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Endocrine Flashcards

1
Q

What 2 electrolyte abnormalities cause nephrogenic DI?

A

High calcium
Low potassium

*Block ADH’s effect on kidney

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2
Q

2 ways pituitary can be damaged?

A

Compression (tumors)

Damage (trauma, radiation, stroke, infection)

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3
Q

Prolactin deficiency manifestations in women & men?

A

Women: NO lactation after delivery
Men: nothing

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4
Q

LH or FSH deficiency manifestations in women & men?

A

Women: amenorrhea (no ovulation or menstruation)
Men: erectile dysfxn & decreased muscle mass

Both = decreased libido

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5
Q

What normally inhibits release of prolactin?

A

Dopamine

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6
Q

Decreased FSH/LH from decreased GnRH w/ anosmia?

A

Kallman syndrome

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7
Q

GH deficiency in women & men?

A

Children: short stature
Adults: few symptoms (other stress hormones available)

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8
Q

What electrolyte abnormality is common in panhypopituitarism?

A

Hyponatremia (low sodium): from hypothyroidism & isolated glucocorticoid underproduction

Potassium is NORMAL b/c aldosterone excretes potassium

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9
Q

Explain Metyrapone test?

A

Metyrapone (-) 11-B hydroxylase = no cortisol release in normal person = ACTH levels rise in normal person

In panhypopituitarism, this test causes no change in ACTH (pituitary not working)

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10
Q

Explain insulin test?

A

Normally, insulin decreases glucose and GH (stress hormone) should rise

In panhypopitutarism, don’t have rise of GH

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11
Q

What hormone is affected in DI? Explain difference in central vs nephrogenic?

A

ADH

Central: no ADH release, but kidney is fine
Nephrogenic: normal ADH, kidney unresponsive to it

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12
Q

Common causes of nephrogenic DI?

A 
Hypercalcemia
Hypokalemia
Lithium
Amyloidosis
Myeloma
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13
Q

Explain serum and urine findings for Na levels and osmolarity?

A

Serum Na = high (water loss)
Serum osm = high (water loss)
Urine Na = low (dilute)
Urine osm = low (dilute)

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14
Q

What symptoms result from hypernatremia?

A

CNS

Confusion, disorientation, lethargy, coma

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15
Q

Vasopressin effect on central vs nephrogenic DI?

A

Central: urine becomes concentrated and serum less dilute (ADH can work on functioning kidney)

Nephrogenic: NO changes (still dilute urine b/c no effect of ADH on kidney)

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16
Q

Treatment for central & nephrogenic DI?

A

Central: vasopressin (desmopressin)
Nephrogenic: correct underlying cause (hypercalcemia, hypokalemia)
*HCTZ, amiloride, NSAIDs –> alters renal countercurrent concentrating ability and causes concentration of urine / NSAIDs block prostaglandins

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17
Q

Most common cancer associated w/ acromegaly?

A

Colon cancer

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18
Q

Signs of acromegaly?

A 
Increasing hat, ring, shoe size
Carpel tunnel
Teeth widening
Deep voice
Body odor
Joint pain
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19
Q

Best initial test for acromegaly?

A

IGF level

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20
Q

What hormone is co-secreted w/ GH?

A

Prolactin

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21
Q

Tx of choice for acromegaly?

A

1) Surgery

2) if surgery fails –> medication (pegvisomant = GH receptor blocker)

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22
Q

Causes for hyperprolactinemia?

A 
Co-secretion w/ GH
Hypothyroidism --> high TRH level stimulates prolactin secretion
Pregnancy
Antipsychotic drugs
Methyldopa
Opioids
Verapamil
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23
Q

Signs of hyperprolactinemia in women and men?

A

Women: galactorrhea, AMENORRHEA, infertility
Men: erectile dysfxn, decreased libido

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24
Q

Diagnostic tests for hyperprolactinemia?

A

Thyroid function tests
PREGNANCY test
BUN/Ct (kidney disease elevates prolactin)
LFTs (cirrhosis elevates prolactin)

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25
Q

Treatment of hyperprolactinemia?

A

Dopamine agonists –> Cabergoline

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26
Q

What drug causes hypothyroidism?

A

Amiodarone

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27
Q

Hypothyroidism SLOWS everything down in the body except what?

A

Menstrual flow (increased)

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28
Q

Thyroid studies in hypothyroidism?

Tx for hypothyroidism?

A

Elevated TSH
Low T4

Tx: levothyroxine (synthroid)

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29
Q

What form of hyperthyroidism has eye and skin findings? What are they?

Best initial therapy?

A

Graves disease –> most common cause of double vision over 50 yo
*TSH receptor autoantibodies

Proptosis
Myxedema

Initial therapy = STEROIDS (decrease glycosaminoglycan deposition behind the eyes)

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30
Q

Form of hyperthyroidism with:
Tender nodule?
High TSH?

A

Tender nodule = subacute thyroiditis

High TSH = pituitary adenoma

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31
Q

Treatment for:
Graves?
Subacute thyroiditis?

A 
Graves = radioactive iodine
Subacute = aspirin
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32
Q

Treatment of thyroid storm/acute hyperthyroidism?

A

1) Propranolol –> inhibits target organ effect, inhibits peripheral conversion of T4 –> T3
2) Methimazole or PTU
3) Iodinated contrast material - blocks peripheral conversion of T4 –> T3 and blocks release of existing hormone (acts to clog up the thyroid gland)

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33
Q

If a thyroid nodule is found, what is first thing to assess?

A

1) Is it HYPER-functioning by TSH/T4

2) If normal = biopsy

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34
Q

First sign to presence of Diabetes Insipidus (DI)?

A

High volume NOCTURIA

35
Q

MEN 2A characterized by what 3 entities?

MEN 2B characterized by what 2 entities?

A

MEN 2A:

 1) Medullary thyroid cancer
 2) Pheo
 3) Hyperparathyroidism (high calcium)

MEN 2B:

1) Medullary thyroid cancer
2) Pheo
3) Ganglioneurmatosis
36
Q

Why are Cushing syndrome/disease patients at increased risk of DVT?

A

Increased Factor 8 and vWF complex with decreased fibrinolytic activity

37
Q

Hypothyroidism can cause what metabolic abnormalities?

A

Hyperlipidemia –> due to decreased LDL surface receptors and/or decreased LDL receptor activity

38
Q

Treatment of AFib in hyperthyroidism?

A

B-blocker (because of increased sensitivity of beta-receptors to sympathetic stimuli)

39
Q

Diabetes medication that is also used for weight loss?

A

GLP-1 agonist (glucagon like peptide)

*some association w/ pancreatitis

40
Q

What hormone is elevated in patients with androgen-producing adrenal tumors?

A

DHEA-S

41
Q

What are Charcot joints?

What are exam findings?

A

Neuropathic damage from diabetes or syphilis resulting in loss of feeling –> progressive damage to feet

Deformity, joint damage w/ swelling and osteophytes on xray

42
Q

How will TSH, T3/T4, and radioactive nucleotide uptake values look in exogenous thyroid hormone ingestion?

A

Factitious thyrotoxicosis –> NO goiter or exophthalmos
LOW TSH
HIGH T3/T4
RAIU LOW

43
Q

Person with hypothyroidism develops amenorrhea and galactorrhea - why?

What other neurotransmitter can cause the same effects?

A

Hypothyroidism –> increased secretion of TRH (which stimulates TSH) –> TRH (+) prolactin secretion = amenorrhea/galactorrhea

*Serotonin & TRH

44
Q

After surgery, person develops tachycardia, HTN, fever, tremor in her hands, altered mental status, and lid lag. What is it? What is best initial test?

A

Thyroid storm

Thyroid function tests & propranolol

45
Q

What presents as galactorrhea and amenorrhea in women and hypogonadism in men?

What is the primary treatment?

A

Prolactinoma

*Dopamine agonists –> dopamine (-) prolactin secretion
Bromocriptine, cabergoline

46
Q

What is non-ketotic hyperosmolar syndrome?

What other systemic effects can it cause?

A

Stress situations (e.g. infection) causes elevation of cortisol and catecholamine levels –> increased glucose levels WITHOUT ketonuria

The hyperglycemia causes osmotic diuresis –> serum hyperosmolarity

Acute hyperglycemia can cause blurred vision due to myopic increase in lens thickness and intraocular hypotension secondary to hyperosmolarity

47
Q

27 male started on thiazide after coming to ER with BP of 157/93. He later develops hypokalemia while his BP remains elevated. What is the next best step in evaluation?

A

Serum renin and aldosterone levels

48
Q

How does a pituitary adenoma respond to dexamethasone suppression test?

A

Is suppressed ONLY with HIGH dose dexamethasone!

49
Q

14 yo with Type 1 DM has recent onset fatigue and rash over extensor surfaces of knees and elbows. Labs show Fe-def anemia. What is an appropriate co-screen for this patient?

A

anti-Tissue Transglutaminase antibodies

Celiac disease associated with T1DM

50
Q

How does estrogen affect thyroid levels?

A

Estrogen increases SHBG and decreases the clearance of TBG –> causes increased TBG levels and binds up free T4 in circulation

**if on Estrogen and patient is hypothyroid – need to give MORE levothyroxine!!

51
Q

Most common cause of thyrotoxicosis with reduced thyroid uptake?

A

Subacute granulomatous thyroiditis

*Intense thyroid pain

52
Q

Untreated hyperthyroidism can result in what 2 conditions?

A

Rapid bone loss (increased osteoclast activity)

AFibrillation

53
Q

What treatment modality for Graves disease can initially worsen the exophthalmos?

A

Radioactive iodine –> first few days after RAI, the destroyed thyroid cells release excess thyroid hormone that can temporarily worsen hyperthyroid state

54
Q

Which anti-thyroid medication causes hepatic failure?

A

PTU

55
Q

Person has s/s of myasthenia gravis. What are the appropriate confirmatory tests?

What following test should be ordered?

A

EMG and ACh-antibody receptor test

**CT of chest –> screen for THYMOMA!!!

56
Q

In diabetes, what is the first change to occur in the kidneys?

A

Glomerular hyperfiltration

ACEi help REDUCE intraglomerular hypertension by dilating Efferent arteriole

57
Q

56 yo woman recent developed diabetes and has had wt loss over 6 months with occasional watery diarrhea. She also has eczematous rash around her mouth that has spread to the R thigh - it now appears as erythematous plaques with central clearing and eroded borders. What is the cause?

A

Glucagonoma

*Causes diabetes (high blood sugar), necrolytic migratory erythema, diarrhea, wt loss

58
Q

What are the criteria for metabolic syndrome?

How many need to be present?

A

3 of these 5

1) Abdominal obesity > 40 in (men) >35in (women)
2) Fasting glucose > 100-110
3) BP > 130/80
4) Triglycerides >150
5) HDL

59
Q

How can you differentiate between insulinoma or exogenous insulin use?

A

C-peptide and proinsulin levels

*C-peptide is cleaved from insulin released from pancreas –> NOT present in exogenous insulin!

60
Q

Proper order of treatment for pheo?

A

1) a-blocker (prevent unopposed alpha stimulation and increased BP)
2) b-blocker

61
Q

Side effect of methimazole?

A

Agranulocytosis

62
Q

Episodic flushing is hallmark for what?

Other s/s?

Diagnostic test?

A

Carcinoid syndrome

Flushing, diarrhea, telangectasias, bronchospasm

*Tricuspid regurgitation –> common heart defect

5-HIAA in urine

63
Q

How to differentiate the MEN syndromes?

A

MEN 1 = 3 P’s 0 M (Parathyroid, Pancreas/ZE, Pituitary)
MEN 2a = 2 P’s 1 M (Parathyroid, Pheo, MTC)
MEN 2b = 1 P 2 M’s (Pheo, MTC, Mucosal neuroma, Marfan-like)

64
Q

40 yo man has episodes of palpitations, anxiety, and sweating and he also has hypermobile joints. He has a family hx of thyroid cancer. He has a 4-cm hard thyroid nodule. He also has elevated serum calcitonin and metanephrines. What else must you look for?

What gene is implicated?

A

Mucosal neuromas

*MEN 2B –> MTC, Pheo, Mucosal neuromas, Marfanoid features

RET proto-oncogene

65
Q

Electrolyte abnormality in DKA?

A

Hyperkalemia –> acidosis causes H+ to move intracellularly in exchange for K moving outward

66
Q

What are common s/s in hypothyroidism?

A

Weight gain
Fatigue
Constipation
Concentration changes

67
Q

In someone with hypocalcemia, what initial causes should be considered?

A

Hypoalbuminemia
Hypomagnesiemia
Recent blood transfusion (citrate)
Drugs (phenytoin, bisphosphonates)

68
Q

What should you consider in hypocalcemia with elevated PTH?

A

Vit D deficiency, chronic kidney disease

*Check creatinine to r/o kidney disease + check 25-hydroxy vitamin D levels

69
Q

If someone has muscle weakness, slowed DTRs, and elevated serum CK, what should be the first initial test?

How is this different than polymyositis?

A

TSH/free T4
*SLOW DTRs
Can be proximal muscles, myalgias

*Polymyositis = normal DTRs

70
Q

Person has unexplained elevated CK + myopathy?

A

Hypothyroidism

71
Q

What s/s suggest primary adrenal insufficiency?

What initial test?

Confirmatory test?

A

Hyponatremia, hyperkalemia, anemia
*Increased pigmentation

Basal early morning cortisol & ACTH –> if low cortisol levels need to do confirmatory test

Confirm with Cosyntropin (synthetic ACTH) –> if NO increase in cortisol after administration = Addison

72
Q

Synthetic analogue of ACTH?

Analogue of ADH?

A

Cosyntropin

Vasopressin

73
Q

What electrolyte abnormality is common in chronic steroid use (Cushing syndrome)?

A

Hypokalemia

*Corticosteroids have some mineralocorticoid activity and will bind to aldosterone receptors in the kidney

74
Q

22 yo has hyperthyroidism. She begins PTU therapy. 2 weeks later, she returns with sore throat. She is febrile and exam shows soft palate, pharynx, and tonsils are red and swollen. What is next best appropriate step?

A

STOP PTU –> agranulocytosis can occur –> low WBC and infections can result

75
Q

What antibodies are most prevalent in:

Hashimoto’s?
Graves?

A

Hashimoto’s = anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin antibody

Graves = thyroid-stimulating immunoglobulins (TSI) –> stimulate TSH receptors

76
Q

A person with carcinoid syndrome is at risk for developing a deficiency in what vitamin or mineral?

A

Niacin

*Serotonin is made in carcinoid cells from tryptophan –> tryptophan is used in the production of niacin
Increased tryptophan conversion to serotonin and 5-HIAA = less niacin production

77
Q

Hashimoto’s thyroiditis predisposes you to increased risk of developing which thyroid disorder?

A

Thyroid lymphoma

78
Q

Person with TB develops low Na, elevated K and low glucose on labs. What acid base disturbance would be expected?

A

Normal anion-gap metabolic acidosis

*TB common cause of adrenal insufficiency (Addison)

  • AI –> high K+, high H+, low Na, low glucose
    • Aldosterone deficient = normally acts to save sodium (reabsorption) and secrete K+ and H+
    • No aldosterone = increased K+ and H+ with low Na
79
Q

Acne-like eruption characterized by erythematous follicular papules on the face, trunk, extremities and comedones are NOT present. What is the cause?

A

Steroid use

80
Q

20 yo male with mild gynecomastia and enlarged spleen. Labs show elevated Hct with normal WBC and platelet count. What is the most probable cause?

A

Steroid drug abuse (androgens are steroid-derived)

  • Gynecomastia, testicular atrophy, aggressive behavior
  • Erythrocytosis, hepatotoxicity
81
Q

38 yo male on steroids for sarcoidosis develops progressive R hip pain present on wt bearing and at rest. He has signs of Cushing disease. What is the most likely cause of his hip pain?

A

Disruption of bone vasculature from steroid use

82
Q

Person has palpitations and wt loss, HTN and tachycardia. Thyroid has 2x2cm L-sided thyroid nodule. T3/T4 are elevated and TSH is undetectable. RAI scan shows uptake in L thyroid nodule; remained of thyroid is reduced. What is the most likely diagnosis?

A

Toxic adenoma

*Thyroxicosis = RAI shows uptake in adenoma only with remainder of gland suppressed

83
Q

Pathophys behind familial hypocalciuric hypercalcemia?

A

Abnormal Ca-sensing receptors on the parathyroid cells and renal tubules
Parathyroid –> blocks normal Ca-induced PTH suppression = high/normal PTH levels
Renal tubules –> defective Ca-sensing receptors cause excess Ca reabsorption = LOW urinary Ca levels

Urine Ca/Cr ratio =

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