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PANCE/EOC > Endocrine #1 > Flashcards

Endocrine #1 Flashcards

1
Q

Chronic Adrenocortical Insufficiency is due to _________

A

Pituitary failure of ACTH secretion

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2
Q

Causes of adrenocortical insufficiency

A

-History of exogenous glucocorticoid use

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3
Q

Symptoms of Primary Adrenocortical Insuffiency (Addison’s Disease)

A

-Due to lack of sex hormone and aldosterone

  • Hyperpigmentation, orthostatic hypotension
  • Amenorrhea, loss of libido, loss of pubic/axillary hair
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4
Q

Baseline labs for adrenocortical insufficiency

A
  • Elevated ACTH (Primary), Decreased ACTH (Secondary)
  • Hypoglycemia
  • Hyperkalemia
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5
Q

Explain the high-dose ACTH Cosyntropin Stimulation Test

A

Adrenal insufficiency if insufficient or absent rise in serum cortisol (< 18) after ACTH administration

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6
Q

Treatment for adrenocortical insufficiency

A
  • Glucocorticoid Replacement: Hydrocortisone

- Mineralocorticoid Replacement: Fludricortisone (In Addison’s, may be added)

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7
Q

Treatment for Addison’s Disease

A
  • Isotonic fluids (normal saline or D5N5) + IV Hydrocortisone or Dexamethasone
  • Fludricortisone to reverse electrolyte disorders
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8
Q

What is Cushing’s Syndrome?

A

Signs and symptoms related to Cortisol excess

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9
Q

4 main causes of Cushing’s

A
  • Long-term high-dose glucocorticoid therapy (MC)
  • Pituitary gland ACTH overproduction (MC endogenous cause)
  • Ectopic ACTH-producing tumor (small cell lung cancer)
  • Adrenal Tumor/Adenoma
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10
Q

Symptoms of Cushing’s

A
  • Weight gain, obesity
  • Moon facies
  • Buffalo Hump
  • Supraclavicular Fat Pads
  • Thin Extremities
  • Striae
  • Acanthosis Nigricans
  • Hypertension
  • Hirsuitism oily skin
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11
Q

Screening tests for Cushing’s

A
  • 24 hour urinary free cortisol (most specific)
  • Nighttime salivary cortisol
  • Low-dose overnight Dexamethasone suppression test
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12
Q

What is the test that helps differentiate Cushing’s from other causes of cortisol excess?

A
  • Baseline ACTH + Dexamethasone suppression test

- –Increased ACTH + suppression of cortisol on high dose = Cushing’s

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13
Q

Treatment of Cushing’s Disease

A
  • Corticosteroid use: Gradual taper

- Transsphenoidal Resection

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14
Q

Primary hyperaldosteronism is a cause of _______

A

Secondary hypertension

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15
Q

Triad of symptoms for primary hyperaldosteronism

A

-Hypertension, Metabolic Alkalosis, Hypokalemia

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16
Q

Labs for hyperaldosteronism

A
  • Plasma renin and aldosterone levels: aldosterone to renin ratio: ARR > 20:1
  • Hypokalemia
  • Metabolic Alkalosis
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17
Q

What is a confirmatory test for primary hyperaldosteronism?

A

oral sodium loading test: high urine aldosterone

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18
Q

what are some symptoms of hypokalemia?

A

Proximal muscle weakness, polyuria, fatigue, constipation, decreased DTRs

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19
Q

Treatment for primary aldosteronism

A

-Spironolactone, ACE inhibitors

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20
Q

A Pheochromocytoma is a ______ secreting tumor

A

Catecholamine

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21
Q

Pathophysiology of a Pheochromocytoma

A

-Secretes norepinephrine, epinephrine, and dopamine autonomously and intermittently

22
Q

Symptoms of a Pheochromocytoma

A

-Hypertension

PHE

  • Palpitations
  • Headache
  • Excessive Sweating
23
Q

Confirmatory test for Pheochromocytoma

A

-24 hour urinary fractionated catecholamines including metabolites (increased metanephrines and vanillylmandelic acid)

24
Q

Treatment for Pheochromocytoma

A
  • Nonselective alpha blockade: Phenoxybenzamine or Phentolamine 1-2 weeks followed by BB
  • Complete adrenalectomy after 1-2 weeks of medications
25
Q

Regarding Levothyroxine for Hypothyroidism, what are the rules if TSH is low or TSH is high?

A

TSH Low: decrease dose of Levothyroxine

TSH high: increase dose of Levothyroxine

26
Q

When using Levothyroxine, when should labs be taken?

A
  • Monitor TSH levels at 6-week intervals, when initiating or changing the dose
  • During pregnancy, the dose needs to be increased
27
Q

Overshoot of Levothyroxine can cause two things. Name them.

A
  • Cardiovascular effects

- Osteoporosis

28
Q

MCC of hypothyroidism in the US in women 30-50

A

Hashimoto Thyroiditis

29
Q

Exam findings of Hashimoto Thyroiditis

A
  • Bradycardia
  • Loss of outer 1/3 of eyebrows
  • Myxedema (non pitting edema)
  • Fatigue, cold intolerance, dry thickened skin, weight gain, menorrhagia, weakness, lethargy
30
Q

Diagnostics for Hashimoto Thyroiditis

A
  • Increased TSH and Decreased free T4 and T3
  • Positive Antithyroid Peroxidase and/or anti-thyroglobulin antibodies
  • Radioactive iodine scan: diffuse decreased iodine uptake
  • Biopsy: rarely done, Hurthle cells, lymphocytic infiltration
31
Q

Treatment for Hashimoto Thyroiditis

A

Levothyroxine

32
Q

Myxedema Coma is MC seen in

A

Elderly women with long standing hypothyroidism during the winter

33
Q

Subacute Thyroiditis often follows

A

Antecedent Viral respiratory tract infection or post-viral inflammation

34
Q

Symptoms of Subacute Thyroiditis

A
  • Hyperthyroidism
  • Painful thyroid gland aggravated with head movements and swallowing
  • URI symptoms
35
Q

Diagnostics for Subacute Thyroiditis

A
  • High ESR + negative thyroid antibodies
  • Hyperthyroid profile early in the disease
  • Biopsy: multinucleate giant cells
36
Q

Treatment for Subacute Thyroiditis

A
  • Supportive

- NSAIDs or Aspirin for pain and inflammation

37
Q

MCC of hyperthyroidism in the US

A

-Graves Disease

38
Q

Pathophysiology of Graves Disease

A

-Autoimmune disease: TSH receptor autoantibodies target and stimulate the TSH receptor

39
Q

Symptoms of Graves Disease

A
  • Atrial Fibrillation, heat intolerance, tremors, palpitations, weight loss
  • Ophthalmopathy: proptosis, exophthalmos, lid lag
  • Pretibial Myxedema: Swollen red patches on leg with non-pitting edema
  • Thyroid Bruit
40
Q

Diagnostics for Graves Disease

A
  • Primary hyperthyroid profile: decreased TSH and high T3 or T4
  • Positive Thyroid-stimulating immunoglobulins (TSH receptor antibodies)
41
Q

Treatment for Graves Disease

A
  • Radioactive iodine
  • Methimazole or PTU
  • BB for palpitations
  • Glucocorticoids for eye symptoms
42
Q

For a TSH-secreting pituitary adenoma, what are the symptoms

A
  • Diffuse goiter
  • Signs of hyperthyroidism
  • Bitemporal Hemianopsia: compression of optic chiasm
  • Headache
  • Mental disturbances
43
Q

Diagnostics for TSH Secreting Adenoma

A
  • Secondary Hyperthyroidism Profile: High TSH and High T3/T4
  • Diffuse increased uptake with radioactive iodine
  • Pituitary MRI to detect adenoma
44
Q

treatment for TSH secreting pituitary adenoma

A

-Transsphenoidal surgery

45
Q

What is a Thyrotoxic Crisis (Thyroid Storm)

A

-Potentially fatal thyrotoxicosis usually after a precipitating event (surgery, trauma, infection, pregnancy)

46
Q

Symptoms of Thyroid Storm

A
  • Hyperthyroid Symptoms
  • Cardiovascular Dysfunction (palpitations, A-fib, tachycardia, CHF)
  • High fever
  • Tremors
  • CNS dysfunction (agitation, delirium, stupor, coma)
47
Q

Treatment for Thyroid Storm

A
  • IVF + Propanolol + Antithyroid Medication (PTU) + Glucocorticoids
  • Then, oral or IV sodium iodide
  • Avoid Aspirin
48
Q

MC type of thyroid cancer

A

-Papillary thyroid carcinoma

49
Q

What diagnostic is done for papillary thyroid cancer?

A

-Fine Needle Aspiration

50
Q

Treatment for papillary thyroid cancer

A

-Thyroidectomy followed by post-op Levothyroxine

51
Q

Papillary Thyroid Cancer is MC after

A

Radiation exposure of the neck

PANCE/EOC (63 decks)

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