Endocrine Flashcards
What level of TSH is considered low-risk for concerning thyroid nodules?
LOW TSH
If a patient has LOW TSH, what scan should then be done to assess for a thyroid nodule?
Radioactive Iodine uptake
Treatment for a Hot thyroid nodule?
Resect
Treatment for a Cold thyroid nodule?
Fine Needle Aspiration to assess for malignancy!
What level of TSH is considered High-risk for thyroid nodules?
HIGH TSH
If a patient has HIGH TSH, what test should be done to assess for a thyroid nodule?
Ultrasound
If a thyroid nodule is larger than 1 cm, what should be done?
Fine Needle Aspiration to assess for malignancy
What 2 types of thyroid nodules are the most concerning for malignancy?
Cold nodules
Large nodules
What 2 types of thyroid nodules are the most concerning for malignancy?
Cold nodules
Large nodules
A Gastrinoma secretes Gastrin which causes?
Parietal cells to secrete lots of acid
What is the sign that someone may have a Gastrinoma?
Peptic Ulcer Disease that fails to improve
What 2 diagnostic images can diagnose a Gastrinoma?
Somatostatin Receptor Scintigraphy
CT scan
How will a patient with an Insulinoma present?
Hypoglycemia even when fasting
– sweating, syncope, tachycardia
What 2 things will be HIGH with an Insulinoma?
Insulin
C-PEPTIDE!! (endogenous insulin)
What should you screen for if someone is presenting similar to an Insulinoma?
Sulfonylureas – taking these cause excess insulin secretion
Levels of PTH, Calcium and Phosphate with Primary Hyperparathyroidism?
HIGH PTH and Calcium
LOW Phosphate
What specific scan detects Primary Hyperparathyroidism?
Sestamibi scan
What is a potential transient post-op complication following resection of Primary Hyperparathyroidism and why?
LOW Calcium
– The parathyroid glands left behind intially under-function because the over-functioning one is gone
What metabolic changes will be present with Primary Hyperaldosteronism?
HTN
LOW K+
LOW Renin
What metabolic changes will be present with Renal Artery Stenosis?
HTN
LOW K+
HIGH Renin
What test should be done to ensure correct lateralization of primary hyperaldosteronism/pheochromocytoma?
Adrenal vein sampling
How is Renal A. Stenosis diagnosed?
US doppler or CTA
How is Primary Hyperaldosteronism diagnosed?
CT/MRI
What do Pheochromocytomas produce? In what fashion?
Catecholamines in a pulsatile fashion
What are the symptoms of a Pheochromocytoma?
5 P’s
- Paroxysms of symptoms
- Pressure is up (BP)
- Pain (headache)
- Palpitations
- Perspire
What are the symptoms of a Pheochromocytoma?
5 P’s
- Paroxysms of symptoms
- Pressure is up (BP)
- Pain (headache)
- Palpitations
- Perspire
What is often diagnostic of a Pheochromocytoma?
Urinary VMA and Metanephrines over 24 hours
What is the unique treatment for a Pheochromocytoma?
- Alpha blocker first
- Beta blocker second
- Resecetion
What are the signs of Cushing’s? What is elevated?
HIGH Cortisol
= Buffalo hump, moon facies, abdominal striae and truncal obesity
If Cushing’s is suspected, what test should be done first?
LOW-dose dexamethasone cortisol suppression test
If someone has Cushing’s Syndrome is present, what is the result of the Low-dose dexamethasone suppression test?
Fails to suppress cortisol
Following the LOW-dose dexamethasone suppression test, what should be measured?
ACTH
If ACTH is LOW, that means what?
ACTH independent elevated cortisol
If the ACTH is HIGH, that means what?
ACTH dependent elevated cortisol
With a Primary Adrenal Tumor, what will be the level of ACTH?
LOW
If ACTH is HIGH, what test should then be done?
HIGH-dose dexamethasone suppression test
With the HIGH-dose dexamethasone suppression test, if cortisol fails to suppress, what is the diagnosis?
Ectopic tumor secreting ACTH
With the HIGH-dose dexamethasone suppression test, if cortisol is suppressed, where is the tumor?
Pituitary tumor
Cushing’s Disease vs. Cushing’s Syndrome
Disease = pituitary tumor
Syndrome = signs of excess cortisol
Treatment for a Pheochromocytoma?
- Alpha blocker
- Beta blocker
- Resection
