Endocrine Flashcards
What are the most common cause of thyroid nodules?
colloid nodules
What is the role of FNAB in thyroid cancer?
can help see cytology in papillary cancer but cannot distinguish follicular adenoma from follicular cancer
What is the preferred therapy for graves disease? What are the other treatment options available?
radioactive iodine therapy is preferred
propylthiouracil and methimazole also used
What are the characteristics of malignant thyroid nodules?
fixed, cold, solitary, hx of radiation
What is the difference between papillary vs. medullary vs. follicular carcinoma?
papillary - most common, least aggressive, positive iodine uptake
follicular - spreads early via hematogenous route, more malignant; variant = Hurtle cell
Medullary - produces calcitonin, associated with MEN II
Anaplsatic - highly malignant, can arise from previous cancer
What is the best way to diagnose nephrogenic vs. central DI?
water deprivation test (both central and nephrogenic will have decreased urine osmolarity); nephrogenic however will not respond to ADH
What are some of the signs of hypoparathyroidism?
rickets, osteomalacia, tetany, prolonged QT interval
What are the signs of hypercalcemia?
stones (nephrolithiasis), bones (bone aches, pathologic fractures), groans (muscle aches, gout, constipation, PUD), psych overtones (depression, anxiety, etc)
What are the signs/symptoms of Cushings?
central obesity, hirsuitism, moon face, HTN, diabetes, proximal muscle wasting, psych disturbances
What is the formula for corrected calcium?
measured Ca+ + 0.8(4-measured serum albumin)
What is the on the differential for hypertension + hypokalemia?
adrenal carcinoma, bilateral adrenal hyperplasia, adrenal adenoma
What is the best way to evaluate hypertension + hypokalemia?
plasma renin ratio
QUICK HIT - walk through the diagnostic algorithm for hypokalemia!
SEE LECTURE
What are the causes of thyrotoxicosis with reduced iodine uptake?
subacute thyroiditis, levothyroxine overdose,
Describe the treatment for diabetes neuropathic pain
tricyclics, gabapentin, NSAIDs
What are the causes of hypogonadotrophic hypogonadism in men?
gonadotroph damage, prolactinoma, Cushing’s, narcotic use, systemic illness, diabetes, hemachromatosis, anabolic steroid use, morbid obesity
What are some of the features of acromegaly?
course facial features, arthralgias, uncontrolled hypertension, increased ring size, skin tags, carpal tunnel syndrome
What is the best test available for diagnosing acromegaly?
IGF-1
What are the different forms of access in dialysis?
Fistula
Graft
Catheter (tunneled and no tunneled) - non tunneled is highest risk
What things do you look for on physical exam while looking a the fistula?
Trouble accesing?
Erythema, warmth, pus
What are some of the causes of DKA?
Infection Noncompliance Pregnancy MI Drugs (cocaine) Pancreatitis
What labs should you draw for someone in DKA
BMP, CBC, blood ketones (beta hydroxy butyrate, acetoacetate) UA, CXR, LFT, Lipase, EKG
how do you prescribe synthroid? What if patient pregnant?
1.7 mg /kg in the young, 1 in the old, take without food or other meds. If patient pregnant, increase dose
How can you distinguish an insulin producing tumor from exogenous administration?
exogenous administration - lower C peptide levels
What are the risks of methimazole treatment for Grave’s? (and what should you do if a patient presents with a fever and sore throat on methimazole?)
agranulocytosis - if someone presents this way, stop therapy!
What are the clinical features of androgen use?
decreased sperm production, gynectomastia, LVH, mood disturbances, polycythemia
Explain the pathophysiology of carpal tunnel in hypothyroidism
deposition of protein complexes in perineurium and epineurium of median nerve
What test can be used to distinguish between cushings and ectopic ACTH?
high dose dexamethasone suppression test - failure to suppress suggests ectopic cause
What are the causes of ectopic ACTH?
small cell lung cancer, pancreatic cancer, neuroendocrine, bronchial carcinoids
A patient presents with headaches, palpitations, abdominal pain, nausea. You give beta blockers - what are the potential complications?
no alpha blockade - can lead to a rapid rise in blood pressure. give alpha blockers before beta blockers!
A patient presents with eye irritation, photophobia, decreased convergence, diplopia and pain in the setting of palpitations. What is the cause of the eye trouble?
anti- TSH autoantibodies causing increased volume of retro-orbital tissues
What are the cancers associated with MEN2A? How does this differ from MEN2B?
MEN1 - pituitary, parathyroid, pancreas
MEN2A- medullary thyroid cancer, pheochromocytoma, primary parathyroidism
MEN2B - more aggresive, with marfanoid
—- mucosal neuromas
A patient presents with difficulty raising her arms, a fine motor tremor and palpitations. This is likely due to …
hyperthyroidism
What is one potentially life threatening complication of metformin?
lactic acidosis
How do thyroxine dosages change with the addition of oral estrogen?
prevent TBG clearence, so more levothyroxine required
What occurs with K+ stores in DKA?
total body stores decreased by can get hyperkalemia due to acidosis and reduced insulin stores
How is follicular thyroid cancer diagnosed and distinguished from follicular adenomas?
invasion of the tumor capsule and blood vessels
What are classic pathological features of papillary thyroid cancer?
psmammoma bodies
What are the X ray deformities seen in Charcot’s joint?
loss of cartilege, osteophyte development, loose bodies
What are the causes of hypoparathyroidism?
post surgical, congenital (digeorge), autoimmune (APECED), resistance to PTH (pseudohypoparathyroidism)
What is APECED?
autoimmune polyglandular endocrinopathy candidiasis and ectodermal dysplasia
Does hypocalcemia resulting from hypoalbuminemia usually cause symptoms?
No - ionized Ca remains the same
What drugs can trigger HHS?
thiazide diuretics
Patients that present with abnormal thyroid levels during an MI likely have…
sick euthyroid syndrome
A patient presents with a firm thyroid nodule. What is the next course of action?
TSH and thyroid ultrasound
What if a patient with a firm thyroid nodule has a low TSH?
radionucleotide scan to see if nodule is hot or not
A patient presents with headaches, visual disturbances and palpitations with a normal TSH and elevated T3. You should..
look for a pituitary adenoma
A patient presents with hearing loss and headaches with high alk phosp as well as high urinary hydroxyproline. He has joint pains and CT shows a skull with thickened cortices and lytic lesions. What is the treatment?
bisphosphonates - this is Paget’s disease
A patient presents with gynecomastia, testicular atrophy and low testosterone with normal FSH and LH. What should be done next?
serum prolactin levels - prolactinoma can cause hypogonadism
What tests are used to diagnose addison’s disease?
ACTH, morning cortisol, cosyntropic (a synthetic analog of ACTH)
What tests are used to diagnose Cushing’s syndrome?
low and high dose dexamethasone tests
low dose - suppression absent in Cushing syndrome
high dose - suppression absent in Cushings due to ectopic ACTH secretion/adrenal abnormalities
What is the most common cause of death in patients with acromegaly?
Congestive heart failure
A patient presents with cold intolerance, fatigue and a diffusely enlarged thyroid. Labs show positive TPO antibodies. What is the malignancy risk for this patient?
thyroid lymphoma
A patient is discovered to have an active prolactinoma. What is the best course of treatment?
cabergoline (dopamine agonist)
What test can be performed to determine if ED is psychogenic or organic?
noctural penile tumescence
A patient presents with asymptomatic hypercalcemia. Urinary calcium/creatinine ration is low. This is..
familial hypocalciuric hypercalcemia
What are the mechansims by which cancer can increase serium calcium?
PTHhP (lung cancer, head and neck, esophageal, renal and bladder)
Vit D production (lymphoma)
Bone metastasis (breast cancer, multiple myeloma) - release cytokines
Ectopic PTH
Has tightening of glycemic control been shown to improve ED?
nope
A diabetic patient has BPH and ED and wants to take sidenafil. What instructions to you give him?
give drugs with a 4 hour interval to prevent hypotension
When is surgery recommended for patients with hyperparathyroidism?
serium Ca >1mg above upper limit of normal
young age
bone mineral density reduced
reduced renal function
A patient presents with weight loss, fever, cough, nausea, abdominal pain. Cosyntropin test is performed and shows minimal response. CT shows calcification of the adrenal glands. this is..
TB in the adrenal glands causing adrenal insufficiency
What are common infectious causes of adrenal insufficiency? What is the most common cause of adrenal insuffiency in developed countries?
HIV, TB, CMV, fungi; autoimmune
A young anxious woman in the psych ward has been increasing her water intaake and has low urine osmolality in addition to low serium Na. Thsi is..
primary polydipsia
A patient presents with polyuria, polydipsia and low urine osmolality. Suspect..
central DI
What is the biggest side effect of radioactive iodine therapy?
hypothyroidism
A patient presents with gynecomastia, elevated estrogen and testosterone, decreased FSH and LH and a 1cm nodule in the testis. This is..
leydig cell tumor
A patient left untreated with a toxic adenoma is at increased risk for…
bone loss, cardiac arrhythmias
A patient presents with increased free serium T3 and T4 as well as normal TSH and cold intolerance, fatigue, weight gain, constipation. This is..
generalized resistance to thyroid hormones
What antibodies are present in Hashimoto’s thryoiditis?
anti - TPO
A patient presents with AMS, rapid deep breathing, weight loss and excessive water intake. This is..
DKA with kussmaul’s expiration
Hypothyroidism is associated with what other lab abnormalities?
hyperlipidema, hyponatriemia, elevated CK, elevated LFTs
