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Endocrine / MSK / Repro > Endo Review > Flashcards

Endo Review Flashcards

1
Q

What does cincalcet do?

A

binds to Ca2+ sensing receptors in parathyroid

decreases levels of PTH

can be used to treat hyperthyroidism

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2
Q

What can make testosterone transiently low?

A

glucocorticoid use and illness

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3
Q

When do you see the GI tract vs. the kidneys contributing to Ca2+ resorption?

A

the GI tract in sarcoidosis (secretes more 1,25-vitamin D)

the kidneys when there is excess PTH

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4
Q

When do you see an increase in the set point for calcium?

A

in FHH

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5
Q

What can lower sex hormone binding globulin (SHBG)? (4)

A

diabetes, obesity, hypothyroidism and steroids

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6
Q

What is a characteristic sign of pseudohypothyroidism?

A

shortened 4th and 5th fingers

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7
Q

What labs do you see in pseudohypothyroidism? Why?

A

increased PTH and increased phosphorous and decreased calcium

PTH being secreted but there is a problem with the PTH receptors

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8
Q

Patient presents with Addison’s disease, thyroid disease and T1DM what are you thinking?

A

Polyglandular autoimmune syndrome type 2

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9
Q

Patient presents with Addision’s disease, hypoparathyroidism and chronic candidas infections?

A

Polyglandular autoimmune syndrome type 1

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10
Q

What is acromegaly? What disease can cause it?

A

excess growth hormone production

MEN1

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11
Q

What does FHH stand for?

A

familial hypocalciuric hypercalcemia

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12
Q

Does FHH increase risk for kidney stones?

A

no, actually protects against them

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13
Q

How is FHH transmitted?

A

autosomal dominant

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14
Q

What is defining feature of FHH?

A

a low 24-hour urine calcium (<100 mg/d) despite getting adequate amounts of dietary calcium.

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15
Q

What do you need to do when working up calcium problems?

A

check an albumin level

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16
Q

After gastric bypass, what are you at risk for?

A

Vitamin D def. which leads to secondary hyperparathyroidism

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17
Q

What level should you check when suspecting Vitamin D def?

A

25-vitamin D (more accurate stores)

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18
Q

What vitamin D do you check in setting of PTH-independent hypercalcemia?

A

1,25-vitamin D

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19
Q

What are exogenous causes of hypogonadotropic hypogonadism?

A

hemochromatosis, ,traumatic brain injury and opoids

(low FSH/LH and low testosterone)

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20
Q

What is exogenous cause of primary hypogonadism?

A

chemotherapy

(low testosterone with high FSH/LH)

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21
Q

How do you treat hypoparathyroidism?

A

calcitriol and calcium supplementation

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22
Q

What can high dose dexamethosone test discriminate between?

A

1) No significant cortisol suppression = ectopic ACTH secretion

2) Significant cortisol suppression = ACTH secreting adenoma on pituitary

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23
Q

What can happen when you replace cortisol and thyroid hormone?

A

when deficient, they increase V1 sensitivity to ADH

so when you replace them, you will only have a small amount of V1 receptors but not as much sensitivity

this can give you a diabetes insidious cause ADH receptors not working well when meds are first started after a deficiency

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24
Q

What does loop diuretic due to RAAS?

A

increases RAAS since you are losing volume (more complex but go with)

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25
Q

what does Liddle syndrome due to RAAS?

A

activates since you aren’t resorbing as much Na+ through ENaC

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26
Q

What can happen when you remove a hormone secreting tumor?

A

you can develop a secondary deficiency

ex: ACTH being produced by a tumor means pituitary is not used to secreting as much and you can get secondary hypocortisol after removing tumor

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27
Q

If you have elevated ACTH and elevated cortisol what is next best step?

A

pituitary MRI to see if there is a mass secreting ACTH

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28
Q

When do you use Inferior petrosal sinus sampling ?

A

only to distinguish between ACTH secreting tumor or pituitary

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29
Q

What labs make you suspicious for hyperaldosteronism?

A

HTN with hypokalemia

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30
Q

What can happen with too much cortisol?

A

cortisol can activate mineralocorticoid receptors and mimic aldosterone

high BP and hypokalemia

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31
Q

What is deficient in 21-hydroxylase deficiency ?

A

cortisol and aldosterone

presents with hypotension and hyperkalemia

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32
Q

What is the glucocorticoid of choice during pregnancy?

A

hydrocortisone

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33
Q

If you see sudden adrenal insufficiency following an illness what should you think?

A

Massive bilateral adrenal hemorrhage / Waterhouse-Friedickson syndrome

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34
Q

What can be a sign of Addison’s disease?

A

low cortisol even after injecting ACTH

there is a primary def.

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35
Q

What besides a pituitary adenoma can cause prolactin excess? Why?

A

hypothyroidism

secrete more TSH which activates thyroid hormone production but also prolactin production

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36
Q

How can a suprasellar mass influence prolactin?

A

can disrupt flow of dopamine to prolactin

this results in increased prolactin since dopamine inhibits its secretion

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37
Q

What is the first line treatment for hyperprolactin caused by pituitary adenoma?

A

dopamine agonist

ex: cabergoline and bromocriptine

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38
Q

Ring size increasing and prominent forehead …

A

acromegaly

excess GH check IGF-1 levels

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39
Q

What CN can pituitary masses affect?

A

3, 4 and 5

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40
Q

When is parathyroidectomy indicated?

A

kidney stones or kidney calcifications

fractures or osteoporosis on DEXA

serume calcium significantly higher than normal?

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41
Q

How do you diagnose AVP def?

A

water deprivation test

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42
Q

What indicates central or nephrogenic diabetes insipidous on water deprivation test?

A

hypernatremia with very low urine osm (<200) after dehydration

(would expect urine osm to be higher when dehydrated and water being retained)

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43
Q

How can you determine central vs. nephrogenic diabetes insipidous?

A

administer DDAVP

increase in Urine osm after DDAVP means ADH receptors are working and you have a central def

44
Q

What do you need to check when giving bisphosphonates?

A

serum creatinine

45
Q

When is insulin the most appropriate option?

A

HbA1c > 10%

evidence of catabolism (weight loss, polyuria and polydipsia)

46
Q

What is the appropriate treatment for someone with subacute thyroiditis?

A

NSAIDs

47
Q

How does subacute thyroiditis present?

A

very painful thyroid after an acute illness

48
Q

What do thyroid uptake and thyroglobulin levels look like in subacute thyroiditis?

A

decreased uptake and high thyroglobulin

49
Q

When do you see increased thyroid uptake with a high thyroglobulin level?

A

Graves disease

50
Q

When do you see decreased thyroid uptake and low thyroglobulin level?

A

exogenous thyroid hormone use

51
Q

If a patient has hypothyroidism, what should you do during pregnancy?

A

automatically increase levothyroxine dose since pregnancy is a state that requires more thyroid

do not need to check labs

52
Q

What is a common cause of hypoglycemia in illness?

A

decreased gluconeogenesis

53
Q

Orthostatic hypotension associated with hypoglycemia points to …

A

cortisol deficiency

54
Q

What 3 hormones are involved in counter response to insulin?

A

glucagon, growth hormone and cortisol

55
Q

Bisphosphonate MOA

A

induction of osteoclast apoptosis by inhibiting farnesyl pyrophosphate synthase

56
Q

Multiple fractures in childhood with minimal trauma leads you to believe …

A

child abuse

osteogenesis imperfecta

57
Q

What do you see besides fractures in osteogenesis imperfecta?

A

blue sclerae

58
Q

What do you see in Paget’s disease?

A

bone pain, fractures, warmth over affected areas and enlarged head (can damage CNs)

59
Q

What are the 4 different ways to diagnose diabetes?

A

a) fasting plasma glucose > 126 on TWO tests

b) random glucose > 200 and symptoms

c) HbA1c > 6.5%

d) > 200 on glucose tolerance test

60
Q

When does someone need an eye exam in diabetes?

A

after they had diabetes for over 5 years

then annually

61
Q

What class of diabetes medications increases the risk of UTIs?

A

-flozins

SGLT-2 inhibitors

62
Q

When is metformin not indicated?

A

eGFR < 30

63
Q

Mxyedema coma

A

an endocrine emergency due to severe hypothyroidism

64
Q

How should you treat a myxedema coma?

A

immediately with levothyroxine and hydrocortisone

65
Q

What should you pay attention to when selecting DM medications?

A

if they are type I or type II

type I needs some sort of insulin

66
Q

If you have hypoglycemia when fasting on insulin what should be changed?

A

your long-acting insulin should be changed

“don’t go”

degludec and glargine

67
Q

What is the inheritance of T1DM?

A

polygenic (not recessive or dominant)

68
Q

What is the inheritance of MODY?

A

autosomal dominant

69
Q

HHS stands for …

A

hyperglycemic hyperosmolar state

70
Q

When do you see hypoglycemia in adrenal insufficiency?

A

after prolonged fasting

non-insulin mediated process

71
Q

When do you see an accelerated rate of bone remodeling?

A

Paget’s disease

72
Q

When do you see low bone mass and poor microarchitecture?

A

osteoporosis

73
Q

When do you see deficient mineralization of bone matrix?

A

Rickets / osteomalacia

74
Q

When do you see defects in collagen assembly?

A

osteogensis imperfecta

75
Q

Headaches and vision loss with hyperthyroid indicates what?

A

this is secondary hyperthyroidism and TSH is also increased

76
Q

What 3 instances can you get hypertension and hypokalemia but have low aldosterone?

A

1) Really high cortisol

2) High levels of DOC

3) Liddle syndrome

77
Q

What is the inheritance of APS I?

A

autosomal recessive

78
Q

How can you tell there is acute adrenal insufficiency?

A

adrenal glands have not had time to shrink yet

they will still be reactive in cortisol stimulation test even though baseline cortisol is low

79
Q

Do you see hyperkalemia and salt wasting in secondary adrenal insuff?

A

no

80
Q

How does 11B-hydroxylase def present?

A

low aldosterone but increased 11-DOC

11-DOC will mimic aldosterone and cause hypokalemia and HTN

also see an increase in androgens

81
Q

What is the only product elevated in 3B-hydroxysteriod def?

A

DHEA

82
Q

3 tests for Cushings syndrome (need two positive)

A

1) overnight dexamethasone suppression

2) late night salivary cortisol

3) 24 hr urine cortisol

83
Q

When do you test petrosal sinus sampling? When is it positive?

A

test in ACTH-dependent Cushings

if positive, this means you have a pituitary adenoma causing the Cushings

84
Q

How do you treat a prolactinoma?

A

dopamine

all other pituitary adenomas you treat with surgery

85
Q

What symptoms do you see in VHL?

A

pheochromocytoma and eye involvement

need Eye Exams

86
Q

What symptoms do you see in NF1?

A

pheochromocytoma and neurofibromas (weird bumps on skin)

see a lot of skin involvement

87
Q

What two conditions have increased insulin with increased C-peptide and proinsulin?

A

insulinoma and sulfonylureas

88
Q

What is the treatment of DKA?

A

1) Fluids

2) Insulin

3) Potassium

89
Q

What do you have to monitor when giving insulin for DKA?

A

blood glucose will drop before lipogenesis and ketogenesis reverses

therefore, might need to give sugars while waiting

90
Q

When should you start potassium for DKA?

A

before you start insulin

insulin will worsen hypokalemia by increasing K+ uptake into cells

91
Q

Who is a good candidate for insulin therapy?

A

tech savvy

able to count carbs

insurance covers

92
Q

How can you tell malignant vs benign adrenal lesions?

A

Malignant: lower fat content with higher density and irregularities

Benign: higher fat content with lower density

93
Q

What is risk factor for thyroid carcinoma?

A

radiation exposure

94
Q

What does medullary carcinoma look like on histology?

A

amyloid

95
Q

What does papillary carcinoma look like on histology?

A

groove nuclei and overlapping

96
Q

What do thyroid uptake levels look like in amiodarone thyrotoxicosis?

A

indeterminant thyroid levels

97
Q

Postpartum thyroiditis iodine uptake

A

low iodine uptake

98
Q

Struma ovarri thyroiditis iodine uptake

A

low iodine uptake

Will see the uptake where the teratoma is instead

99
Q

What can severe magnesium def in hospitalized patients cause?

A

no PTH which presents with hypocalcemia

100
Q

When do you use FRAX score?

A

to see if people with osteopenia need to be treated

101
Q

In central adrenal insufficiency from exogenous steroids being withdrawn does aldosterone decrease?

A

no

aldosterone is not affected

102
Q

How do you diagnose pheo?

A

measure levels of catecholamine in the blood and urine

103
Q

Honeymoon phase in T1DM

A

enough remaining B-cells to make insulin

do not need as much insulin

104
Q

What is a good way to manage hypoglycemia in an elderly person with unawareness?

A

continous glucose monitor

check blood sugar often

maybe use shorter acting agents

105
Q

What do benign adrenal tumors look like on CT?

A

dark and homogenous

106
Q

How does osteomalacia present?

A

bone pain

fractures

muscle weakness

Endocrine / MSK / Repro (8 decks)

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