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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
what does Liddle syndrome due to RAAS?
activates since you aren't resorbing as much Na+ through ENaC
26
What can happen when you remove a hormone secreting tumor?
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
27
If you have elevated ACTH and elevated cortisol what is next best step?
pituitary MRI to see if there is a mass secreting ACTH
28
When do you use Inferior petrosal sinus sampling ?
only to distinguish between ACTH secreting tumor or pituitary
29
What labs make you suspicious for hyperaldosteronism?
HTN with hypokalemia
30
What can happen with too much cortisol?
cortisol can activate mineralocorticoid receptors and mimic aldosterone high BP and hypokalemia
31
What is deficient in 21-hydroxylase deficiency ?
cortisol and aldosterone presents with hypotension and hyperkalemia
32
What is the glucocorticoid of choice during pregnancy?
hydrocortisone
33
If you see sudden adrenal insufficiency following an illness what should you think?
Massive bilateral adrenal hemorrhage / Waterhouse-Friedickson syndrome
34
What can be a sign of Addison's disease?
low cortisol even after injecting ACTH there is a primary def.
35
What besides a pituitary adenoma can cause prolactin excess? Why?
hypothyroidism secrete more TSH which activates thyroid hormone production but also prolactin production
36
How can a suprasellar mass influence prolactin?
can disrupt flow of dopamine to prolactin this results in increased prolactin since dopamine inhibits its secretion
37
What is the first line treatment for hyperprolactin caused by pituitary adenoma?
dopamine agonist ex: cabergoline and bromocriptine
38
Ring size increasing and prominent forehead ...
acromegaly excess GH check IGF-1 levels
39
What CN can pituitary masses affect?
3, 4 and 5
40
When is parathyroidectomy indicated?
kidney stones or kidney calcifications fractures or osteoporosis on DEXA serume calcium significantly higher than normal?
41
How do you diagnose AVP def?
water deprivation test
42
What indicates central or nephrogenic diabetes insipidous on water deprivation test?
hypernatremia with very low urine osm (<200) after dehydration (would expect urine osm to be higher when dehydrated and water being retained)
43
How can you determine central vs. nephrogenic diabetes insipidous?
administer DDAVP increase in Urine osm after DDAVP means ADH receptors are working and you have a central def
44
What do you need to check when giving bisphosphonates?
serum creatinine
45
When is insulin the most appropriate option?
HbA1c > 10% evidence of catabolism (weight loss, polyuria and polydipsia)
46
What is the appropriate treatment for someone with subacute thyroiditis?
NSAIDs
47
How does subacute thyroiditis present?
very painful thyroid after an acute illness
48
What do thyroid uptake and thyroglobulin levels look like in subacute thyroiditis?
decreased uptake and high thyroglobulin
49
When do you see increased thyroid uptake with a high thyroglobulin level?
Graves disease
50
When do you see decreased thyroid uptake and low thyroglobulin level?
exogenous thyroid hormone use
51
If a patient has hypothyroidism, what should you do during pregnancy?
automatically increase levothyroxine dose since pregnancy is a state that requires more thyroid do not need to check labs
52
What is a common cause of hypoglycemia in illness?
decreased gluconeogenesis
53
Orthostatic hypotension associated with hypoglycemia points to ...
cortisol deficiency
54
What 3 hormones are involved in counter response to insulin?
glucagon, growth hormone and cortisol
55
Bisphosphonate MOA
induction of osteoclast apoptosis by inhibiting farnesyl pyrophosphate synthase
56
Multiple fractures in childhood with minimal trauma leads you to believe ...
child abuse osteogenesis imperfecta
57
What do you see besides fractures in osteogenesis imperfecta?
blue sclerae
58
What do you see in Paget's disease?
bone pain, fractures, warmth over affected areas and enlarged head (can damage CNs)
59
What are the 4 different ways to diagnose diabetes?
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
When does someone need an eye exam in diabetes?
after they had diabetes for over 5 years then annually
61
What class of diabetes medications increases the risk of UTIs?
-flozins SGLT-2 inhibitors
62
When is metformin not indicated?
eGFR < 30
63
Mxyedema coma
an endocrine emergency due to severe hypothyroidism
64
How should you treat a myxedema coma?
immediately with levothyroxine and hydrocortisone
65
What should you pay attention to when selecting DM medications?
if they are type I or type II type I needs some sort of insulin
66
If you have hypoglycemia when fasting on insulin what should be changed?
your long-acting insulin should be changed "don't go" degludec and glargine
67
What is the inheritance of T1DM?
polygenic (not recessive or dominant)
68
What is the inheritance of MODY?
autosomal dominant
69
HHS stands for ...
hyperglycemic hyperosmolar state
70
When do you see hypoglycemia in adrenal insufficiency?
after prolonged fasting non-insulin mediated process
71
When do you see an accelerated rate of bone remodeling?
Paget's disease
72
When do you see low bone mass and poor microarchitecture?
osteoporosis
73
When do you see deficient mineralization of bone matrix?
Rickets / osteomalacia
74
When do you see defects in collagen assembly?
osteogensis imperfecta
75
Headaches and vision loss with hyperthyroid indicates what?
this is secondary hyperthyroidism and TSH is also increased
76
What 3 instances can you get hypertension and hypokalemia but have low aldosterone?
1) Really high cortisol 2) High levels of DOC 3) Liddle syndrome
77
What is the inheritance of APS I?
autosomal recessive
78
How can you tell there is acute adrenal insufficiency?
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
Do you see hyperkalemia and salt wasting in secondary adrenal insuff?
no
80
How does 11B-hydroxylase def present?
low aldosterone but increased 11-DOC 11-DOC will mimic aldosterone and cause hypokalemia and HTN also see an increase in androgens
81
What is the only product elevated in 3B-hydroxysteriod def?
DHEA
82
3 tests for Cushings syndrome (need two positive)
1) overnight dexamethasone suppression 2) late night salivary cortisol 3) 24 hr urine cortisol
83
When do you test petrosal sinus sampling? When is it positive?
test in ACTH-dependent Cushings if positive, this means you have a pituitary adenoma causing the Cushings
84
How do you treat a prolactinoma?
dopamine *all other pituitary adenomas you treat with surgery*
85
What symptoms do you see in VHL?
pheochromocytoma and eye involvement *need Eye Exams*
86
What symptoms do you see in NF1?
pheochromocytoma and neurofibromas (weird bumps on skin) see a lot of skin involvement
87
What two conditions have increased insulin with increased C-peptide and proinsulin?
insulinoma and sulfonylureas
88
What is the treatment of DKA?
1) Fluids 2) Insulin 3) Potassium
89
What do you have to monitor when giving insulin for DKA?
blood glucose will drop before lipogenesis and ketogenesis reverses therefore, might need to give sugars while waiting
90
When should you start potassium for DKA?
before you start insulin insulin will worsen hypokalemia by increasing K+ uptake into cells
91
Who is a good candidate for insulin therapy?
tech savvy able to count carbs insurance covers
92
How can you tell malignant vs benign adrenal lesions?
Malignant: lower fat content with higher density and irregularities Benign: higher fat content with lower density
93
What is risk factor for thyroid carcinoma?
radiation exposure
94
What does medullary carcinoma look like on histology?
amyloid
95
What does papillary carcinoma look like on histology?
groove nuclei and overlapping
96
What do thyroid uptake levels look like in amiodarone thyrotoxicosis?
indeterminant thyroid levels
97
Postpartum thyroiditis iodine uptake
low iodine uptake
98
Struma ovarri thyroiditis iodine uptake
low iodine uptake Will see the uptake where the teratoma is instead
99
What can severe magnesium def in hospitalized patients cause?
no PTH which presents with hypocalcemia
100
When do you use FRAX score?
to see if people with osteopenia need to be treated
101
In central adrenal insufficiency from exogenous steroids being withdrawn does aldosterone decrease?
no aldosterone is not affected
102
How do you diagnose pheo?
measure levels of catecholamine in the blood and urine
103
Honeymoon phase in T1DM
enough remaining B-cells to make insulin do not need as much insulin
104
What is a good way to manage hypoglycemia in an elderly person with unawareness?
continous glucose monitor check blood sugar often maybe use shorter acting agents
105
What do benign adrenal tumors look like on CT?
dark and homogenous
106
How does osteomalacia present?
bone pain fractures muscle weakness

Endocrine / MSK / Repro (8 decks)

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