscle cramps, perioral numbness, and tingling in her hands. Physical examination reveals facial twitching when tapping over the facial nerve (Chvostek sign) and carpal spasm after inflating a blood pressure cuff (Trousseau sign). Which of the following electrolyte abnormalities is most likely responsible for her symptoms?
A) Hyperkalemia
B) Hypokalemia
C) Hypocalcemia
D) Hypernatremia
E) Hypomagnesemi
C) Hypocalcemia
What is the treatment of chocie for Hypocalcemia ?
IV calcium gluconate
What EKG findings are consistent with Hypocalcemia?
prolonged QT
hyponatremia is defined as a serium sodium of < _____
135
Name 3 ways to treat hyponatremia
asymptomatic -free water restriction
moderate hyponatremia-IV normal salineloop diuretics may be added
severe hyponatremia - hypertonic (3%) saline
why do we restrict water in hyponatremic patients?
because too much water dilute the sodium concentration in the blood even further making the hyponatremia worse
47-year-old woman presents with muscle cramps, tingling around her mouth, and irritability. Physical exam reveals a positive Chvostek sign and Trousseau sign. Her labs show a calcium level of 6.4 mg/dL (normal: 8.5-10.5 mg/dL) and a phosphorus level of 5.8 mg/dL (normal: 2.5-4.5 mg/dL). Which of the following is the most likely diagnosis?
A) Hyperparathyroidism
B)Hypoparathyroidism
C) Vitamin D toxicity
D) Primary hyperaldosteronism
B)Hypoparathyroidism
What is the treatment of choice hypothyrodism
Vitamin D and Calicum
What is the treatment of chocie for Hypothyroidism
Levothyroxine
Whats the typical presentation of patient with hypothyrodism
Cold intolerance, fatigue, constipation, depression, weight gain, bradycardia
what key lab findings are associated with pagets disease of the bone ?
elevated alkaline phosphates (hallmark)
normal calicum and phostphate
What X-ray findings are consistent with pagets disease of the bone?
lytic and sclerotic changes (“cotton wool” appearance of skull)
what is the treatment of choice for pagets disease of the bone?
Bisphosphonates (alendronate, zoledronic acid)
What hormones are secreted by phemochromcytoma ?
norepinephrine and epinephrine autonomously and intermittently
What is the test of choice for pheochromocytoma?
24-hour catecholamines including metabolites (metanephrine and vanillylmandelic acid)
What are signs of of pheochromocytoma
5 P’s:
pressure, pain (Headache), perspiration, palpitations, pallor
and high blood pressure unresponsive to therapy
A 45-year-old patient is diagnosed with a pheochromocytoma and is scheduled for adrenalectomy. Which of the following is the most appropriate initial step in preoperative medical management?
A) Initiate a beta-blocker immediately to control heart rateB) Begin a nonselective alpha-blocker for 7-14 days before adding a beta-blockerC) Start IV nicardipine and proceed with surgery immediatelyD) Observe and proceed with surgery without medical therapy
B) Begin a nonselective alpha-blocker for 7-14 days before adding a beta-blocker
what is pheochromocytoma?
a catecholamine-secreting adrenal tumor
What is the treatment of choice for pheochromocytoma ?
complete adrenalectomy
During preoperative preparation for adrenalectomy in a patient with pheochromocytoma, a beta-blocker is accidentally started before alpha-blockade. Which of the following complications is the patient most at risk for?
A) Life-threatening hypertension due to unopposed alpha constriction
B) Severe bradycardia and hypotension
C) Pulmonary embolism
D) Hyperkalemia and cardiac arrhythmia
A) Life-threatening hypertension due to unopposed alpha constriction
What are the most common signs and symptoms associated with pituitary adenomas
MC visual ie diminished temporal vision or bitemporal hemianopsia
a 31-year-old woman who complains of irregular, infrequent menstrual periods. On further questioning, she complains of headaches, fatigue, and breast discharge. She takes ibuprofen only occasionally. The serum prolactin level is 380 μg per what is the most likely diagnoses?
prolactinoma (lactotroph adenoma)
Treatment of choice for pituiatry adenomas
(dopamine agonists )cabergoline and bromocriptine; first-line because dopamine naturally inhibits prolactin secretion.
if dopamine agonists are unsuccessful, transsphenoidal resection of the pituitary tumor should be considered
What is the most common type of thyroid cancer?
papillary carinome = popular**
Describe iodine uptake consistent with Thyroid cancer
Solitary cold nodule on thyroid uptake scan
What is the 1st line imaging when evaluating a thyroid nodule ?
First-line imaging for a thyroid nodule is ultrasound
.🔹 If the nodule is >1 cm with suspicious features on ultrasound → fine-needle aspiration (FNA)
biopsy
🔹 If the nodule is >1 cm but no suspicious features → decision to biopsy depends on size and patient risk factors (sometimes observed instead).
🔹 Thyroid uptake scan (radioactive iodine scan) is NOT routinely done for all nodules — it’s specifically used if TSH is low (suggesting possible hyperfunctioning/autonomous nodule).
