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Internal Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

How should pheochromocytoma be treated prior to surgery?

A

Alpha-blocker (e.g. phenoxybenzamine, nonselective and irreversible) 7-14d before - beta-blocker alone could lead to hypertensive crisis due to unopposed alpha stimulation
Patient encouraged to increase sodium and water intake due to side effect of alpha blockade
Propranolol 2-3d before surgery

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2
Q

Carcinoid syndrome - signs and treatment

A

Signs: flushing, diarrhea, elevated 5-hydroxyindoleacetic acid
Treatment: Somatostatin analog (e.g. octreotide)

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3
Q

Papillary thyroid cancer - primary treatment

A

Surgical resection - smaller tumors may only require partial thyroidectomy/lobectomy

Adjuvant radioiodine ablation, thyroid hormone replacement - for those with increased risk of tumor recurrence

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4
Q

Calcitonin is marker for which thyroid cancer?

A

Medullary - arises from parafollicular C cells

(Papillary and follicular arise from epithelial cells)

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5
Q

In absence of infection, what is likely causing persistent fever, tachycardia, and HTN in patient with severe burns?

A

Hypermetabolic response

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6
Q

Hypermetabolic response to burns - treatment

A
  1. Burn excision and grafting (to decrease inflammation)
  2. Beta blockers (to decrease catecholamine effects)
  3. Nutrition, anabolic steroids (to minimize lean muscle mass loss)
  4. Insulin (to control hyperglycemia)
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7
Q

Which thyroid cancer has calcitonin?

A

Medullary - it is made by C cells

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8
Q

What paraneoplastic syndrome is associated with thymoma?

A

Myasthenia gravis

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9
Q

What should be done for patient in adrenal crisis?

A

IV dexamethasone or hydrocortisone + aggressive volume repletion

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10
Q

What are the thyroid parafollicular cells?

A

These are the neuroendocrine C cells that secrete calcitonin
They are in medullary thyroid cancer
Surveil with calcitonin levels

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11
Q

Signs of medullary thyroid cancer

A

Asymptomatic but may have some diarrhea and flushing
Calcium usually normal unless part of MEN2A hyperparathyroidism

Risk of metastasis and surveillance can both be assessed with calcitonin levels
Also measure carcinoembryonic antigen

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12
Q

What protooncogene is associated with MEN2?

A

RET

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13
Q

MEN1

A
  1. Parathyroid
  2. Pituitary
  3. Pancreas (enteropancreatic endocrine cell tumor)
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14
Q

What cancers use thyroglobulin as a cancer marker?

A

Papillary and follicular differentiated thyroid cancers

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15
Q

MEN2

A
  1. Medullary thyroid cancer
  2. Pheochromocytoma
  3. A: Hyperparathyroidism; B: marfanoid habitus + mucosal neuromas
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16
Q

Describe testicular cancer appearance on scrotal ultrasound

A

Seminoma - solid, hypoechoic
Nonseminomatous germ cell tumor - cystic areas and calcifications

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17
Q

What does PTH do?

A

Increases calcium mobilization from bone
Decreases phosphate reabsorption at proximal tubule

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18
Q

How does CKD lead to hypocalcemia and hyperphosphatemia?

A

Decreased vitamin D conversion
Decreased filtration of phosphate

Secondary parathyroidism and chronic parathyroid stimulation can lead to parathyroid hyperplasia and tertiary parathyroidism due to autonomous PTH secretion, due to downregulation of calcium-sensing receptor and vitamin D receptor in parathyroid glands

At this point, you would see very high PTH, hypercalcemia, and hyperphosphatemia

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19
Q

What bone observation on x-ray is highly specific for elevated PTH?

A

Subperiosteal resorption

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20
Q

How to treat secondary hyperparathyroidism?

A

Reducing serum phosphorus (e.g. dietary phosphate restriction, phosphate binders

Overtreatment –> adynamic bone disease, low bone turnover
Undertreatment –> osteitis fibrosa cystica, high bone turnover

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21
Q

Homocystinuria - common signs

A
  1. Lens dislocation
  2. Intellectual disability
  3. Marfanoid features
  4. Increased risk of arterial and venous thrombi
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22
Q

Hypocalcemia symptoms

A
  1. Muscle spasms
  2. Hyperreflexia
  3. Paresthesias
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23
Q

Reversible causes of atrial fibrillation

A
  1. Hyperthyroidism
  2. Mitral valve disease
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24
Q

Primary adrenal insufficiency

A

Fatigue, malaise, weakness, weight loss
GI symptoms

Hypotension:
Aldosterone deficiency –> volume depletion, hyperkalemia, hyperchloremic metabolic acidosis
Cortisol deficiency –> loss of vascular tone

Increased secretion of ADH –> water retention, hyponatremia

Skin hyperpigmentation (cosecretion of melanocyte-stimulating hormone with ACTH)

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25
Euthyroid sick syndrome - labs
Early: Low T3, normal T4 and TSH Late: Low everything else During recovery, patients may experience modest, transient increase in TSH that can be misinterpreted as subclinical hypothyroidism (elevated TSH, normal thyroxine levels)
26
Explain the hemodynamics of thyroid storm
1. Decreased SVR (increased metabolism, direct endothelial vasodilation) 2. Increased cardiac output (decreased SVR, direct effect on myocardium) 3. High venous oxygen content (less time for tissues to extract oxygen --> low arterial-venous oxygen difference) 4. Increased venous return --> increased pulmonary capillary wedge pressure + pulmonary edema
27
Primary hyperparathyroidism vs familial hypocalciuric hypercalcemia - urinary calcium excretion
Both have hypercalcemia and high PTH Primary hyperPTH: net urinary calcium excretion is increased due to resorption from bone > reabsorption from distal tubule Familial: low urinary calcium excretion (<100 mg/24 hr)
28
Primary adrenal insufficiency and adrenal crisis - treatment
Glucocorticoid (dex > hydro, does not interfere with cortisol measurement), followed by mineralicorticoid (fludrocortisone), which takes a few days to
29
Somatostatin receptor scintigraphy
Used in evaluation of pancreatic or metastatic gastrin-producing tumor (Zollinger-Ellison syndrome)
30
What causes hoarseness in hypothyroidism?
Deposition of matrix glycosaminoglycans in tissue interstitial space
31
Alpha subunit is common to which pituitary hormones?
TSH, LH, FSH, bhCG
32
Main sign of glucagonoma
Necrolytic migratory erythema - painful, pruritic papules that coalesce to large indurated plaques Due to excess catabolism, aa deficiency
33
Primary adrenal insufficiency - testing
Concurrently do these tests: 1. AM cortisol + ACTH level 2. ACTH stimulation test
34
Cushing - testing
24-hr cortisol Dexamethasone suppression test
35
What does excess cortisol do to muscle?
Catabolic muscle atrophy due to breakdown and impaired regeneration -> proximal weakness No pain because not direct injury to myocytes CK is normal
36
VIPoma symptoms
VIP increases fluid and electrolyte secretion in intestinal lumen: 1. Watery diarrhea (tea-colored, odorless) 2. Muscle weakness/cramps (hypokalemia) 3. Hypochlorhydria (decreases gastric acid secretion) Hypercalcemia from bone turnover Hyperglycemia from glycogenolysis Stool sodium increased, osmolal gap <50 VIPoma commonly found in pancreatic tail May have concurrent MEN and hyperthyroidism
37
Systemic mastocytosis
Mast cell proliferation, causing pruritius, flushing, and dyspepsia from gastric hypersecretion Diagnosis via skin or bone marrow biopsy
38
What endocrine conditions can causd carpel tunnel?
Hypothyroidism, acromegaly - cause soft tissue swelling in tunnel
39
When to do radioactive iodine uptake test?
Differentiating hyperthyroid (low TSH) or when low TSH in discovered nodule Cold nodule workup then depends on ultrasound features - suspicious requires FNA or repeat US based on size, whereas nonsuspicious also may require FNA or repeat US based on size
40
When should thyroid FNA be done?
Nodules >1 cm with high-risk features or any nodules >2 cm
41
What is the most common cause of ACTH-secreting paraneoplastic Cushing?
SCLC Other neuroendocrine tumors (e.g. bronchial carcinoid, medullary thyroid)
42
What is the only cause of severely elevated hypercalcemia (>12)?
Malignancy - PTHrP Expect to see significant lethargy, other neuro symptoms Other causes would have modest hypercalcemia with milder, nonspecific symptoms (e.g. constipation)
43
Hyperthyroidism vs pheochromocytoma
Hyperthyroidism has widened pulse pressure due to peripheral vasodilation (decreased diastolic) and increased stroke volume (PP) Pheochromocytoma typically have episodic headaches and diaphoresis
44
Glitazones
Thiazolidinediones - increase insulin sensitivity by binding PPAR-gamma and regulating transcription Associated with weight gain and peripheral edema
45
Methimazole - primary concern
Agranulocytosis
46
Propylthiouracil - primary concerns
Fulminant hepatic necrosis ANCA-positive vasculitis
47
What is cosyntropin?
Synthetic ACTH
48
Medullary thyroid cancer should be worked up for what else?
Pheochromocytoma (as part of MEN2 due to RET gene) - can be asymptomatic but manifest with hypertensive crisis during surgery
49
Primary hyperparathyroidism has what CV effect?
Hypertension - variety of pathways
50
Thiazolidinedione - adverse
Weight gain, edema (don't use in HF), hepatotoxicity, bone loss
51
What are the gliptins?
Dipeptidyl peptidase-4 inhibitors - inhibit degradation of GLP-1
52
Alpha-glucosidasr inhibitors (acarbose, miglitol)
Decrease intestinal absorption of carbs
53
How to differentiate thyroiditis/iodine exposure/extraglandular production vs exogenous hormone?
Exogenous hormone would have low thyroglobulin in blood
54
Graves ophthalmopathy treatment
Remove surgically; if causing diplopia or threatening vision, give steroids
55
Thyroid storm management
1. Beta-blocker 2. Antithyroid (PTU preferred) 3. Potassium iodide 4. Cholestyramine
56
Thyroid cancer histology showing round microcalcifications and large, optically clear nuclei
Papillary thyroid cancer - Psammoma bodies and Orpahn Annie nuclei
57
Papillary vs follicular thyroid cancer
Papillary has Psammoma bodies and Orphan Annie nuclei; lymphatic spread ( vs hematologic)
58
Other osteoporosis treatments
Teriparatide (PTH analog) Denosumab (anti-RANK-L) Raloxifene (SERM)
59
Shortened 4th and 5th metatarsal or metacarpal bones
Albright hereditary osteodystrophy - PTH resistance with low calcium, high phosphate despite high PTH
60
How to prevent secondary hyperPTH in CKD?
Phosphate binders (Ca salts, sevelamer, lanthanum carbonate) Restrict phosphate intake Cinacalcet is calcimimetic that lowers serum PTH in hyperPTH caused by renal failure or those who cannot undergo surgery
61
Hyperpigmentation seen in primary or secondary adrenal insufficiency?
Primary adrenal insufficiency
62
Pegvisomant
Growth hormone receptor antagonist - blocks peripheral effects of GH in acromegaly
63
Petrosal sinus sampling with CRH
When no pituitary adenoma detected, used to assess central-peripheral ACTH gradient; if positive, Cushing disease, otherwise it is ectopic ACTH-dependent Cushing syndrome

Internal Medicine (23 decks)

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