Endocrine Flashcards
high cortisol, low ACTH
ACTH-independent Cushing’s
most common cause of ACTH-dependent Cushing’s
pituitary adenoma
high cortisol, high ACTH
ACTH-dependent Cushing’s
causes of ACTH-independent Cushing’s (4)
adrenal hyperplasia
neuroendocrine tumors
other hyperplasia
pheochromocytoma
definitive test for Cushing’s
24h urine free cortisol
gold standard for Cushing’s
dexamethasone suppression test
Cushing’s rx (3)
Mitotane
Ketoconazole
Metyrapone
cosyntropin stimulation test uses
adrenal hypofunction
Cushing’s
adrenal insufficiency
clonidine suppression test use
diag. of pheochromocytoma
hallmark tetrad of adrenal insufficiency
weakness/fatigue
wt loss
hyperpigmentation
hypotension
weakness, fatigue, hypoglycemia, wt. loss, N/V, abd pain
glucocorticoid deficiency
hyponatremia, salt craving, hypovolemia, orthostatic hypotension, hyperkalemia, mild metabolic acidosis
mineralocorticoid deficiency
loss of axillary and pubic hair in females, amenorrhea
adrenal androgen deficiency
low cortisol, high ACTH
adrenal gland failure
low cortisol, low ACTH
hypopituitarism
gold standard for adrenal insufficiency
cosyntropin stimulation test
salivary sampling expected results for Cushing’s
high nighttime cortisol
salivary sampling results for adrenal insufficiency
low morning cortisol
adrenal insufficiency tx (5)
hydrocortisone prednisone dexamethasone fludrocortisone DHEA creams/oral
HTN, hypokalemia, muscle weakness, parestesias, headache, polyuria, polydipsia
Primary Hyperaldosteronism
labs: increased plasma and urine aldosterone, low plasma renin
Primary hyperaldosteronism
headache, sweating, palpitations, paroxysmal HTN
pheochromocytoma
pheochromocytoma tx (2)
IV nitro & B-blocker for acute attacks/control
Surgery is definitive treatment
inhomogenous w/ central necrosis, unilateral, diameter > 4 cm, calcifications, low lipid content
adrenal carcinoma
sign of metastases on adrenal incidentaloma
bilateral
when to resect benign adrenal incidentalomas
> 2 cm
most common pituitary adenoa
Prolactinoma
tx for prolactinomas (3)
dopamine agonists: Bromocriptine & Cabergoline
surgery
radiotherapy
increased risks with GH-secreting adenomas? (3)
DM
HTN
CAD
imaging finding on acromegaly (4)
enlarged sella
frontal bossing
thickened skull
tufting of terminal phalanges
labs for acromegaly/gigantism
random serum IGF-1: for adenoma
1 hr glucose tolerance test
Prolactin levels
GH-secreting pituitary adenoma tx (4)
Somatostatin analogs (Octreotide & Lanreotide)
Dopamine agonists (Bromocriptine & Cabergolide)
GH receptor antagonist (Pegvisomant)
transsphenoidal microsurgery & radiation
slower growth rate, height below 3rd percentile, normal body proportions, chubby build, immature face
pituitary dwarfism
reduced energy, depressed mood, emotional changes, decreased libido… similar to aging
GH deficiency in adults
ACTH deficiency with atrophic pituitary gland
ACTH stimulation test result
negative
ACTH stimulation test result with a functional pituitary gland but an ACTH deficiency
positive
tx for ACTH deficiency (2)
hydrocortisone
prednisone
tx for TSH deficiency
Levothyroxine
tx for gonadotropin deficiency (4)
OCPs
estrogen
progesterone
testosterone
stalk effect
compression of pituitary stalk –> decreased dopamine –> increased prolactin
common cause of elevated prolactin
stalk effect –> decreased dopamine
sulfonylureas (2)
Glipizide (Glucotrol XL)
Glimepiride (Amaryl)
Meglitinides (2)
Repaglinide (Prandin)
Nateglinide (Starlix)
two drug classes of insulin secretagogues
sulfonylureas
meglitinides
side effects of Metformin (4)
iodine contrast risk
lactic acidosis
intense diarrhea
minimal weight gain
TZDs (2)
Proglitazone (Actos)
Rosiglitizone (Avandia)
a-glucosidase inhibitors (2)
Acarbose (Precose)
Miglitol (Glyset)
drug classes of insulin sensitizers (3)
biguanides
TZDs
a-glucosidase inhibitors
incretin mimetic
Exenatide (Byetta)
indications for Exenatide (Byetta)
failed metformin, sulfonylurea, or both
useful in type 1 and type 2 diabetes
Pramlintide acetate (Symlin)
DPP-4 inhibitors (2)
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
SGLT2 inhibitors (2)
Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
signs of microvascular dz in DM (3)
retinopathy
nephropathy
neuropathy
rebound hyperglycemia due to nocturnal hypoglycemia
Somogyi phenomenon
insulin lispro onset, peak, and effective duration
onset: <15 min
peak: 1 hr
effective duration: 2-4 h
regular insulin onset, peak, effective duration
onset: 0.5-1 hr
peak: 2-3 hr
effective duration: 3-6 h
NPH onset, peak, effective duration
onset: 2-4 h
peak: 6-12 h
effective duration: 10-16 h
glargine onset, peak, effective duration
onset: 1-2 h
peak: no peak
duration: 20-24+ h
dopamine agonists (2)
Bromocriptine
Cabergoline
somatostatin analogs (2)
Octreotide
lanreotide
GH receptor agonist
Pegvisomant
most common type of thyroid cancer
papillary
painful glandular enlargement w/ dysphagia
assoc. w/ viral illness
thyroiditis
diagnostic signs of hypoparathyroidism (2)
Chvostek sign
Trousseau phenomenon
symptoms of hyperparathyroidism (4)
bones, stones, moans, groans
1 cause of hyperparathyroidism
parathyroid adenoma
hyperthyroidism tx (4)
methimazole
PTU
radioiodine ablation
surgery
HbA1c for diabetes diagnosis
6.5%
fasting plasma glucose for diabetes diagnosis
126 mg/dl or greater
random plasma glucose for diabetes diagnosis
greater than 200
with symptoms of hyperglycemia
sweating, tremor, tachycardia, anxiety, hunger
dizziness, headache, clouded vision, confusion, seizures, coma
hypoglycemic symptoms
when are you safe to increase the bedtime insulin dose?
if blood sugar drops between 2-4 am
