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Internal Med EOR > Endocrine 3 > Flashcards

Endocrine 3 Flashcards

1
Q

Paget disease of the bone is also known as

A

osteitis deformans

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2
Q

what is Paget disease of the bone

A

abnormal bone remodeling in aging bones (increased osteoclast bone resorption and disordered osteoblastic bone formation) leading to focal areas of larger, weaker bone formation

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3
Q

sx Paget disease of the bone

A

most asx
incidentally high alkaline phosphatase

bone pain - MC
skull enlargement –> deafness (compression of CN 8), HA, osteosarcoma is rare

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4
Q

dx Paget disease of the bone

A

isolated markedly elevated alkaline phosphatase

increased urinary pyridinoline and N-telopeptide
increased serum C-telopeptide

plain radiograph

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5
Q

what will plain radiograph show for Paget disease of the bone

A

lytic phase - blade of grass or flame shaped lucency
sclerotic phase - increased trabecular markings
skull radiographs - cotton wool appearance - sclerotic patches that are poorly defined and fluffy as a result of thickened, disorganized trabecular, which leads to sclerosis in previously Lucent bone

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6
Q

tx Paget disease of the bone

A

asx - usually no tx
bisphosphanates first line
vit D and calcium supplemention during bisphosphonate tx

NSAIDs for pain

Calcitonin if unable to take bisphosphonates

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7
Q

what is pheochromocytoma

A

catecholamine-secreting tumor arising from the adrenal medulla

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8
Q

what percent of pheochromocytoma are benign

A

90%

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9
Q

what does pheochromocytoma secrete

A

norepinephrine
epinephrine
dopamine

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10
Q

sx pheochromocytoma

A

HTN MC
PHE - palpitations, HA, excessive sweating

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11
Q

dx pheochromocytoma

A

step 1 - biochemical testing
metanephrines - measurements for elevations in urinary and plasma fractionated metanephrines and catecholamines

step 2 - imaging
abdominal imaging - MRI or non contrast CT abdomen and pelvis to locate tumor after testing

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12
Q

tx pheochromocytoma

A

1 - nonselective alpha blockade (phenoxybenzamine or phentolamine followed by BB or CCB to control BP prior to surgery)
2 - BB
3 - surgery - definitive

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13
Q

what is the MC pituitary adenoma

A

prolactinoma

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14
Q

sx prolactinoma

A

women - oligomenorrhea, amenorrhea, infertility, decreased libido, galactorrhea

men - decreased libido, erectile dysfunction, infertility, oligozoospermia

HA
bitemporal hemianopsia

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15
Q

labs for prolactinoma

A

increased prolactin
decreased LH, FSH

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16
Q

tx prolactinoma

A

dopamine agonists - cabergoline or bromocriptine

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17
Q

somatotroph adenoma

A

growth hormone secreting pituitary adenoma that leads to acromegaly or gigantism

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18
Q

sx somatotroph adenoma

A

DM or glucose intolerance
enlargement of soft tissues, cartilage, bone –> increased ring size, shoe, hat size

HTN
HA
bitemporal hemianopsia
colonic polyps

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19
Q

dx somatotroph adenoma

A

insulins-like growth factor (IGF-1) initial test - increased

confirmatory - oral glucose suppression test - failure of GH suppression within 1-2 hours of an oral glucose load

MRI imaging of choice

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20
Q

tx somatotroph adenoma

A

transsphenoidal surgery

octretodie or lanreotide first line medical - somatostatins inhibit GH release

dopamine agonists - bromocriptine or cabergoline - dopamine inhibits GH

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21
Q

corticotroph adenoma is also called

A

Cushing’s disease

22
Q

what is corticotroph adenoma

A

ACTH secreting pituitary adenoma that leads to hypercortisolism

23
Q

sx corticotroph adenoma

A

proximal muscle weakness
weight gain
HA
oligomenorrhea
erectile dysfunction
polyuria
osteoporosis
mental disturbance

24
Q

what distinguishes Cushing’s disease from other causes of crushing’s syndrome

A

increased baseline ACTH + suppression of cortisol ion high-dose dexamethasone suppression test = Cushing’s disease

25
tx corticotroph adenoma
transsphenoidal resection of the pituitary tumor
26
meds that cause iatrogenic hypothyrodism
amiodarone interferon alfa lithium Propylthiouracil and methimazole
27
what characterizes subclinical hypothyroidism
isolated increased TSH - give levo if TTSH 10 mIU/L or higher normal free T4
28
dx hypothyroidism
increased TSH + decreased free T4 or T3 positive antithyroid peroxidase and/or anti-thyroglobulin antibodies bx - lymphocytic infiltration w germinal centers and hurthle cells (enlarged epithelial cells w abundant eosinophilic granular cytoplasm)
29
how often should you monitor TSH after starting levo
every 6 weeks when initiating or changing dose
30
ADE levo
cardiovascular effects w overshoot - A fib osteoporosis
31
what is euthyroid sick syndrome
abnormal thyroid function tests in patients w normal thyroid function most commonly seen w severe non-thyroidal illness (sepsis, cardiac, malignancies) low T3 syndrome - decreased free T3 and increased reverse T3 most common tx and management of underlying dz
32
what is subacute thyroiditis
inflammation of the thyroid gland characterized by neck pain, a tender diffuse goiter, and transient thyrotoxicosis often occurring after a viral infection
33
sx subacute thyroiditis
hyperthyroidism is usually initial presentation followed by euthyroidism then hypothyroidism then restoration of normal thyroid function neck pain or discomfort + sore throat URI sx - low grade fever, myalgias, malaise, fatigue, anorexia
34
PE subacute thyroiditis
diffusely tender goiter
35
dx subacute thyroiditis
high ESR + negative antibodies hyperthyroid profile early in disease
36
tx subacute thyroiditis
supportive NSAIDS or aspirin for pain and inflammation
37
what is suppurative thyroiditis
bacterial infection of the thyroid gland by gram-positive bacteria (staph aureus MC) or gram-negative
38
sx suppurative thyroiditis
thyroid pain and tenderness - sudden onset; may have overlying erythema fever, chills, pharyngitis
39
dx suppurative thyroiditis
leukocytosis and increased ESR thyroid function tests usually normal fine needle aspiration w gram stain and culture thyroid US
40
tx suppurative thyroiditis
abx surgical drainage if fluctuant
41
what is graves disease
autoimmune dz which primarily affects the thyroid gland, characterized by hyperthyroidism due to an increase in synthesis and release of thyroid hormones due to thyroid stimulating autoantibodies
42
what is MC cause of hyperthyroidism in US
graves
43
dx graves disease
decreased TSH + increased free T4 or T3 thyroid stimulating immunoglobulins (TSH receptor antibodies) hallmark radioactive uptake scan - increased iodine uptake
44
what is the MC type of thyroid CA
papillary thyroid carcinoma
45
risk factors for papillary thyroid carcinoma
ionizing radiation exposure of head and neck - esp in childhood increase age
46
fine needle aspiration papillary thyroid carcinoma
the 2 hallmark morphological features of conventional PTC are the papillae and nuclear findings. neoplastic epithelial lining and cells organized into papillary fingers. nuclear grooves, ground glass/empty nuclei (orphan Annie nuclei) and the presence of psammoma bodies (calcifications)
47
tx papillary thyroid carcinoma
thyroidectomy usually followed by post levothyroxine
48
what is the least aggressive type of thyroid CA
papillary thyroid carcinoma
49
important things about follicular thyroid CA
generally more aggressive than papillary but also slow-growing distant METS are more common than local METS - lung most common ; think follicular = FAR
50
how does follicular thyroid carcinoma present
single asx painless thyroid nodule with or without thyroid gland enlargement
51
tx follicular thyroid carcinoma
thyroidectomy followed by postop levo
52

Internal Med EOR (17 decks)

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