Endocrine Flashcards
1
Q
Metabolic syndrome
A
People at high risk of diabetes and cardiovascular disease
2
Q
Metabolic syndrome associated condition
A
Small dense LDL
Proinflammatory state
Hyperinsulinemia
Hyperuricemia
Chronic kidney disease
Dementia/cognitive decline
Steatosis, fibrosis, cirrhosis
Insulin resistance
PCOS
Sleep apnea
3
Q
Metabolic syndrome labs and tests to consider
A
Hemoglobin A1C
Lipid panel
BMP
C-reactive protein
Liver panel
TSH
Uric acid
ECG
Vascular ultrasound
Stress test
Sleep study
4
Q
Underweight BMI
A
<18.5
5
Q
Normal BMI
A
18.5-24.9
6
Q
Overweight BMI
A
25-29.9
7
Q
Obesity class 1
A
30-34.9
8
Q
Obesity class 2
A
35-39.9
9
Q
Extreme obesity (class 3)
A
> 40
10
Q
Man waist size at risk of obesity
A
> 40
11
Q
Woman waist size at risk of obesity
A
> 35
12
Q
Man waist to hip ratio at risk of obesity
A
> 1
13
Q
Woman waist to hip ratio at risk of obesity
A
> 0.85
14
Q
Leptin
A
Tells brain you’re full
Decrease when you’re fat
15
Q
Grhelin
A
Tells you you’re hungry
16
Q
BMI indications for weight loss meds
A
> 27 with comorbidities
30
17
Q
Phentermine
A
Weight loss drug
Adrenergic agonist
Decrease appetite
Short term use
18
Q
Orlistat
A
Weight loss drug
Inhibits intestinal lipase
Causes diarrhea if eat lots of fat
19
Q
Phentermine/topiramate
A
Weight loss drug
GABA modulation
Decreases appetitie and speeds metabolism
TERATOGENIC
20
Q
Naltrexonebupropion
A
Weight loss drug
Appetite suppression
Two tabs twice daily over four weeks
21
Q
Liraglutide
A
Weight loss drug
GLP-1 receptor agonist
Increases satiety
Daily injectable
22
Q
Semaglutide
A
Weight loss drug
GLP-1 receptor agonist
INcreases satiety
Weekly injectable
Contraindicated for pts with pancreatitis or thyroid C-cell tumor hx
23
Q
Tirzepatide
A
Weight loss drug
Dual GLP-1 agonist and GIP
ONce weekly subcutaneous injection
Fasting ansd post-prandial glucose
Lowers A1C by more than 2%
24
Q
Common adverse effects of GLP-1 receptor agonist
A
Nausea
Vomiting
Diarrhea
Constipation
25
Less common more serious adverse effects of GLP-1 receptor agonist
Pancreatitis
Intestinal obstruction
Gastropareisis
Medullary thyroid carcinoma
26
Orbera
Intragstric balloon placed and removed endoscopially
27
Obalon
Intragastric balloon swallowed then inflated then removed endoscopally
28
Transpyloric shuttle
Removable gastric balloon blocks pylorus so food sits in stomach longer and you feel fuller
Removed by endoscopy
29
Duodenal jejunal bypass liner
Impermeable sleeve
Only approved for one year of use
30
Aspire Assist Aspiration Device
Endoscopically placed tuvbe to aspirate food after meals
31
Super absorbent hydrogel capsules
Take three capsules before two big meals of day
32
Laprascopic adjustable gastric band
Silicone band placed around upper part of stomach
Adjustable and reversible.
Slower weight loss
Lesss overall weight loss
33
Laparascopic sleeve gastrectomy
Small sleeve-shaped stomach is created
Outpatient
Bad for pts with reflux
34
Endoscopic sleeve gastroplasty
70-80% of stomach is collapsed with sutures
Reversible if necessary
Outpatient
35
Roux-en-Y Gastric Bypass
Small intestine attached to esophagus
Stomach reattached down stream so you can still have intrinsic factor.
Can cause malabsorption
Can CURE DIABETES
36
What is a cure for diabetes
Roux-en-Y Gastric Bypass
37
Biliopancreatic diversion with duodenal switch
Malabsorptive process
Stomach is made smaller
Small inestine is bypassed
Need vitamin supplementation (B12)
38
Chief cells
On parathyroid
Secrete parathyroid hormone
39
Parathyroid hormone
Secreted by Chief cells
Stimulates osteoclast activity to pull Ca from bone into blood
40
Parathyroid hormone effects on kidney
Allows DCT to be more permeable to Ca so it is Reabsorbed raising blood Ca levels
41
Parathyroid effect on GI
Turns Vitamin D into active form
Causes calcium channels in gut to be expressed
Allows more calcium from GI tract to be absorbed into blood
42
Calcitonin
Comes from thyroid gland
Inhibits osteoclast activity thus increasing osteoblast activity
43
Two most common causes of hypercalcemia
Primary hyperparathyroidism
Malignancy
44
Non-parathyroid mediated hypercalcemia causes
Vitamin D intoxication
High bone turnover
Multiple endocrine neoplasia
Renal failure
Hyperthyroidims
Acromegaly
Pheochromcytoma
Adrenal insufficiency
45
Medications that cause hypercalcemia
Thiazide diuretics
Lithium
Excessice vitamin A
46
Hypercalcemia symptoms
Bone disease (bones)
Nephrolithiasis (stones)
Abdominal pain (groans)
AMS (psychiatric moans)
47
Bone disease
Osteitis fiibrosa cystica
Decreased bone mineral density
INcreased risk of fractures
48
What do you have to relate your calcium labs to for each pt if abnormal
Albumin
Low albumin makes hypercalcemia severity underestimated
High albumin makes calcium level look high even when its not (pseudohypercalcemia)
49
Hypercalcemia affect on EKG
Short QT interval
50
Hypercalcemia cardiac problems
HTN
Vascular calcification
Left ventricular hypertrophy
Short QT
Arrythmias
51
Moderate hypercalcemia treatment
Saline hydration
Bisphosphonates
52
Bisphosphonates
-nate and zoledronic acid
Used against osteoclast mediated bone loss
Used for osteoporosis, paget disease, metastatic bone disease, and hypercalcemia
53
Most common presentation of hypercalcemia
Asymptomatic
54
Severe hypercalcemia treatment
IV isotonic saline
Subcutaneous calcitonin
IV bisphosphonate
Dialysis is last resort
55
Primary hyperparathyroidism
Abnormal regualtion of parathyroid hormone secretion
56
Parathyroid adenoma
Most common cause of primary hyperparathyroidism
Tumor made of chief cells
Can be on parathyroid or ectopic lotcation
57
Causes of primary hyperparathyroidism
Parathyroid adenoma
Glandular hyperplasia
Carcinoma
Radiation
Low calcium intake (parathyroid overstimulated)
Genetics
Meds
58
How do thiazide diuretics cause hypercalcemia
Less urinary calcium is excreted
59
Releationship between phosphate and calcium
Inverse
60
Relationship between alkaline phosphatase and calcium
direct
61
Hyperparathyroid diagnostics
Technetium sestamibi scan
Checks for adenomas
62
Treatment of primary hyperparathyroid asymptomatic patient
Monitor
Stop meds associated with hyperparathyroidism
Hydration
63
Treatment of primary hyperparthyroid symptomatic patient
Surgical excision of abnormal tissue
Loop diuretics
Hydration
Calcimimetics
Bisphosphonates
64
Loop diuretics job against primary hyperparathyroidism
Inhibits sodium and calcium reabsorption
65
Calcimimetics job against primary hyperparathyroidism
Activates calcium sensing receptors so parathyroid doesn't release PTH
66
What is a person given after parathyroid surgery
Calcium and Vitamin D supplementation
67
Secondary hyperparathyroidism
Calcium is low!!!! causing prathyroid gland to be overstimulated
Disease outside parathyroid gland causes gland to become hyperactive.
Parathyroid gland itself is not diseased
68
Causes of secondary hyperparathyroidism
Renal failure
Malabsorption (celiac and chrohn)
Vitamin D deficiency
69
Secondary hyperparatyroidism Symptoms
Asymptomatic
70
Secondary hyperparathyroidism diagnosis
Low calcium
High PTH
Order studies to check renal function (GFR, BUN, creatinine)
Vitamin D deficiency
71
Treatment of renal failure
supplememntation with calcium and vitamin D
Medications that activate Ca receptors (calcimimetics)
72
Phosphate binders
Prevent body from absorbing phosphate in food.
Used to treat secondary hyperparathyroid
73
Hypocalcemia causes
Renal failure
Hypoparathyroidism
Vitamin D deficiency
Hypomagnesemia
Loop diuretics
Foscarnet
Burns
74
Hypocalcemia symptoms
Trousseau sign
Cvostek sign
Convulsions
Arrhythmia
Tetany
Spasms and stridor
Numbess in fingers
75
Hypocalcemia EKG problems
Prolonged QT
76
Treatment for hypocalcemia
IV calcium gluconate
PO calcium
77
Hypoparathyroidism causes
Usually post-surgery
Destruction of parathyroid glands
Abnormal parathyroid gland development
Altered regulation of PTH production
Impaired PTH actoin
Autoimmne
Mg defciency
Iron overload
Copper overload
78
What happens when PTH secretion is insufficient
Hypocalcemia
79
How is cortisol released
CRH from hypothalamus causes ACTH to be released from ant pit
ACTH causes cortisol to be released from adrenal gland
80
Cushing syndrome
High cortisol
Neoplasia increases production of cortisol
ACTH dependent (90%)
ACTH independent (10%)
81
Addison's disease
Low cortisol
Destruction of adrenal gland or inherited autoimmune disorder disrupts cortisol synthesis
82
Where is cortisol produced
Zona fasciculata and zona reticularis of adrenal cortex
83
Cortisol characteristics
Glucocorticoid
Secreted unbound
Circulates bound to plasma proteins
Only 4% is free for use
Excreted in urine and stool
84
When is cortisol highest
Morning
85
ACTH dependent cushing syndrome cause
ACTH-secreting pituitary tumor (cushing's disease)
Pituitary adenoma (cushing's disease)
Small cell lung carcinoma
Medullary thyroid carcinoma
Carcinoid tumors (bronchus)
86
Carcinoma
Malignant tumor
87
Adenoma
benign tumor
88
ACTH independent cushing syndrome cause
Adrenal carcinoma
Adrenal adenoma
89
Latrogenic cushing syndrome cause
HPA axis supprestion
Prolonged steroid use
90
Pseudo-cushing syndrome
conditions biochemically same as cushings
Elevated cortisol
Disruption of cortisol secretion
Depression
Chronic alcoholism
Chronic kidney disease
91
Common findings in other body systems from cushing syndrome
Muscle atrophy
Hyperglycemia
Weight gain from adipose tissue
Insulin resistance
Skin thinning
Striae
Bruising
Osteoporosis
Secondary Hyperparathyroidism
HTN
Susceptibility to infection
Hirstuism and acne
Buffalo hump
Moon face
Apple body
92
Initial screening for hypercortisolism
24 hour urinary free cortisol.
Confirms hypercortisolemia
93
Dexamethasone suppression test
Establishes diagnosis of cushing syndrome
94
What happens if you give desmethasone to healthy person
Cortisol levels drop
95
What happens if you give dexmetasone to person with cushing syndrome
cortisol won't drop
96
How to determine if cushing syndrome is ACTH dependent or independent and what to do for each
ACTH serum Less than 5 ACTH independent so get adrenal CT
ACTH serum Greater than 20 means ACTH dependent so get pituitary MRI
97
Primary adrenal insufficiency
Addison disease
Dysfunctino of adrenal cortices
98
Secondary adrenal insufficiency
Anterior hypopituitarism
Deficient secretion of ACTH
99
Acute adrenal crisis
Emergency due to insufficient corisol
Abrupt withdrawal of glucocorticoid relacement
PRecipitated by trauma or infection
100
Most common cause of adrenal insufficiency
Autoimmune
101
Adrenal insufficiency treatment
Hydrocortisone
Fluid replacement
Adress underlying cause
102
Adrenal insufficiency (addison) presentation
GI symptoms
Bronze pigmentation
Weakness
Weightloss
HTN
103
Primary adrenal insufficiency treatment
Hydrocortisone
Fludrocortisone
104
Secondary adrenal insufficiency treatment
Hydrocortisone
105
How can we clinically see aldosterone issues in lab
Potassium
High aldosterone looks like HTN with hypokalemia
106
Aldosterone job
Sodium retention (reabsorption) in kidneys causing potassium diuresis and increased urine acidity.
107
Primary hyperaldosteronism cause
Bilateral adrenal hyperplasia
Adrenocortical carcinoma
Adrenocortical adenoma
108
Secondary hyperaldosteronism cause
Renal artery stenosis
Decreased intravascular volume (heart failure, chronic diuretic or laxative use)
Sodium -wasting disorder(CKD, renal tubular acidosis)
109
Hyperaldosteronism symptoms
Hypertension
Potassium depletion causing fatigue, los of stamina, weakness, conturia, lassitude
THirst and polyuria from hypokalemic nephropathy
110
Primary hyperaldosteronism conformation test
Saline infusion (test for failure of aldosterone suppression)
Plasma aldosterone (put on high Na diet and test urinary aldosterone)
Fludrocortisone challenge to see if aldosterone will suppress
111
Secondary hyperaldosteronism treatment
Salt restriction
Address underlying cause
112
Adrenal adenoma causing primary hyperaldosteronism treatment
Potassium sparing diuretics
HTN control
Management of hypokalemia
113
Bilateral adrenal hyperplasia causing hyperaldosteronism treatment
Bilateral arednalectomy
Aldosterone receptor blockers (spiralactone or eplerenone)
Na channel blockers (Amiloride)
114
Hypoaldosterone causes
Adrenal sestruction
Defects in mineralocorticoid
Inadequate adrenal stimulation
Genetics
Latrogenic
Hyporeninemic hypoaldosteronism
115
Ion problems in hypoaldosterone
Hyponatremia
Hypovolemia
Hypotension
Metabolic acidosis
Hyperkalemia
116
Where is the thyroid
Inferior to cricoid cartilage
Anterior on either side of the neck
117
Damage to what nerve in thyroidectomy causes vocal cord paralysis
Recurrent Laryngeal nerve
118
TRH
Made in hypothalamus
Stimulates ant pit to release TSH
119
TSH
Made in ant pit
Stimulates thyroid to release TH
120
What thyroid hormone is made most
T4
121
What thyroid hormone is more metabolically active
T3
122
Where are TSH receptors
Membranes of follicular cells
123
Follicular cells of thyroid
Make thyroxine (T4) and triiodothyrine (T3)
Cavity between cells filled with colloid called thyroglobulin
Have TSH receptors
124
Parafollicular cells
C-cells between follicles
secrete calcitonin
125
Reverse T3
Not metabolically actie and found more often in stress
126
T4
Thyroxine
Carried in [lasma bound to proteins.
Not as metabolically active
Converted to T3 in peripheral to be used
127
T3
Triiodothyrine
Less protein bound and more active
128
Normal TSH range
0.5-5
129
What interferes with TSH levels in labs
Biotin
130
Fine needle aspiration
Cana be done in office or interventional radiology to get needle biopsy of thymus to check for malignancy
131
Bethesda classifications for thyroid biopsy
I- Repeat FNA
II- clincal follow up
III- Repeat FNA and genetic testing
IV- lobectomy and genetic testing
V- Near total thyroidectomy
VI- Near total thyroidectomy
132
Thyroscintigraphy
Radioactive iodine uptake
Only indicated if pt has HYPERactive thyroid.
Normal is 10-30% at 24 hrs
Oral dose of I123
High uptake with no zones means graves disease
Low uptake means thyroiditis
133
Cold nodule
Nodule on thyroid that has very little iodine uptake.
Could be malignant
134
Hot nodule
Nodule on thyroid that has lots of iodine uptake
Usually benign
135
Goiter
enlargement of thyroid gland
Happens in hypothyroidism to compensate for lack of thyroid hormone.
Happens in hyperthyroidism to make thyroid hormone
Nodular goiters enlarge as function of increased tissue mass as result of nodules
136
Most common cause of goiter world wide
Iodine deficiency
137
Most common cause of goiter in US
Autoimmune
138
Goiter presentation
Lump in neck
Hoarseness
Dysphagia
Neck pain
Dyspnea
139
Goiter physical exams findings
Nonetender enlargement of thyroid gland or nodule
Other symptoms of hypo/hyperthyroid state
140
What to do if pt comes in with goiter
Order TSH, free T4, total T3
Evaluate size and cahracteristics on ultrasound
Radioactive iodine uptake scan if hyperthyroidism
Fine needle aspiration if indicated by TIRADS
141
How big does nodule have to be for radiofrequency or alcohol ablation
>3cm
142
Thyrotoxicosis
Another word for hyperthyroidism
143
Primary hyperthyroidism labs
Low TSH
High T4 and T3
144
Secondary hyperthyroidism
High TSH
High T4 and T3
Rare
Problem in ant pit
145
Signs and symptoms of hyperthyroidism
Weight loss
Tachycardia
Stare
Lid lag
Sweating
Anxiety
Irritability
Palations
Abd pain
Fatigue
146
What to do if hyperthyroidism is causing eyes to bulge out
MRI of orbits to see extraocular muscles
147
Methimiazole
Antithyroid/thioamide med
Inhibits thyroid synthesis in thyroid gland
148
Propylthyouracil (PTU)
Antithyroid/thioamide
Used in first trimester of pregnancy
Inhibits thyroid hormone synthesis of thyroid gland
Can decrease conversion from T3 to T4
149
Beta-blockers in antithyroid
Controls adrenergic symotomes
Once daily atenolol or metoprolol
High dose of propranolol decreases conversion of T4 to T3
150
Dexamethasone and hydrocortisone use in antithyroid
Decreases peripheral conversion of T4 to T3 and can alleviate pain in thyroiditis
151
Most concerning side effect of methimazole or PTU
Agranulocytosis (not making WBC)
152
Graves disease pathophys
Most common hyperthyroidism
Autoimmune antibodies bind to TSH receptors causing overproduction of T4 and T3
More common in women 20-40
Elderly get apathetic hyperthyroidism and cardiac issues
153
Graves disease physical exa
Warm skin
Fine tremor
Tachycardia
Goiter
Proptosis, stare, lid lag
Thyroid acropachy, onycholysis, pretibial myxedemaI
154
Thyroid eye disease treatment
Refer to ophthalmology
DO NOT treat with radioactive iodine
155
Graves disease treatment
Symptomatic treatment with beta-blockers.
Methimazole or PTU
Radioactive iodine therapy if no opthalmopathy
Total thyroidectomy
156
Thyroid storm symptoms
Agitation
Delirium
High fever
Vomiting
Diarrhea
Dehydration
157
What can thyroid storm cause
Life threatening
Heart failure
Sinus tachycardia
V-fib
MI
Cardiogenic shock
158
Thyroid storm treatment
Beta blocker
PTU
159
Toxic adenomas and toxic multinodular goiter pathophys
Hyperthyroidism
95% benign
Exacerbated by radionuclide study
160
Toxic adenoma and toxic multinodular goiter findings
Nodule(s)
Low TSH
High T3 and maybe T4
Usually no antibodies
161
Toxic adenoma and toxic multinodular goiter treatment
Beta-blockers
Methimazole
Radioactive iodine
Surgical excision
162
Thyroiditis
Inflammation of thyroid causing damage to thyroid follicles and uncontrolled release of thyroid hormone into blood stream
163
Thyroiditis presentation
First presents as hyperthyroidism then resultas in hypothyrooidism or reverts to euthyroid
Low iodine uptake
164
Thyroiditis treatment
NSAIDs
Steroids
Beta-blockers
165
Four types of thyroiditis
Autoimmune
Painful
Infectioussuppurative
IgG4
166
Types of autoimmune thyroiditis
Chronic lymphocytic/Hashimoto's
Postpartum
Painless (silent) subacute
Meds, iodine, illness
167
Risk factors for autoimmune thyroiditis
Head-neck external beam radiation
Turner syndrome
Hepatitis C
Iodine supplementation
Tobacco use
168
Post-partum thyroiditis treatmet
Symptomatic hyperthyroidism
Short term hormone replacement
169
Post-partum thyroiditis risk factors
High TPO antibodies
T1DM
Other autoimmune
170
Painful subacute thyroiditis presentation
Tender thyroid gland with painful dysphagia.
Same clinical course as post-partum
Usually follows URTI
Could have fever and skin involvement (abscess)
Elevated WBC, ESR,, CRP
171
Painful subacute thyroiditis treatment
NSAIDs or steroids for pain
172
Thyrotoxicosis facitia
Caused by overtreatment or abuse of T4
Low TSH, high T4
RAI uptake abscent
173
Hydatidiform mole
Excess productono f HCG having TSH-like activity
Gestational trophoblastic disease
Low TSH high T4
174
Struma Ovarii
Ovarian teratoma containting thyroid tissue.
Low TSH high T4
RAI uptake in pelvis
175
Medications associated with hyperthyroidism
Iodine supplementation
Amiodarone
Tyrosine kinase inhibitors
Immune checkpoint inhibitors
176
Types of hypothyroidism
Hashimoto
Secondary
Subclinical
Euthyroid sick syndrome
Cretinism
Myxedema
177
Signs and symptoms of hypothyroidism
Weight gain
Dry skin
Thinning hair
Thinning nails
Bradycrdia
Skin palor
Puffy face
Goiter
Decreased body temp
Fatigue
Menorrhagia
Constipation
Myalgia and cramps
178
Hypothyroid physical exam findings
Periorbital edema
Dry skin
Dry, brittle nails
Edema/lymphedema
179
Levothyroxine
BEST
Initial treatment of primary and secondary hypothyroidism
Take on empty stomach
No other food or meds for 30-60 mins
Monitor labs every six weeks until dose stable
Pregnancy increases needs by 30%
180
What is the goal TSH for someone you're giving levothyroxine
1.0 (low, normal range)
181
How to determine dosing for levothyroxine
0.75 mcg/lb/day
182
What dose to start elderly person at on levothyroxine
50-75 mcg daily
183
Armour Thyroid, Nature-Thyroid, NP Thyroid
Mixed T3 and T4 from pigs (porcine)
60-65 mg = 100mcg of levothyroxine
184
Liothyrine
Synthetic T3
Metabilized more quickly than T4 so dosed twice daily
25mcg = 100 mcg of levothyroxine
185
Most common hypothyroidism in US
Hashimoto
From antibodies against gland
186
Hoshimoto treatment
Thyroid hormone replacement
187
Subclinical hypothyroidism
Elevated TSH
Normal T4
Can resolve itself
No treatment needed unless TSH is extremely high or if pt is having symptoms
188
Nonthyroidal illness syndrome
Low T4 and T3
Normal TSH
High reverse T3
Seen in severe illness
Increased metabolism of T4 and decrease of thyroid binding immunoglobulin
No treatment, recheck labs in 6 weeks
189
Congenital hypothyroidism (cretinism)
High TSH
Low T4
Detected in newborn
190
Congenetal hypothyroidism (cretinism) cause
THyroid gland agenesis or thyroid hormone receptor resistance
191
Congenital hypothyroidism symptoms
Poor feeding
Hypotonia
Enlarged tongue
Cardiac malformation
Possibly permanent cognitive impairement
192
Myxedema cause
Long standing untreated hypothyroidism
20-50% mortality
193
Myxedema presentation
Hypothermia
Hypotension
Bradycardia
Hypoxia
Lethargy
Psychosis
Coma
194
Myxedema treatment
Levothyroxine 200-400mcg
Admission to ICU
195
Myxededma increased susceptibility
Bacterial pneumonia
Megacolon
Rhabdomyolysis
Renal impairmnt
Respiratory arrest
Cardiomegaly (myxedema heart)
196
Thyroid cancer presentation
Asymptomatic
Hard, fixed, painless mass in neck <5cm
Recent onset with rapid growth
Lymphadenopathy
Hoarsenss
Odynophagia
197
What to do if someone comes in with possible thyroid cancer
Check TSH
Ultrasound
FNA if needed
198
Thyroid cancer types in order of common to least common
Also least dangerous to most dangerous
Papillary
Follicular
Medullary
Anaplastic
199
Follicular thyroid cancer
Associated with autosomal dominant cowden syndrome (loss of tumor suppressor)
200
Medullary thyroid cancer
Associated with MEN 2A and 2B
Secrete calcitonin used as tumor marker
Discontinue GLP anlalogs
201
Anaplastic thyroid cancer
Least common and most dangerous
Rapidly enlarging mass in multinodular goiter
Metastasizes to adjacent nodes and distant sites
202
Treatment for thyroid cancer
Thyroidectomy]
Then radioactive iodine if high risk
T4 replacement keeping TSH slightly low
Deep neck ultracsound every 6-12 months for five years
Monitor TSH ensuring it stays a little low
Test for thyroglobulin adn calcitonin
RAI total body scans
203
Radioactive iodine total body scans
Measure thyroglobulin and thyroglobulin AB
Locak or metastatic lesions will take up RAI
204
Thyroidal peroxidase (TPO)
Oxidizes iodine so it can be used in TH production
205
Where is T4 converted to T3
Liver and Kidney
206
TH MOA
T4-->T3
T3 binds to binds to nuclear receptor altering gene expression
207
Entire process of making TH
TRH binds to receptor on follicular cell
Increases iodide uptake from Na/I symporter.
Increases synthesis and secretion of thyroglobulin
TPO converts Iodide into iodine
TPO links iodine with tyrosine residues on thyroglobulni to make MIT and DIT
TPO connects DIT with another DIT or MIT
Proteolytic enzymes cleave T3 and T4 from thyroglobulin
208
Osmolarity
Osmoles per liter of solvent
209
Osmolality
Osmoles per kg of solvent
210
Tonicity
Describes osmolality of solution
211
SIADH
Post pit releases too much ADH (AVP)
212
Diabetes insipidus
Post pit releases not enough ADH (AVP) or kidneys not responding to ADH (AVP)
213
ADH (vasopressin) physiology
Acts on V2 receptors in principal cells of collecting ducts to stimulate aquaporin expression
Aquaporin 2 moves water down osmotic gradient from collecting duct into principal cell
Aquaporin 3 and 4 move water out of principal cell into medullary extracellular fluid and circulation
214
What causes release of ADH
Increased plasma osmolality
Decreased intravascular pressure
215
Renal response to ADH
Increase concentrated urine
Decrease diluted urine
216
ADH effect on vasculature
Vasoconstriction to increase BP
217
What regulates thirst
Osmostat in anteromedial hypothalamus
218
Causes of SIADH
Small cell lung carcinoma
Uterine carcinoma
Thymoma
Drugs
INfection
Pulm disorders
219
SIADH pathophys
Water retention
natriuresis (Na loss)
220
SIADH lab presentation
Hyponatremia
Hypotonic
High urine osmolality
High urine Na
High specific gravity
Normal blood volume
221
SIADH symptoms
Nausea, malaise, muscle cramps
Headache, lethargy, weakness
Cerebral edema, confusion, AMS, seizure, resp distress
222
SIADH testing
Water load then assess urine osmolality
223
SIADH treatment
Fluid restriction
Hypertonic saline
V2 receptor agonist
Demeclocycline
Fludrocortisone
224
Primary polydeipsia cause
Patient drinking a lot of water
225
Central diabetes insipidus cause
Decreased ADH secretion
Hypothalamus lesion
Post pit tumor
Lung or breast tumor
Head trauma
Infectious diseas
226
Nephrogenic diabetes insipidus cause
Decreased renal response to ADH
Renal disease
Sickle cell
Renal ischemia
Nephrotoxic drugs
227
Central diabetes insipidus pathophys
Hypofunction of hypothalamus or post pit
Urinary free water excretion (polyuria)
Increased plasma osmolality
Hypernatremia
228
Nephrogenic diabetes insipidus
Decreased renal responsivness to ADH
Urinary free water excretion (polyuria)
INcreased plasma osmolality
Hypernatremia
229
Diabetes insipidus lab presentation
Hypernatremia
Polyuria
Low urine osmolality
230
Diabetes insipidus clinical findings
Lots of dilute urine
Excessive thirst (polydipsia)
231
Diabetes insipidus diagnostic test
Water deprivation test
Desmopressin stimulation test
232
Water deprivation test
Test for diabetes insipidus
Decrease water intake and check urine volume and concentration.
Positive test if urine remains diluted and low urine osmolality and lots of volume.
233
Desmopressin stimulation test
Shows what type of diabetes insipidus
Give desmopressin
Measure urine volume 12 hrs before and 12 hrs after.
Central diabetes insipidus will have decreased urine output
Nephrogenic diabetes insipidus will have no response
234
Neuroendocrine cell
Epithelial cell that recieces messages from nerons and releases hormones
235
Neuroendocrine tumors (NET)
Slow growth (indolent)
Mostly nonfunctional
Rare (37 per mil)
236
What does over 90% of GEP-NET's have that help us with treatment
High concentrations of somatostatin receptors.
We can image with octreotide or other radionucleotides
237
Most common NET
1.Gastrointestinal treact (GiNET)
2. Pancreatic (PNET)
3. Lung
238
NET cause
Familial
25% associated with MEN1
MEN 1-4
Von Hippel-Landau Syndrome
Neurofibromatosis (NF 1)
239
NET clinical presentation
Depends on location
many asymptomatic
Carcinoid syndrome
240
Carcinoid syndrome
Classic NET
Small bowel (midgut) most common)
Increased serotonin, histamine, prostaglandin
241
Carcinoid syndrome symptoms
Abd pain
DIarrhea
Skin flushing (after meals)
Bronchospasm if in lung
242
GiNET
Gastrointesitinal NET
Type I - most common with chronic atrophic gastritis and pernicious anemia
Type II - 5% gastrinomas and MEN1
Type III - 20% more aggressive
Type VI - Chronic PPI use and less malignant
243
Small intestinal GiNET
Usually ileum
Abd pain
often misdiagnosed IBS
244
Appendix GiNET
Usually neoplasm of appendix
Almost always found accidentally in appendectomy
245
Colorectal GiNET
Most discovered by accident in colonoscopy
246
PNET (pancreas)
20% alpha (glucagon)
70% beta (insulin)
5% D cells (gastrin or somatostatin)
5% F cells (pancreatic polypeptide)
247
NET diagnosis
Stepwise
Labs show it
CT scan
Biopsy
PET with Ga-68 DOTA-peptide for staging and restaging
248
NET treatment
Surgery if not metastatic
Somatostatin analog therapy
Lutathera
Chemo (only for high grade (fast growing))
249
Carcinoid syndrome treatment
Surgery id possible
Somatostatin analog therapy
250
Pheochromocytoma
Rare catecholamine-secreting tumor in adrenal medulla
251
Pheochromocytoma symptoms
Extreme uncontrollable HTN
All sympathetic nervous symptom stuff bc release catecholamines (epi and norepi)
252
Pheochromocytoma cause
Multiple Endocrine Neoplasy type 2 (MEN2)
Von hippel-lindau syndrome
Neofibromatosis type I
253
Classic triad of symptoms for pheochromocytoma
Episodic headache, sweating, tachycardia
254
Best test for pheochromocytoma diagnosis
24 hr fractionated catecholamines and metanephrines
Plasma fractionated metanephrines (more sensitive)
CT or MRI (>10 HU on noncontrast)
255
Surgical treatment for pheochromocytoma
Laparascopic adrenalectomy
256
Pheochromocytoma pre-op treatment
Combined alpha (phenoxybenzamine) and beta adrenergic blockade 7 days before surgery(START WITH ALPHA FIRST)
Beta just couple days before
257
Phenoxybenzamine
Alpha blocker used in pheochromcytoma pre-op
Nonselective
258
Metyrosine
Decreases catecholamine production in pheochromocytoma pre-op
Blocks tyrosine hydroxylase preventing conversion of tyrosine to dopamine
259
Adrenal incidentaloma
Mass greater than 1cm found accidentally on adrenal gland when looking for something els.
Look to see if it is malignant or functional (secretes something)
260
Tumors of adrenal cortex
Adrenocortical adenoma
Adrenocortical carcinoma
261
Tumors of adrenal medulla
Neuroblastoma
Pheochromocytoma
262
Characteristics of benign adrenal adenoma
Less than 4 cm
ROund and smooth
Homogenous
Located in cortex
Unilateral less concerning
263
At what size adrenal mass do you refer to surgery
>10cm
264
MEN1 associated tumors
Parathyroid hyperplasia
Pituitary adenomas
Pancreatic NET
Other NET
265
What issue happens in 90% of MEN1 patients
Hyperparathyroidism
266
Pituitary adenoma
Secrete prolactin in 60% of MEN1 tumors
267
MEN2 cancers
Medullary thyroid cancer
Pheochromocytoma
268
Common symptoms of Type 1 diabetes mellitus
polydipsia
polyuria
Hunger
Dry skin
Drowsy
Blurry vision
Slow healing
269
Common signs of Type 1 Diabetes mellitus
Diabetic ketoacidosis
Hyperglycema
Hyperkalemaia
Hyponatremia
Glucosuria
Ketonuria
Metabolic acidosis
270
Diagnostic tests of T1DM
Fasting plasma glucose >126
Random plasma glucose >200
Hemoglobin A1C >6.5
3 hour glucose tolerance test >200
C-peptide
Autoimmune markers
Ketonemia/ketonuria
271
Stage 1 T1DM
Autoimmunity
normoglycemia
Antibodies present
No treatment
272
Stage 2 T1DM
Autoimmunity
Dysglycemia
Presymptomatic
Antibodies present
Teplizumab for treatment
273
Stage 3 T1DM
New-onset hyperglycemia
Symptomatic
Standard treatment
274
Honeymoon phase of T1DM
Soon after starting insulin therapy
Temporary recovery of beta cell function for about a year.
Educate patient to continue testing blood glucose because it will eventually end
275
Musculo skeletal problems with T1DM
Charcot's joint
Cheiroarthropathy
Adhesive capsulitis
Carpal tunnel
Dupuytren contractures
Amputation
276
Neonatal diabetes
Occurs by 6 months of ae.
Life long condition but don't always need insulin
Small fetuses for gestational age
277
Cystic fibrosis related diabetes
Result of pancreatic scarring
20% of CF pts
Treated with insulin
278
Ketosis-prone type 2 diabetes
Autoantibody negative
Inherited
Episodic DKA with varying degrees of insulin deficiency between episodes
279
Postpancreatitis diabetes
From pancreatic scaring
Treated with insulin
280
What does A1C measure
glycemic control over 2-3 months
Remember it is an average so doesn't tell the whole story
281
Goal A1C for adult with T1DM
7%
282
Goal A1C for child
6.5% if can be done without lows
7% normal
8% if history of sever lows
283
Goal A1C for elderly
7-7.5%
8-8.5% if difficult
284
What does fructosamine level measure
Glucose control over 1-2 weeks when A1C is unreliable
285
Continuous glucose monitor
Measures interstitial glucose levels constantly
(Dexcom)
286
What all is prescribed in finger stick glucose monitoring
Meter
Test strips
Lancet
287
Time in range
Percent of day when bllood sugar is between 70-180
High TIR correlates with lower A1C
Low TIR correlates with microvascular complications
288
Time in range goal
70%
289
T1DM treatment
INSULIN
pramlintide
GLP-1 agonists
SGLT-2 antagonist
Teplizumab
290
Where to inject insulin
Fatty tisssue
Upper posterior arm
Abdomen
Buttocks
Thigh
Best to spread around where you give a shot bc of lipohypertrophy
291
Insulin pumps
Use basal insulin drip throughout day.
Can change rate of insulin
292
Basal bolus regimen
Multiple daily injections of insulin to mimic body's basal bolus activity
Basal is dose taken in morning and it kind of stays with you.
Bolus is jump in insulin at meals
293
How much bolus insulin should be given based on carbs
1 unit per 10 grams of carbs each meal
294
When should bolus shot be given
Less than 15 minutes before meal
295
How much does one unit of insulin drop blood glucose
30 points
296
Dawn phenomenon
Morning hyperglycemia from natural cortisol and GH rise
297
Somogyi effect
Nocturnal hypoglycemia results in surge on counterrregulatory hormones causing hyperglycemia
298
Metabolic causes of hypoglycemia
INsulinoma
Hypothyroidism
Addison's disease
Liver failure
Alcoholism
Malnutrition
Renal failure
Beta cell proliferation
Alpha cell fatigue
IGF-2 and GLP-1 secreting tumors
299
Diabetic meds that can cause hypoglycemia
Insulin
Sulfonurea
Glinides
SGLT2 inhibitors
GLP-1 analogs
300
Non-diabetic meds that can cause hypoglycemia
Floroquinolones
Beta blockers
Ace inhibitors
301
When does seizure happen from hypoglycemia
Sugar less than 30
302
Common symptoms of hypoglycemia
Shaky
Sweaty
Dizzy
COnfusion
Hungry
Weakness
Headache
Nervous
303
Fasting hypoglycemia
5 or more hours after eating
Related to basal insulin
Sulfonylurea use
Insulinoma
304
Post-prandial hypoglycemia
Reactive
Within 2 hours after meal
Related to bolus insulin
Common in rapid weight loss surgery
305
Behaviooral hypoglycemia
Stacking of insulin doses
Delivered bolus too early before getting meal
Alcohol induced
Activity induced
306
How to treat hypoglycemia orally
Eat/drink 15g of carbs
Wait 15 mins
Check blood
Repeat if still low
307
How to treat severe hypoglycemia
IM or intranasal glucagon
IV D50 (50% dextrose)
308
Insulinoma
Over 99% in Isle of Langerhans
90% are benign
From MEN1
309
Signs and symptoms of insulinoma
Fasting hypoglycemia
Anxiety
310
Insulinoma treatment
Surgery
311
Insulinoma diagnosis
Elevated C peptide levels
CT and MRI
312
Euglycemic DKA
DKA with normal blood sugar
Associated with SGLT-2 inhibitors
313
DKA
Diabetic ketoacidosis
Body can't utilize glucose so ketoacids are accumulated because of lipolysis (gluconeogenesis)
314
What patients have DKA
Usually T1DM but can be seen in T2DM
Also can be caused by infection, trauma, MI, surgery, bad insulin, not taking insulin
315
Symptoms of DKA
Polyuria
Polydipsia
Hypotension
Fruity breath
316
Lab finidngs in DKA
Hyperglycemia
Hperkalemia
Hyponatremia
Elevated BUN
Elevated creatinine
Hyperphosphatemia
317
Normal serum osmolality
280-300
318
DKA treatment
Restore plasma volume with normal saline until BG gets to 250 switch to D5
Give potassium even though its high
Give insulin
319
HHNS
Hyperglycemic Hyperosmolar Nonketotic Syndrome
Normal aniongap
320
What patients normally getn HHNS
Type 2 diabetics
321
HHNS cause
Partial or relative insulin deficiency causes hepativ glucose output.
Massive fluid loss related to osmotic diuresis results in renal impairment
322
Lab findings of HHNS
Hyperglycemis
Hyponatremia
Hyperkalemia
Elevated BUN
Elevated creatinine
Elevated serum osmolality
323
HHNS signs and symptoms
Weakness
Polyuria
Polydipsia
Dehydration
Nausia
Coma
Confusion
Convulsion
324
HHNKS treatment
Restore plasma volume with half norma saline
Reduce blood glucose without bolus
Fix electrolytes with potassium
325
T2DM
Excess lipids in adipocytes lead to insulin resistance
Production of adiponectin (insulin-sensitizing peptide) is reduced and cause increase in glucose production in liver causing fasting hyperglycemia.
326
Post prandial glucose
After meal glucose
Utilized by skeletal muscle
Insulin stimulates glucose uptake
327
Cause of T2DM
Peripheral insulin resistance
Increased hepatic glucose production
Impairment of insulin secretion
328
What can cause falsely low A1C
IV iron
EPO therapy in CKD
Vitamin C and E
329
What can cause falsely elevated A1C
Splenectomy
Hereditary spherocytosis
IDA
330
What A1C is considered prediabetic
5.7-6.4%
331
Criteria for screening for T2DM
BMI 25+
Fam history
CVD history
HDL cholesterol
HTN
PCOS
Pre-diabetic
332
T2DM signs
Fatigue
Blurred vision
Nausea
Polyphagia
Polydipsia
Polyuria
Weight change
Numbness in legs
Metabolic syndrome
40% asymptomatic
333
T2DM physical findings
Obesity
HTN
Eye issues
acanthosis nigrans, candida infections
Neuro issues
Dry skin
Muscle atrophy
Claw toes
Ulcer
334
T2DM chronic macrovascular complications
Coronary artery disease
Carotid artery/cerebrovascular disease
Peripheral artery disease
335
T2DM chronic microvascular complications
Neuropathy
Nephropathy
336
What's the risk of T2DM patient to have MI
Same as someone without T2DM who has had an MI
They have elevated plasminogen activator inhibitors and fibrinogen that can cause thrombosis
337
T2DM peripheral vascular risk
Ischemia of lower extremities
Erectile disfunction
Intestinal angina
338
Neuropathy
in 50% of pts with T2DM
Myelinated and unmyelinated fibers lost
Usually bilateral
CN 3,4,6 involvementA
339
Autonomic neuropathy
Long standing DM
Orthostatic hypotension
Gastroparesis
Incontinence
ED
Hypoglycemia unawareness
340
Neuropathy clinical testing
Pin prick for small fiber function
Vibratory sense for large fiber function
Monofilament test for protective sensation
341
Charcot foot
Structural changes to foot from neuropathy
342
Neuropathy management
Alpha lipoic acid
B12 replacement
Tricyclic antidepressants
Calcium channel modulators
Serotonin norepinephrine reuptake inhibitors
343
Diabetic nephropathy
T2DM
Microalbuminuria
Pts have high risk of diabetic retinopathy
Macroalbuminuria over next 10 years in 50% of pts
344
Nephropathy diagnostic test
Spot urine for microalbumin/creatinine ratio
Creatinine every three months
Refer to nephrology if macroalbuminuria >300mg/day or eGFR<30
345
Leading cause of blindness between ages of 20-74
Diabetes mellitus
346
VEGF in diabetes
Causes production of new blood vessels in retina associated with retinopathy of DM
347
Proliferative retinopathy presentation
Cotton wool spots from growth of new capillaries and fibrous tissue in retina and vitreous cahmber
More common T1DM
348
Nonproliferative retinopathy presentation
Earliest stage
Microaneurysms, dot hemorrhages, exudates, retinal edema
349
How to treat chronic complications of T2DM
Glucose control
Treat HTN with ACEi/ARBs, diuretics
Treat cholesterol with statins
Weight management
350
What predicts mortality of T2DM
A1c levels within three months of initial diagnosis
So follow up more often than three months until pt gets stable
351
What is the first drug for patients with T2DM and obesity
Metformin
352
Metformin
#1 drug for T2DM and obesity
Decreases insulin resistance
Decreases hepatic gluconeogenesis
Don't give pt with GFR<30
Can cause Vitamin B12 deficiency and hypoglycemia
Weight neutral
353
DPP4 inhibitor
T2DM
-gliptin
increases and prolongs incretin hromone activity
INcrease insulin release and reduce glucagon secretion
Post-prandial glucose
Weight nutral
354
GLP-1 agonsit T2DM
-glutide
Post prandial glucose
Weight loss
Lowers A1C by 1.5
355
Rybelsus
Semaglutide as weekly oral agent
356
SGLT2 inhibitors
-flozin
Lowers renal glucose threshold causing more glucose excretion in urine
Weight loss
Lowers A1C by 1%
Not for pts with GFR>30
Reduction in microaluminuria
Used in HF pts
357
Sulfonylureas
Glipizide and glimepiride most common
Glyburide not for people over 65
Increase insulin secreetion and decrease hepatic glucose production
Post prandial glucose
Weight gain
Lowers 1C by 1%
358
Thiazoolidinediones
Pioglitazone
Reduces circulating fatty acid concentration.
Lower glucose by increasing muscle, fat, and liver's sensitivity to insulin.
Not for people with heart problems
Fasting and post prandial glucose
Weight gain
Lowers A1c by 1%
359
Exubera adn Afrezza
Inhaled insulin
Quick acting
360
Soliqua
Combo of fixed doses of basal insulin and GLP-1
Lixisenatide is the GLP-1 inside
361
What meds to give pt with ASCVD for T2DM
GLP-1 (-glutide)
SGLT-2 (-gliflozin)
362
What med to give pt with heart failure for T2DM
SGLT-2 (-gliflozin)
363
What med to give pt with CKD for T2DM
SGLT-2 (-gliflozin)
364
Gestational diabetes cause
Insulin secretory capacity not sufficient to overcome insuln resistance created by anti-insulin hormones secreted by placenta during pregnancy
365
Safest way to treat and monitor pregnant pt with hyperglycemia
Insulin
366
Babies born to mothers with uncontrolled blood sugar
Usually premature and weigh >9lbs
Baby at risk of hypoglycemia and jaundice
Should be screened every 1-3 years for diabetes
367
Maturity-onset diabetes of the young (MODY) symptoms
Polyuria
Polydipsia
Dehydration
Blurry vision
Recurrent skin/yeast infection
Nonobese
368
Diabetic med control pre-op
Pre-op visit if A1c < 8%
Metformin held day of surgery
SGLT-2 held 3-4 days before surgery
GLP-1 held one week before surgery
369
Preferred insuln treatment for non-critically ill pateints
basal plus bolus
370
Fequently usd medications that can elevate glucose levels
Corticosteroids
Beta-blockers
Thiazide diuretics
Antipsychotics
Statins
371
IGF-1 release sequence
GHRH from hypothalamus
GH from ant pit
IGF-1 from liver
372
IGF-1 function
Increase muscle size, bone size, and endochondral ossification.
INcreases activity of collagen, proteoglycans, osteoblasts, and osteoclasts
373
Gigantism
Excess GH before puberty
374
Acromegaly
Excess GH after puberty
375
Acromegaly cause
Ant pit adenoma
376
Acromegaly clinical manifestations
Little effect on stature and height
Growth of bones
Suddenly shoes, gloves, hats, rings don't fit
Soft tissue swelling
Organ enlargement
Thyroid goiter/megaly
Hyperhydrosis "moist handshake"
Hirsutism
Visual probs
Small dick from co-secretion of prolactin
Decreased libido
377
Gigantism clinical manifestations
Abnormal growth
378
Acromegaly/Gigantism lab diagnostics
Increased IGF-1
Glucose suppression test to see if rise in GH
MRI of pituitary
Prolactin
GLucose, A1C
CMP
TSH, T4
379
Acromegaly complications
Carpal tunnel
DM
CHF
HTN
Colon polyps
Difficult intubation
Sleep apnea from pharynx/larynx enlargement
380
Acromegaly/gigantism management
SURGICAL EXCISION
CABERGOLINE (dopamine receptor agonist) if not good for surgery
Octeotride and lanreotide
Pegvisomant
381
Growth hormone deficiency cause
Pituitary tumor or treatment from pituitary tumor
Extrapituitary tumor
Sarcoidosis
Sheehan syndrome
382
What adults should be evaluated for GH deficiency
Known hypothalamic or pituitary disease
History of pediatric GH deficiency
383
Congenital GH deficiency clinical manifestations
Short stature (2 SD below mean)
Slow development
Hypoglycemia, jaundice, and hypogonadism in new borns
384
Pediatric GH deficiency clinical manifestations
Slow growth
Distinct facial features
Central obesity
Delayed puberty
Webbed neck
Short limbs compared to trunk
385
Adulthood GH deficiency clinical manifestations
Central obesity
Depression
Mem probs
Decreased lean body mass
Decrease bone and mineral density
Increased risk for cardiovascular disease
386
Pediatric growth hormone deficiency diagnostics
Growth assessment (charts)
A projected height that differs more than 10 cm from parents suggest possible problem
387
GH deficiency lab studies
Low IGF-1
GH provaction testing where GH should be made to rise by meds
388
GH deficiency management
Early diagnosis
Recombinant human GH ASAP (Norditropin once daily or lonapegsomatotropin, somopacitan, or somotrogon once weekly)
Can be stopped whenever goals are met
Assess growth every 3-6 months and bone age every 1-2 yrs
389
Male primary hypogonadism
Disease of testes
Low testosterone and/or sperm count
High LH and/or FSH
390
Secondary hypogonadism
Disease of pituitary or hypothalamus
Low testosterone and/or sperm count
Normal or low LH and/or FSH
391
Male Hypogonadism symptoms in adolescents
Appear younger
Small genetalia
Difficult in gaining muscle mass
Lack of facial hair
High pitch voice
392
Male hypogonadism in adults symptoms
Decreased energy and libido
Decreased muscle mass and body hair
Hot flashes
Gynecomastia (most likely primary)
Infertility
Testes decrease in size in primary
393
Male hypogonadism diagnosis
Unequivocally low serum total testosterone concentrations between 8 and 10am on at least two occasions
<300
394
Most important single test to evaluate for testosterone
Serum testosterone
395
Male hypogonadism free testosterone
18-69 y/o: <35
70+ y/o: <30
396
Testosterone replacement contraindications
No low testosterone
ActiveActive breast or prostate cancer
Untreated sleep apnea or heart failure
397
Klinefelter syndrome
47, XXY (47 chromosomes with extra X)
Most common cause of primary hypogonadism
Destruction of seminiferous tubules and leydig cells causing decreased sperm and testosterone production
398
Klinefelter syndrome symptoms
Long legs and arms
Sparse body hair
Small testes
Infertility
Gynecomastia
Not present until after puberty
399
Klinefelter syndrome therapy
NOT for prepubertal boys.
Start at age 13 until growth ceases or until 18-19 to cause genetal development, facial and pubic hair, muscle development, and growth
Full doses of testosterone replacement for adult men
400
Gynecomastia
Males develop breast tissue
Pseudo is just fat tissue
401
Signs of malignancy in gynecomastia
Asymetry
Nipple retraction
Bleeding
Discharge
402
Gynecomastia labs
Liver tests
BUN
Creatinine
Endocrine testing
Serum prolactin
Estradiol
hCG
403
Gynecomastia imaging
Mammography or chest CT
404
Gynecomastia treatment
Reassure and observe during puberty
Remove drug causing it
Raloxefine or anaastrazole if persistent
Surgery last resort
405
Primary amenorrhea
Absence of menarche by age 15
Or absence of menarche and no breast tissue at 13
406
Secondary amenorrhea
3 consecutive months without menses in women who previously had regular menses or 6 months in women with irregular menses
407
Primary amenorrhea cause
Gonadal dysgenesis (turner syndrome)
Vaginal agenesis
408
Turner syndrome
Most common sex chromosome abnormality in females
Loss of part of X chromosome (45,X-)
Early ovarian failure
409
Turner syndrome symptoms
Short stature
Broad chest
Short and webbed neck
Kyphoscoliosis
410
Secondary amenorrhea cause
Pregnancy
PCOS
411
Primary amenorrhea treatment
Treat underlying cause
Help achieve fertility if desired
Estrogen replacement
412
Primary amenorrhea diagnostics
hCG, FSH, TSH, PRL
MRI of pituitary
Pelvic US
Karyotype to check for turners
413
Secondary amenorrhea labs
hCG, FSH, TSH, PRL
Estradiol
Testosterone
414
Secondary amenorrhea treatment
Treat underlying cause
Help achieve fertility if desired
Estrogen replacement
(same as primary)
415
Hirsutism
Male pattern hair growth on women
416
Hirsutism cause
PCOS
417
Virilization
Development of male physical characteristics in women
418
Hirsutism and virilization treatment
Oral contraceptives (combined estrogen-progestin)
Spironolactone
Laser hair removal
419
Ovarian germ cell tumor presentation
Abd enlargement
Abd pain
Precocious puberty from hCG production
Fever
Vaginal bleeding
420
Ovarian germ cell tumors diagnostics
Pelvis US
Tumor markers (hCG and AFP elevated)
421
Prader-Willi syndrome
Hypopituitarism
Paternal chromosome 15 deleted or unexpressed
422
Prader-Willi syndrome symptoms
Trouble sucking or swallowing
Floppy baby
Abnormal facial features
Mental development delay
Short stature
Hyperphagia or morbid obesity
Hypogonadism
423
Kallman syndrome
Hypopituitarism
Defective hypothalamic gonadotropin-releasing hormone causes low LH and FSH
424
Kallman syndrome clinical presentation
Delayed or absent puberty
Color blindness
Ansomnia
Optic atrophy
Cleft palate
Renal probs
Cryptorchidism
Neurologic abnormalities like mirror movements
425
Sheehan's syndrome
Hypopituitarism
Postpartum pituitary gland necrosis
No lactation
Decreased PRL
426
What ACTH value shows pituitary failure
<10
427
Test for pituitary failure
Insulin tolerance testing
428
Most common cause of hyperpituitarism
Pituitary adenoma
429
Pituitary adenoma
Most common cause of hyperpituitarism
slow growing
Can put pressure on optic chiasm causing periferal vision loss
Functioning means it secretes hormone
Micro is <1cm macro is >1cm
Macro more common
430
Pituitary adenoma symptoms
Headache
Vision probs
NV
Changes in behavior
Nasal
431
Pituitary adenoma diagnosis
Check hormones
MRI or CT
432
Pituitary adenoma treatment
Transphenoidal pituitary microsurgery EXCEPT PROLACTINOMAS
Radiation if persistent or can't have surgery
433
Hyperprolactinemia cuase
PRL secreting tumor
Pregnancy
Meds
Familial
434
What is most common pituitary tumor
Prolactinoma
435
Main pharamacologic cause of hyperprolactinemia
Antipsychotics
Antidepressants
Anti HTN
436
Hyperprolactinemia symptoms
Fatigue, depressoin
Hypogonadism, decreased libido, impotenc, nnfertility, gnecomastia in men
Galactorrhea, infertility, oligomenorrhea, amenorrhea in women
437
Prolactinoma treatment
Dopamine agonist (Cabergoline)
438
Suppressed HPI axis patients (they need peri-operative steroid stress dose)
If they are on >20mg prednisone qd for >3 weeks
Any dose of steroids with cushingoid appearance
Dosing based on the amount of stress you expect in surgery then taper back to their normal dose
439
Nonsuppressed HPA axis (they don't need peri-operative steroid stress dose)
If they are on any dose of steroids for <3 weeks
<5mg prednisone daiy or <10mg prednisone every other day
440
What to do if unexplained hypotension happens in surgery
Stress dose of steroid should be given
441
Most common cause of hypercalcemia in inpatient setting
Malignancy
442
Most common cause of hypercalcemia in outpatient setting
Hyperparathyroidism
443
Parathyroidectomy indications for hyperparathyroidism
Ca >1 above upper limit of normal
Bone problems
GFR<60
Age less than 50
444
Parathyroidectomy complications
Hematoma causing airway compromise
Recurrent laryngeal nerve injury
Hypoparathyroidism
Hypocalcemia
445
How to find out if you're looking at recurrent laryngeal nerve in surgery
Touch it with electric probe and sound will be made
446
What characteristics on CT are suspicious for malignancy
>4cm
>10 HU (Hounsfield units)
Hypervascularity (increased contrast uptake)
Heterogenous
447
