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Systemic Disease (Wolfe) > Endocrine > Flashcards

Endocrine Flashcards

1
Q

The #1 endocrine disorder

A

diabetes

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2
Q

Dx of DM at what A1C?

A

> or = to 6.5

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3
Q

Dx of DM at what fasting blood glucose

A

> or = to 126

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4
Q

Dx of OGTT for gestational DM

A

> or = 200

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5
Q

What is the classic VF presentation of a pituitary tumor?

A

bitemporal hemianopia; progression of hemifield loss can also tell you what kind of tumor it is

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6
Q

Why will VFs defects progress superior to inferior?

A

press on inferior fibers first affected

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7
Q

What is the most common anatomical presentation?

A

central-fixed, instead of pre or post fixed chiasm

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8
Q

Knee of Von Willebrand

A

nasal fibers decussate and some fibers travel slightly anteriorly in the contralateral optic nerve before traveling posteriorly

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9
Q

What scotoma does a knee of von willebrand cause?

A

junctional scotoma

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10
Q

What is the most prevalent pituitary tumor?

A

prolactinoma 40-45%, secretes prolactin

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11
Q

What are the 4 pituitary tumors from in order of most common?

A

prolactinoma 45%, somatotrophic adenoma 20%, gonadotrophic 15%, corticotrophic 10%

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12
Q

What does a somatotrophic adenoma secrete?

A

growth hormone

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13
Q

What does a gonadotrophic adenoma secrete?

A

follicle stimulating hormone and leutinising hormone

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14
Q

What does a corticotrophic adenoma secrete?

A

adrenocorticotropic hormone

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15
Q

Anterior pituitary

A

ACTH, TSH, GH, PRL, FSH, LH, MSH

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16
Q

Posterior pituitary

A

ADH, Oxytocin

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17
Q

Pituitary apoplexy

A

emergency condition, intense pain, vomiting, not able to stand

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18
Q

Craniopharyngioma

A

another common tumor that can present in a bitemporal field loss; however, VF defect created is slightly different

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19
Q

Which tumor is more common in Asian women?

A

craniopharyngioma

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20
Q

Pituitary apoplexy

A

a medical emergency, immediate refferal and imaging

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21
Q

Symptoms of pituitary apoplexy

A

sudden vision loss, severe headache, ocular motility disturbance, loss of consciousness, nosebleeds

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22
Q

How does the VF progress for a craniopharyngioma?

A

bitemporal hemi that grows inferior to superiorly

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23
Q

What is the reference range for prolactin?

A

2.1 to 17.7 ng/mL

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24
Q

What does <100 ng/mL mean?

A

intrasellar microadenomas aka within the boundary of the sella turcica

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25
Q

What does > 200 ng/mL mean?

A

corresponds to tumor size

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26
Q

What does 1000 ng/mL mean?

A

extrasellar extension of tumor

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27
Q

What was the pituitary case?

A

nonfunctional pituitary macroadenoma and s/p resection

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28
Q

Micro-adenoma

A

less than 10 mm tumor size

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29
Q

Macro-adenoma

A

greater than 10 mm tumor size

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30
Q

Treatment for pituitary tumors

A

surgical treatment, trans-sphenoidal microsurgical removal or transcranial surgical removal

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31
Q

Radiation treatment for pituitary

A

decreased rates of recurrence with immediate therapy postoperatively; 6% of patients with incomplete removal w/ radiation experienced recurrence; 28% of patients with incomplete removal w/o radiation experienced recurrence

32
Q

Medical treatment only works for

A

secretory adenomas

33
Q

Treatment for prolactinomas

A

dopamine agonist

34
Q

What is the preferred dopamine agonist for prolactinoma?

A

cabergoline&raquo_space; bromocriptine due to less side effects

35
Q

What is the triphasic recover of visual field?

A

initial fast, delayed slower and late mild

36
Q

What is initial fast recovery?

A

minutes to 1 week; restoration of signal conduction along retinal ganglion cell axons

37
Q

What is delayed slower recovery?

A

1-4 months; restoration of axoplasmic transport and remyelination of the decompressed optic nerve

38
Q

What is late mild recovery?

A

6 months to 5 years, unknown cause

39
Q

What is the recurrence/regrowth of nonfunctioning macroadenomas?

A

12-58% of patients within 5 years

40
Q

What makes risk of tumor relapse more likely?

A

incomplete resection, cavernous sinus invasion, absence of postoperative radiation therapy

41
Q

What is the most common reason for recurrence of tumor?

A

incomplete resection by surgeon, often purposeful to let patient live a normal life

42
Q

What are predictors of visual function?

A

tumor size, patient age, duration of symptoms, visual field defects, visual acuity, tests that measure optic nerve function

43
Q

What are tests that measure optic nerve function?

A

color vision, optic atrophy, ERG, OCT retinal nerve fiber thinning and ganglion cell analysis

44
Q

What is the tumor MRI sign?

A

snowman sign

45
Q

Testing to perform with patient with Hx of pituitary tumor

A

BCVA, close eval of pupils, color/red cap/contrast sensitivity, DFE/stereo ONH photo/OCT optic disc cube: RNFL and ganglion cell, HVF 30-2 SITA full threshold, document signs and symptoms of pituitary apoplexy as negative each visit

46
Q

When to re-eval Hx of pituitary tumor?

A

3, 6, 9, 12 months post op and then annually

47
Q

Symptoms of pituitary apoplexy

A

sudden vision loss, severe HA, ocular motility disturbances, loss of consciousness, nosebleeds

48
Q

T/F hypopituitarism can be genetic or acquired

A

true

49
Q

Genetic hypopituitarism

A

growth and developmental disorders in children, like laurence-moon-bardet-biedl syndrome with blindness by 30 from retinal degeneration

50
Q

Acquired hypopituitarism

A

mostly causes sexual dysfunction in adults, either infiltrative or infectious

51
Q

Infiltrative acquired hypopituitarism

A

sarcoidosis granuloma induce DM in adults, delayed growth and mental development in children

52
Q

Infectious acquired hypopituitarism

A

TB or syphilis, cause hypo functioning hormone levels, can also cause uveitis

53
Q

Empty sella syndrome

A

sella tursica appears empty on imaging (looks empty but it’s there); usually normal pituitary function because there is pituitary tissue rimming sella

54
Q

T/F empty sella syndrome puts pituitary more at risk if ICP increase

A

true

55
Q

Band keratopathy in younger patient think

A

hypercalcemia

56
Q

Band keratopathy in older patient think

A

reaction to drops

57
Q

What is band keratopathy?

A

calcium deposition in Bowmans

58
Q

What does parathyroid hormone do?

A

regulates Ca, acts on bones to reabsorb Ca, acts on kidneys to reabsorb Ca

59
Q

Elevated PTH causes

A

hypercalcemia

60
Q

S/s of hypercalcemia

A

fatigue, depression, confusion, nausea, anorexia, decreased urination, cardiac arrhythmias

61
Q

Ocular signs of hypercalcemia

A

band keratopathy, conjunctival lithiasis, check PTH levels when signs notice in young/middle age

62
Q

What is Cushing’s syndrome?

A

hyperproduction of adrenal glands resulting in excess cortisol

63
Q

What causes Cushings?

A

adrenal tumor, prolonged glucocorticoid use, adrenal hyperplasia resulting from pituitary hyperplasia

64
Q

Appearance of Cushings

A

moon face, lump on back, red striae on belly

65
Q

What hormone does the adrenal cortex glomerulosa release?

A

mineralcorticoid ex: aldosterone

66
Q

What hormone does the adrenal cortex fasciculata release?

A

glucocorticoid ex: cortisol

67
Q

What hormone does the adrenal cortex reticularis release?

A

androgens ex: dehydroepiandrosterone

68
Q

What does the adrenal medulla release?

A

stress hormones ex: NE and Epi

69
Q

What is primary Addisions?

A

insufficiency of adrenals; destruction from autoimmune, TB or infarction

70
Q

What is the appearance of primary Addisons?

A

bronzing of skin and pigmentation of the folds of the skin, more ACTH tries to kickstart non functioning gland and stimulates melanin-releasing hormones

71
Q

What is secondary Addisons?

A

insufficient ACTH from pituitary; no hyperpigmentation

72
Q

What are symptoms of Addison’s?

A

weakness, nausea, hypotensive crisis, hyperpigmentation if primary

73
Q

Which president had Addison’s?

A

JFK

74
Q

What is a pheochromocytoma?

A

tumor of the adrenal medulla causing NE and Epi to go crazy

75
Q

What does a pheochromocytoma secrete?

A

catecholamines

76
Q

What is the result of catecholamines?

A

extreme systemic HTN, heart palpitations/arrhythmias, HA, profuse sweating, anxiety, impending sense of doom, death

77
Q

What is treatment of pheochromocytoma?

A

surgical resection which is highly successful

Systemic Disease (Wolfe) (10 decks)

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