Endocrine 1

Question 1

Hypoparathyroidism

Answer 1

Hypocalcemia
-causes: surgical removal of parathyroid glands, DiGeorge syndrome, hereditary autoimmunity syndrome

**most common cause of hypocalemia

Signs and Sx:
-neuropsych: seizures, dementia, depression, paresthesia around mouth and fingers and toes, CHF, hypotension, prolonged QT, dry coarse skin, myalgia

Chvostek Sign
Trousseau’s Sign

Question 2

Primary Sign and Sx of Hypoparathyroidsm

Answer 2

numbness and tingling around mouth and fingers

-myalgia

Question 3

What is the primary cause of hypocalcemia?

Answer 3

hypoparathyroidism

Question 4

Chvostek Sign

Answer 4

tap on the facial nerve at zygomatic arch
found with hypocalcemia
+ sign=twitching at the mouth, spasm of all muscles

Question 5

Trousseau’s Sign

Answer 5

found in hypocalcemia

inflate blood pressure cuff: spasm of arm and hands

Question 6

Workup for Hypocalcemia

Answer 6

Serum calcium, albumin, magnesium, PTH level

24 hr urine calcium

Question 7

Management and Treatment

Answer 7

supplement calcium and vitamin D

Question 8

Hyperparathyroidism

Answer 8

Hypercalcemia
-1 hyperparathyroidsim:
-2 hyperparathyroidism:
Symptoms: lethargy, weakness, confusion, coma, polyuria, dehydration, nocturia, renal stones, renal failure, constipation, nausea, anorexia, renal stone, syncope

“Stone, bones, groans, thrones, psychiatric overtones”

Question 9

1 hyperparathyroidism

Answer 9

causes high PTH
Adenoma associated with MEN1
gland englargement of chief cells
carcinoma

Question 10

2 hyperparathyroidism

Answer 10

low calicium causes high PTH

renal failure, vit D def, malabsorption

Question 11

Presentation of Hyperparathyroidism

Answer 11

Stones: renal/biliary calulus
Bones: bone pain
Groans: abdominal pain, nausea, vomiting
thrones: polyruria
psychiatric overtones: depression, anxiety, cognitive dysfunction

Question 12

Workup for hyperparathyroidism

Answer 12

serum calcium, albumin, magnesium, PTH level

workup for malignancy, genetic disorder, evaluate patients medications, diet evaluation

Question 13

Management and Treatment

Answer 13

monitor dietary and medication high in calcium and vid D
keep well hydrated
maintain physical activity
surgery

Question 14

Thyroid

Answer 14

anterior to trachea
synthesizes, stores, and secretes thyroid hormone (T3, T4)
T4: inactive
T3: active

Question 15

Goiter

Answer 15

Enlarged Thyroid gland

Question 16

Hypothyroidism

Answer 16

High TSH, Low T3, T4
caused by hashimotos thyroiditis-autoimmune
medications: lithium
pregnancy 
Thyroidectomy 

Sx: constipation, depression, fatigue, pale dry skin, sensitivity to cole, increased cholesterol, weight gain

Question 17

Workup for hypothyroidism

Answer 17

Serum TSH, T4

Question 18

Hyperthyroidism

Answer 18

Low TSH, High T3 and T4
Grave's Disease: autoimmune
Toxic nodular or multinodular goiter
thyroiditis
pregnancy or first year after birth 

signs and symptoms: fatigue, hand tremors, mood swings, nervousness, anxiety, rapid heart rate, skin dryness, trouble sleeping, weight loss, thinning of hair

Question 19

Grave’s Disease

Answer 19

Hyperthyroidism

Exophthalmos

Question 20

Workup for Hyperthyroidism

Answer 20

serum TSH, T4

Radio-iodine uptake study

Question 21

Management and Treatment

Answer 21

Methimazole
Radio-iodine ablation
Thyroidectomy

Question 22

Adrenal Insufficiency

Answer 22

Addisons Disease
-under production of cortisol

primary: infection, surgical removal
secondary: lack of ACTH

Question 23

Primary Adrenal Insufficiency

Answer 23

70% are autoimmune
20% due to TB
due to chronic infections, surgical removal, cancer cell affecting adrenals

Question 24

Secondary Adrenal Insufficiency

Answer 24

lack of ACTH

• sudden exogenous glucocorticoids like prednisone
• surgical removal of ACTH producing tumors
• pituitary gland: suddenly stopes producing ACTH

Question 25

Addison’s Disease

Answer 25

cortisol under-production
-skin darkening, salty food craving, hypotension, worsening of fatigue, muscle weakness, weight loss, irritability, hypoglycemia, menstrual irregularities

Question 26

Acute Adrenal Insufficiency

Answer 26

Addisonian Crisis

• usually appears at the time of stress
• sudden penetrating pain of back, extremities, vomiting, diarrhea

Question 27

Workup for suspected Addison’s disease

Answer 27

serum cortisol level, serum ACTH level,

Question 28

Management for Addison’s disease

Answer 28

Steroids

Question 29

Cushing Syndrome

Answer 29

Cortisol Overproduction
affects women more than men
endogenous and exogenous

causes is primary endogenous

• pituitary tumor
• adrenal tumor

moon shaped, red face
purple striae
buffalo hump on shoulders
central adiposity 
easy bruising
excess hair on face

Question 30

Signs and Sx of Cushing Syndrome

Answer 30

fatigue and sleeping problems
headaches
backaches
swelling
irritability
repeated infection and poor wound healing
acne 
hairloss

Question 31

Workup for suspected Cushing

Answer 31

salivary cortisol levels or urinary cortisol levels
overnight 1 mg dexamethasone supression test
management and tx:
surgery for tumor
adrenal enzyme inhibitor

Question 32

Hypersecretion of hormone

Answer 32

clinical symptoms of cushing with ACTH
amenorrhea with prolactin secretion
gigantism w/ GH secretion
hyperthyroid symptoms witih TSH secretion

Question 33

Deficiency of Hormone

Answer 33

loss of libido and fatigue in females with LH and FSH

Question 34

Hyperprolactinemia

Answer 34

most common pituitary adenoma
galactorrhea:menstrual abnormalities, hypogonadism, erectile dysfunction, infertility

large mass=vision loss and headaches

Question 35

workup for hyperprolactinemia

Answer 35

blood prolactin levels

MRI

Question 36

Treatment of hyperprolactinemia

Answer 36

medications: dopamine agonist

surgery