Endocrine 1

Question 1

Parathyroid regulates what

Answer 1

calcium

Question 2

what does the kidney do to vitamin D?

Answer 2

enzyme 1-alpha hydroxylase converts 25 hydroxyvitamin d to 1,25 dihydroxyvitamin D (the active form)

Question 3

thyroidectomy

numbness and tingling around the mouth and fingers. muscle pain, mild activity.

what do you expect in labs?

what gland is not working?

Answer 3

hypocalcemia

parathyroid.. this is hypoparathyroidism. it can’t break down stuff to increase Ca

Question 4

signs and symptoms of hypocalcemia?

neuropsychiatric

neuromuscular

CV

autonomic

other?

Answer 4

hypoparathyroidism

neuropsychiatric –> seizures, dementia, anxiety.

neuromuscular –> parasthesia around mouth and fingers

CV: CHF, hypotension

Autonomic –> Biliary colic

other –> cataracts, dry coarse skin, hyperpigmentation, eczema.. steatorrhea.

Question 5

Chvostek sign?

Answer 5

hypocalcemia / hypoparathyroidism

tapping on facial nerve just anterior to the ear and you’ll elicit spasms of the lips.

Question 6

Trousseau’s Sign

Answer 6

hypocalcemia / hypoparathyroidism

blood pressure cuff is squeezing on brachial artery and you have spasm of the hand.

Question 7

left sided flank pain. constipated, urinating. leg cramps, leg pain.

kidney stone on side that hurts.

what should you see in the labs?

what could be causing this?

Answer 7

hypercalcemia

hyperparathyroidism

caused by the increase in calcium. enlargement of the glands, benign tumor or malignant tumor.

Question 8

what causes hyperparathyroidism?

Answer 8

adenoma 80% of cases

15% hyperplasia

Question 9

if you have hypercalcemia and it’s not coming from the parathyroid, what’s happening?

Answer 9

renal failure, vitamin D deficiency, causing increased PTH

2ndary hyperparathyroidism

Question 10

increase in calcium does what?

Answer 10

slows down everything.. weakness, confusion, lethargy,

dehydration, nocturne, renal stones

Question 11

Hyperparathyroidism mnemonic?

Answer 11

Stones --> renal or biliary calculus
Bones --> bone pain
Groans --> abdominal pain
Thrones --> polyuria, dehydration
Psychiatric Overtones --> depression

Question 12

thyroid makes what? which is active?

what makes this? (axis)

Answer 12

t3 and t4. t3 is active

hypothalamus makes TRH which makes the anterior pituitary make TSH

Question 13

how do you palpate the thyroid?

Answer 13

posteriorly. have them swallow water or swallow in general.

Question 14

person feels cold all the time, hair loss, thinks they’re getting older, feels rundown all the time

Answer 14

hypothyroidism

Question 15

most common cause of hypothyroidism?

Answer 15

Hashimoto’s thyroiditis (autoimmune)

or thyroidectomy

Question 16

how do you test for hypothyroidism?

what are the levels that you expect?

Answer 16

TSH and free T4

high TSH, low T3 and T4

Question 17

woman has a ton of weight loss and irritability. hot all the time and racing heart. bulging of eye

what is happening?

what lab values would you see?

most common cause?

Answer 17

hyperthyroidism

too much T3 T4, so lower TSH

Grave’s disease (autoimmune) –> stimulating TSH through TSIs

Question 18

other hyperthyroidism problems?

Answer 18

excessive consumption of iodine or meds

goiter sometimes

thyroiditis

Question 19

hyperthyroidism symptoms

Answer 19

irregular heart rate
fatigue
hand tremors
mood swings
weight loss
hot all the time.
skin dryness
diarrhea

Question 20

Exophthalmos?

Answer 20

pushes the eye forward from fat behind the eyes in Graves’ disease.

hyperthyroidism

Question 21

Weakness and extreme fatigue. dizziness and joint pain.

hyperpigmentation of the skin and intermittent GI distress

Answer 21

Addison’s disease (adrenal insufficiency)

Question 22

what happens during Addison’s disease?

most common cause?

what is going on?

what is also happening?

Answer 22

adrenal insufficiency

most common is autoimmune. surgical removal of thy

you’re underproducing cortisol and you’re hypotensive because you’re not making as much aldosterone

Question 23

Symptoms of Addison’s?

Answer 23

skin darkening, N/V/D 50% of cases

salt food craving (because no aldosterone) –> hypotension

Question 24

Addisonian Crisis/Acute Adrenal Insufficiency?

Answer 24

patient has almost no use of their adrenal gland

appears at time of stress

sudden penetrating pain of back, extremities, vomiting, diarrhea.

leads to death if not treated

Question 25

what do you give someone with Addison’s disease?

Answer 25

steroids to bring up cortisol level and ACTH level

Question 26

drastic weight change primarily in the abdomen and upper back.

purple stretch marks on abdomen.

Answer 26

Cushing’s Syndrome

Question 27

Cushing’s syndrome vs Cushing disease?

what happens to it?

Answer 27

adrenal tumor, cancer overproduction of Cortisol

Cushing disease –> pituitary tumor

Question 28

exogenous Cushing syndrome?

Answer 28

taking tons of steroids.

Question 29

symptoms of Cushing syndrome

Answer 29

fatigue, headache, irritability

round (moon-shaped) red face

purple striae on them.

fatty deposits on upper back (buffalo hump)

easily bruising.

receding hairline

Question 30

purple striae, what is it?

Answer 30

Cushing’s.

stretching the skin

Question 31

severe headaches. wake up all the time at night. intermittent milky discharge

takes an OCP. negative pregnancy test

Answer 31

prolactinoma (or just a pituitary tumor)

Question 32

Prolactinoma causes what?

Answer 32

amenorrhea.. because Prolactin inhibits FSH and LH secretion in the hypothalamus.

loss of libido

Question 33

hyperprolactinemia causes what

what are you looking for in the workup?

Answer 33

over secreting prolactin.

infertility in both sexes

prolactin levels + MRI

Question 34

secondary hyperparathyroidism?

Answer 34

low calcium causes high PTH (from renal failure, via D deficiency, malabsorption

Question 35

someone has salt craving.. what would you think?

Answer 35

adrenal insufficiency… so aldosterone is low… hypotensive.