Endocrine Flashcards
The SIGMA trial stated what?
In asthma, patients that used budesonide-formoterol as needed was non-inferior to BID budesonide with severe asthma exacerbations but was inferior to controlling symptoms. Not to mention, the budesonide-formoterol had 1/4 fewer steroid exposure episodes
The FRAME trial showed what?
Romosozumab was associated with a lower risk of vertebral fracture that placebo at 12 months and with transition to denosumab at 24 months. Clinical fracture risk is decrease at 1 year with Romosozumab.
What is the mechanism of action of Romosozumab?
Targets and inhibits the protein sclerostin, preventing the inhibition of bone formation. This allows the WNT messenger to bind to LDL receptor related proteins.
What is the mechanism of action of denosumab?
Prevents RankL from activating its receptor RANK on the surface of osteoclasts and their precursors, this prevents the activation of osteoclasts and decreases bone breakdown
What is the preferred drug of choice for Myasthenia Gravis?
Pyridostigmine
If there is an insulinoma concern, what is the first to order?
72 hour fast, watch blood sugar
Symptomatic Management of an insulinoma, what is a good medication to give, new?
Diazoxide
Side Effects are Hirsutism and Fluid retention
Large amount of Diarrhea, hypokalemia, hypercalcemia, hyperglycemia, non-anion gap metabolic acidosis, and a low calculated stool osmotic gap, what is this sounding like?
VIPoma
Graves disease and pregnancy, what should be done?
1st Trimester?
2nd and 3rd trimester?
1st Trimester: PTU
2nd and 3rd trimester: Methimazole
When a patient has a high risk thyroid cancer/thyroid removed, what should be done regarding the replacement hormone?
Start levothyroxine to suppress TSH be less than 0.1 uU/L
Why would a thyroglobulin level be measured?
Ensure that thyroid tissue is no longer functioning and gone, do not check until after 25 days, half life is a long time
Thyroid storm occurs, what thionamide should be started?
PTU or Methimazole
What is the mechanism of action via Methimazole?
inhibits synthesis of thyroxine and triiodothyroine by blocking the oxidation of iodine in the thyroid gland
Patient has severe autoimmune conditions, rash, Raynaud’s Disease and such. What is this? What is the autoantibody disease name?
Mixed Connective Tissue Disease
Anti-U1 Ribonucleoprotein
What are the top 2 drugs to treat an elevated prolactin level?
1) Cabergoline
2) Bromocriptine
How old does a patient need to be for a DEXA scan?
Average person, no acute concerns
65 years old if average risk factors
In regards to a pituitary tumor
What is the magic size that requires more frequent imaging or possible resection if vision is affected?
1.0 cm
Microadenomas , less than 1.0 cm
Macroadenomas, greater than 1.0 cm
What disease classically happens after birth, mother has low BP and general function 2/2 low hormones?
Sheehan Syndrome
What disease will have 2 of 3 symptoms:
Ovulatory Dysfunction
Clinic evidence of hyperandrogenism
Ultrasound evidence of Polycystic Ovaries
Polycystic Ovary Syndrome
PCOS treatment
If fertility is not desired, what is the treatment?
If fertility is desired, what is the treatment?
No pregnancy: Spironolactone and OCP
Pregnancy: Clomiphene Citrate or Letrozole
What should not be measured if the following items are not present:
Regular Morning Erections
No Gynecomastia
Genital Examination is normal
Testosterone levels
If a patient is using testosterone therapy, what are two lab values that should be evalulated?
What side effects can occur?
PSA and Hemoglobin (Erthyrocytosis)
Infertility and Small Testicles
If a patient has an adrenal incidentaloma, what is the size?
Greater than 1.0 cm
If a patient has an adrenal incidentaloma, what are the 3 tests that need to be ordered?
1) Metanephrines -> phemochromoctyoma
2) Overnight Dexamethasone -> Cushing Syndrome
3) Plasma Aldosterone and Renin -> Hyperaldosteronism
A patient has an adrenal mass that has low attenuation ( <10 Hounsfield units), what is this most likely?
High Lipid content, benign adenomas
A patient has an adrenal mass that has low attenuation ( >20 Hounsfield units), what is this most likely?
Adrenal Metastasis, adrenocortical carcinoma, or pheochromocytoma
What is this? Treatment?
A patient has weakness and lethargy, large tongue, face
Hypothermia, bradycardia, and diastolic hypertension
IV T3 and T4
Levothyroxine T4 (starting dose is 200-400 mcg)
IV Hydrocortisone 50-100 q6hr to q8hr
Wernicke-Korsakoff has what hallmark symptoms?
Oculomotor Dysfunction and Disordered Gait
DDX: Myxedema Coma (Cranial Nerves ok)
What endocrine disease has the following?
Primary Hyperparathyroidism
Pancreatic Tumors
Pituitary Tumors
MEN Type 1
What Endocrine disease has the following?
Medullary Thyroid Cancer
Phemochromocytoma
Parathyroid Hormone
MEN 2A
Concern for RET mutation
What Endocrine disease has the following?
Medullary Thyroid Cancer
Phemochromocytoma
Mucosal Neuromas/Marfan’s Syndrome
MEN 2b
Concern for RET mutation
Concern for pituitary apoplexy, hypotension, what is the next best step?
High Dose Glucocorticoid
Methylprednisone 500mg to 1000mg a day
After a parathryoid surgical removal, the following labs are seen
low calcium
low phosphorus
normal PTH
What is this?
Hungry Bone Syndrome
