Endocrine 1 Flashcards
Pt presents with anemia, diarrhea, necrotic migratory erythema, weightloss, chelosis. Dx? Test? Rx?
Glaucognoma. Check gucagon levels > 500. Resect
Single most common cause of hypothyroidism?
Test?
What antibodies to check and why?
Rx?
Hashimoto’s Thyroiditis.
Measure TSH and FT4.
Can check TPO antibodies ONLY if Diagnosis is Unclear
Rx: Thyroxine.
Pt presents with EPISODIC/Paroxsymal Hypertension, HA, sweating, palpitations, tremors.
Dx?
1. First step in diagnosis?
2. 2nd Step?
3. When to do MIBG?
4. Rx?
Pheochromocytoma.
- 24 hr Urinary fractionated Metanephrine and Catecholamines or Plasma Metanephrines
- CT or MRI of abdomen to look for tumor
- When CT or MRI is negative
- Alpha blockers (Phenoxybenzamine) for 2 weeks before surgery
Severe Hypothyroidism, AMS, Puffy face, Hands and Enlarge Tongue, Hypothermia.
Dx?
What to give first and why?
Myxedema Coma
Admit to ICU
Give IV Hydrocortisone before IV T3 and T4.
( They usually have concomitant Adrenal Insufficiency. Avoid Adrenal Crisis)
Hyperthyroidism with Proptosis and Exopthalmus and Myxedema.
- Dx?
- Best initial test?
- Definitive Test?
- Rx (3)?
- Side effect of Drug?
- Which treatment is good for pregnant patients?
- What medication will patients need after?
- Graves Disease
- LOW TSH and HIGH T4
- RAUI (Evidence of Diffuse Increased uptake)
- Radioactive Iodide Ablation Therapy ( Do not use in Pregnant
Patients) - 1st Propranolol and Methamizole (1st Line) -
Can be definitive RX for 50% patients OR
given in preparation for Thyroidectomy - Thyroidectomy
- Radioactive Iodide Ablation Therapy ( Do not use in Pregnant
- Agrangulocytosis
- PTU during 1st trimester, Also given in Thyroid Storm
- Synthroid after Ablation
Hyperthyroid with Tender Thyroid.
Pt was sick previously with URI and fever.
- Dx?
- Best initial test?
- Most accurate test?
- Where is the Scan presentation also seen in?
- Rx for Mild and Severe Cases?
- Subacute Granulomatosis Thyroiditis, (Dequarveins Thyroiditis)
- Occurs POSTVIRAL infection. - Transient: Low TSH and High T4, Then High TSH and low T4 (HYPERthyroid to HYPOthyroid) - the gland burns out
- RAUI decreased uptake (due to Destruction of Gland No synthesis done).
- Also Seen in Postpartum, Silent, Iodine Induced Thyroiditis.
- NSAID for mild pain. Steroids For sever Pain. BB for tachycardia.
Like DKA for the Hyperthyroid. Pt presents with Coma, Delirium, Tachycardia, Restlessness, Emesis, Jaundice and Diarrhea.
Dx?
Management?
Thyroid Storm (Brought on by trauma, stress, infection, surgery)
IVF
IV PTU
IV Propanolol,
IV Dexamethasone (Prevents Conversion of T3 to T4 & Adrenal Support)
Iodine-Postassium Solutions (to inhibit hormone release)
Pt presents with delirium, been on ventilator, has had mutiple surgeries Low TSH, T4 and T3. Dx?
Sick Euthyroid State
Old lady with a hx of Goiter. Now presents with Palpitations. BP 142/92, HR 97 and 2 large nodules felt on examination.
RAIU shows patchy uptake.
Dx?
Rx?
Multinodular Toxic Goiter.
(Patchy uptake on RAIU) as oppose to ONE Toxic Adenoma which has a LOCALIZED uptake on RAIU.
Rx With Radioactive Ablation Therapy or Thyroidectomy
24 yo med student presents with Weightloss, Tremors, Palpitations, Non painful thyroid gland, NO nodules, NO myxedema, NO proptosis. She states she takes no meds.
TSH Low and T4 High.
RAIU Low. Not Uptake Seen.
Dx?
Next step in management?
Exogenous/Surreptitious Thyroid Use.
Check Thyroid Globulin levels
(These are ELEVATED in ENDOgenous Thyroid Hormone Production and SUPPRESSED in EXOgenous USE)
Male presents with Gynecomastia, Lack of Labido, Small Testes, Sterility, Thin Wrinkly Skin and Mental Retardation.
Dx?
Test?
Rx?
Kinefelter Syndrome
(Most common pRimary Developmental Abnormality causing Hypogonadism)
47, XXY (Barr Body never lef.)
There is HIGH LH, FSH, Estradiol levels with LOW Urinary 12-ketosteroid and LOW testosterone levels.
Testosterone replacement
HTN diagnosed under 30 or above 60, HTN not controlled on 2 medications, associated with polyuria, polydipsia, hypokalemia.
- Dx?
- Best initial test?
- Definitive test?
- What test can be done if the first 2 test are equivocal?
- Rx for Adenoma?
- Rx for Hyperplasia?
Hyperaldosteronism (Conn Syndrome.)
Hypernatremia, Hypokalemia
- Best initial test is PAC/PRA ratio > 20
(Tells the difference between Primary and Secondary). - Definitive test Aldosterone Suppression Test
- (Oral Saline) should suppress Aldosterone
- Can Check Venous Sampling if Aldosterone Suppression is Equivocal.
CT scan can be done after biochemical testing. to check for tumor/hyperplasia
- Adenoma - Rx with Laparotomy
- Bilateral Hyperplasia Rx with - Eleprenone/ Sprinolactone
- Next step in management after discovering a firm tender thyroid on physical exam?
- When is FNA indicated?
- When will you do a I-123 Synctigraphy?
- TSH and US of Thyroid Gland
- FNA is indicated when TSH is NORMAL
- Cold Nodule/ Hypofunctioning/ Normal TSH
- Family Hx of Thyroid cancer (MEN)
- Suspicious Findings on US (Hypoechoic,
>1cm) - When the US and Lab are Equivocal Test
-the Synctigraphy will tell if the nodule us
HYPO or HYPER then you will do FNA
- Name 1 cause of Primary Hyperaldosteronism, Renin and Aldosterone Levels?
- Name 2 causes for Secondary Hyperaldosteronism, Renin and Aldosterone Levels?
- Name 3 causes for Exogenous or NON- Hyperaldosteronism, Renin and Aldosterone Levels?
- Adenoma/Hyperplasia
(Decrease Renin, increase Aldosterone) - Malignant HTN, Reno-vascular Artery Stenosis (Increase Renin, Increase Aldosterone)
- Cushings Dz, Congenital Adrenal Hyperplasia Exogenous Mineralocorticoid use (Low Renin, Low Aldosterone)
Name the laboratory findings of Osteitis Deformans (Pagets Disease)
Normal Ca and Phosphate
Elevated Alk Phos Levels, Urinary Hydroxyproline, N- Telopeptide, C-Telopeptide