Endo Uworld Flashcards
pins and needles sensation and mucle cramps. no PMH or FMH
has low Ca and high phosphorus and BUN 10 Cr 0.8
hypoparathyroid- primary
post hysteretomy patient develops nausea vomiting and acute abdomenal pain
has Hx SLE and takes prednisone
BP 70/40 pulse 110 and BP increases slightly after 4 L fluid
adrenal insufficiency having acute adrenal crisis
what drug can bring out adrenal crisis during surgery
etomidate
16 year old with facial hair, irregular menstrual cycles, and normal external genitalia
LH and FSH inc
17 hydroxyprogesterone inc
serum testosterone inc and DHEA inc
CAH from 21 a hydroxylase deficiency
what to check for primary amenorrhea
prolactin TSH and FSH after checking pregnancy
primary amenorrhea with increased FSH
premature ovarian failure
primary amenorrhea with increased TSH
hypothyroid
Euthyroid sick syndrome
fall in T3 levels. normal T4 and TSH
during acute sick illness
why do heavy women have milder post menopasual Sx
conversion of adrenal androgens to estrogens by adipose tissue
2 months fatigue and nausea vomiting, polyuria and polydipsia with constipation
smoking and drinking Hx
normal vitals
mucous membranes dry
Ca elevated, albumin norm. PTH low. Cr 1.9 BUN 54 glucose 180 and mildly low activated Vit D
hypercalcemia of malignancy
- osteolytic mets
- PTHrp
- inc tumor production activated Vit D (lymphoma)
- inc IL6 levels in MM
what releases PTHrp usually
squamous cell lung! renal bladder breast ovarian
signs of precocious puberty next step
check bone age
if advanced then check basal LH
if normal then isolated development- no further testing
what does basal LH tell you in precocious puberty
if low then do GnRH stimulation and if still low it is peripheral precocious (gonadotropin independent)
if high- central (gonadotropin-dependent)
dosing levothyroxine with pregnancy
increase dose when pregnant
6 mo history fatigue, HA, decreased libitdo
decreased testicular volume
low LH, low Testosterone, low TSH and T4 and mildly elevated prolactin
hypopituitarism
pituitary adenoma
DKA presentation
15 year old in ED with confusion, rapid breathing, abdominal pain. cold 3 days ago. has urinary frequency and progressive fatigue and somnolence
mucous membranes dry
K is high in serum Na normal bicarb very low
generalized bone pain. just had bowel resection for crohns. has pseudofractures and proximal muscle weakness
osteomalacia
labs of osteomalacia
decreased Ca, decreased phosphorus.
increased PTH
C peptide reflects what
natural insulin by product
how to Dx primary polydipsia
if urinary omsolality increases after water deprivation test
how to Dx central vs nephrogenic DI
central will get better with vasopressin
nephrogenic barely has a response to vasopressin in increasing urine osmolality
untreated hyperthyroidism is greatest risk for
bone loss
signs hyperthyroid with painless nodule and decreased uptake
painless thyroiditis
what DM med is helpgul to reduce weight and control BP
GLP-1 agonist
exenatide or lireglutide
side effect of GLP-1 agonists for dM
pancreatitis
DM with decreased appetite nausea and abdominal bloating. gets early satiety and low glucose right after meals
delayed gastric emptying (gastroparesis)
Tx with metoclompramide or small frequent meals
signs hyperthyrdoi and thyroid exam show 2 nodules on scan only uptake in one of them and no uptake anywhere else
toxi adenoma
what dugs can precipitate hyperosmolar hyperglycemic states in DM
thiazides because volume deplete and dec GFR more which activates hormones to counter regulate
comorbidities with PCOS
overweight/obesity glucose intolerance/DM dyslipidemia OSA endometrial hyperplasia/cancer
best step in manageing diabetic nephropathy
BP control
fatigue myalgias and muscle weakness in both elgs for a month. difficult standing up out of a chair. weakness and cramping in legs
decreased strength in proximal mm in LE and sluggish ankle jerks
normal ESR and elevated CPK
electrolytes normal
enxt step
measure thyroid hormones because hypothyroid can cause myopathy
signs hyperthyroid. on diet, has diffuse decrease uptake on scan
low TBG level due to exogenous thyroid supplements
what CA is associated with hashimoto
lymphoma of thyroid
decreaseing HbA1c to less than 6.5% helps prevent what
retinopathy
progressive watery diarrhea. cramps and feels dehydrated. stools are tea colored and has episodic flushing of face no traveling normal vitals normal abdominal exam mass on pancreatic tail on imaging
VIPoma
achlorhydria from dec gastric acid secretion
lab findings in VIPoma
hypokalemia
hypercalcemia
hyperglycemia
first line for DM neuropathy
TCA
high TSH T3 T4
TSH secreting pituitary adenoma
causes of proximal muscle myopathy
polymyosistis dermatomyositis hypo or hyper thyroid cushings lambert eaton myasthenia gravis steroids
HTn and hypokalemia
check plasma aldosterone/renin ratio
what do you check if suspect acromegaly
IGF-1 if high then do glucose suppression test. if does not suppress GH = acromegaly
low and high dose DXM does not suppress cortisol
ectopic ACTH production
calcification of both adrenal glands
from mexico
TB causing adrenocortical insufficiency
what is the main difference between primary adrenal insufficiency and secondary from chronic glucocorticoid
secondary does not affect aldosterone. only decrease in cortisol and ACTH because aldosterone is primarly regulated by RAAS
secondary do not get hyperg\pigementation or hyperkalemia
why does TSH decrease in pregnancy
bhcg causes inc T4 in first trimester then suppressing TSH
change in thyroid hormones in pregnancy
increase total T4
increase free T4
decrease TSH
best markers fr resolution of ketoacidosis
serum anion gap and beta hydroxybutyrate
best immediate therapy for Sx hyperthyroid
propranolol
low Ca with high PTH
vit D deficiency
chronic kidney disease
pancreatitis or sepsis
tumor lysis
prussian blue stain
presence hemosiderin
underlying path in G6PD def
oxidative stress
heinz bodies
G6PD def
in glucagon world what gets converted to pyruvate
lactate, alanine and otehr aa
unique property of collicular carcinoma of thyroid
encapsulated. so invasion of tumor capsule and blood vessels
when is oral glucose testing done in pregnancy
24-28 weeks
what organ is responsible for precocious sexual development
adrenal androgen release
isolated premature adrenarche
PCOS, MD 2 or metabolic syndrome
management of prolactinoma in premenopausal with no mass effects
cabergoline or bromocriptine
How does steatorrhea affect Calcium
aka celiacs
disrupts absorption vit D. so get vit d deficiency with low Ca, phosphorus and high PTH
signs of thyroid storm
high fever! tachy cardia and hypternsion arrhythmias agitation, delirium goiter, lid lag, tremor warm and moist skin n/v/d and jaundice
how does prolactinoma cause hypogonadism
suppress gnRH hormone
what cancer most commonly produces PTHrp
metastatic breast cancer
clinical manifestations carcinoid
skin flushing, telangiectasias GI diarrhea and cramping valvular lesions in heart bronchospams niacin deficiency
Dx carcinoid
increased 5HIAA
CT MRI abdomen and pelvis
octreoscan to see mets
echo
deficiency in carcinoid
niacin and tryptophan
niacin def
dermatitis, diarrhea dementia (pellagra)
sheehan
pituitary infarction- ischemic necrosis
signs primary adrenal insufficiency (addison)
fatigue, hyperpigmentation, low BP, eosinophilia, low sodium and hyperkalemia
what are the tests for adrenal insufficiency
basal early morning cortisol, ACTH and cosyntropin test
what is cosyntropin test
ACTH synthetic analogue
serum cortisol usually increases after administration cosyntropin unless have adrenal insufficiency
low basal cortisol in morning with low ACTH
central adrenal insufficiency (pituitary or hypothalamus)
central adrenal insufficiency is synonymous with
secondary or tertiary
signs of refeeding syndrome
arrhythmia
CHF
seizures
wernicke encephalopathy
what causes refeeding syndrome
the release of insulin causing uptake phosphorus, K and Mg
fast refeeding can cause cardiopulmonary failure
what is hyperCa of immobilization
increased osteoclastic bone reabsorption
need hydration and bisphosphonates
what causes neonatal thyrotoxicosis
transplacental passage materna anti TSH R Ab causing warm moist skin tachy cardia poor feeding, poor weight gain low birth weight
what is T for neonatal thyrotoxicosis
self resolves once Ab disappears
give methimazole and beta blocker for Sx
what will happen if give betablocker to pheo exacerbation
BP will increase rapidly from unnopposed alpha
why can large tranfusion cause hypocalcemia
patient has to have liver impairment usually
citrate in tranfused blood binds the active ionized Ca
side effects of antithyroid drugs
agranulocytosis
methimazole is 1st trimester teratogen
propylthiouracil cause hepatic failure and ANCA assoc vasculitis
most common cause death in acromegaly
CHF
signs of glucocorticoid deficiency
fatigue, loss of appetite, hypoglycemia, hyponatremia and eosinophilia
what is not affected in pan hypopituitarism
aldosterone
remember it is central adrenal insufficiency or secondary.
what sex hormone is primarily made in adrenals
DHEA-S
overproduction DHEA-S
gets converted to testosterone, hirsutism!
most common cause primary adrenal insufficiency
autoimmune
most common malignant thyroid carcinoma
papillary from epithelial-thyroid follicular cells)
definition constitutional growth delay
delayed growth spurt
delayed puberty
delayed BONE AGE!!!!
chronic kidney disease cause what imbalance in electrolytes
secondary hyperPTH from low Ca from low Vit D conversion
also holds onto phosphorus which also stimualtes PTH
TSH and LH values in prolactinoma
low LH
normal TSH
target blood glucose for gestational DM
fasting
what is next step if diet modification is not good enough for Gestational DM
insulin
what are complications of late maternal hyperglycemia for neonate
polycythemia from inc metabolic demand
organomegaly
macrosomia shoulder dystocia
neonatal hypoglycemia
MEN 1
pituitary adenoma
primary hyper PTH
pncrease/GI gastrinoma
best initial therapy for primary hyperaldosteronism
eplerenone
side effects spironolactone
decreased libido and gynecomastia in men
breast tenderness and menstural irregularities in women
best management in young girl with PCOS no intention of getting pregnant
combined OCP
which treatment for graves will worsen eyes temporarily
radioactive iodine pre treat with glucocorticoids to decrease effects
nephrotic syndrome. what is causing low serum Ca
low albumin
what metabolic abnormalities occur with hypothyroid
hyperlipidemia and hyponatremia
sometimes aSx elevations CPK and increased AST ALT
hypercortisolism
glucose HTN and weight gain. cushings.
can cause proximal wekaness, central adiposity and abdominal striae
HA
usually exogenic. can be small cell lung cancer making ACTH
or ACTH porducing pituitary adenomas (cushing diseasE)
hyperCa, metabolic alkalosis and renal failure
milk alkali syndrome
PTH will be suppressed.
HTn with undetectable renin activity
primary hyperaldosteronism
how do kidneys escape excess Na with hyperaldosteronism
increase renal blood flow and GFR and atrial natriuretic peptide is relased all to promote Na excretion
thyroid nodule. next step
TSH and U/S
46 XX with vomiting, poor feeding, dry mucous membranes, skin turgor decreased, enlargement clitoris and fusion labioscrotal folds with no palpable gonads
Na is low and K is high
what is increased
17-hydroxyprogesterone from a deficiency in 21 hydroxylase
salt wasting!!!
best IV fluid for hyperosmolar hyperglycemic state
normal saline
patient with hypothyroid taking levothyroxine. now going on estrogen. what is going to happen
need more leveothyroxine because TBG increases
osteomalacia
impaired osteoid matrix mineralization from vit D def
if this electrolyte is low can cause hypoCa
Mg because induces resistance to PTH and decrease PTH secretion
how does PE affect Ca
increase Ca bound to albumin so decrease serum Ca
because respiratory alkalosis causes H to dissociate from albumin freeing up space for Ca
respiratory alkalosis effect on Ca
causes H to dissociate albumin freeing space to bind Ca
so decrease serum Ca
preferred Tx for graves
radioactive iodine therapy unless severe opthamology or pregnant
advanced bone age, precocious puberty but LH and after gnRH still is low
peripheral cause– CAH
15 weight gain with muscle weakness proximally and HTN
glucose is elevated and CXR show right hilar mass and lymphadenopathy
cushings from small cell cancer creating ACTH
hyperandrogenism in adult female occuring rapidly
check DHEA-S and testosterone
elevated testosterone and normal DHEA-S in female
ovarian source
elevated DHEA-S and normal testosterone
adrenal source
most common testicular sex cord stromal tumor
leydig cell tumor
what do leydig cell tumors produce
testosterone and estrogen from increased aromatase activity
secondary inhibition LH and FSH
skin hyperpigmentation
primary adrenal insufficiency!!!!! not secondary!!!!!!!!!!
what causes HTN in thyrotoxicosis
increased myocardial contractility
MEN2B
marfinoid!!!
Pheo
medullary thyroid carcinoma
mucosal neuromas
Men2A
PTH
Pheo
medullary thyroid
fever and sore throat after starting anti thyroid
stop meds! agranulocytosis
glucagonoma Sx signs
necrolytic migratory erythema- erythematous plaques on face, perineum enalarge and coalesce DM - mild hyperlycemis diarrhea, anorexia, abdominal pain weight loss ataxia, dementia, proximal mm wekaness
DM patient with rash and has lost a lot of weight
glucagonoma
when do ulcers require amputation
gangrene
when to hospitalize for foot ulcer
cellulitis and abscess formation or osteomyelitis
gangrene
risk factors for graves opthamology
SMOKING
female se
advancing age
