Endocrine Flashcards
What causes increase of TBG? Decrease?
more with preggers and OCP. So more T4 is made to keep T4
Free T3/T4 are normal even in hepatic failure
Toxic adenoma or toxic multinodular goiter shows what on scan? Tx?
Increased thyroid uptake. Tx by thionamides again or radioactive iodine or resection
Tx of subacute thyroiditis?
Supportive. NSAIDs and bta blocker if needed for symptoms. IT IS TRANSIENT
Beta blockers can help with hyperthyroid symptoms
Amiodorone can do what to thyroid?
Hperthryroid. Check TFT, LFT and PFTs with it
Tx of thyroid storm?
Beta blockers
Thionamides
IV sodium iodid
Glucocorticoids reduce T4-T3 transition!!!
If you had to chose how to treat Graves, what would you do?
radioctive iodine
What is silent thyroiditis?
Temporary painless goiter with hyperthroiditis. IT IS SELF LIMITED
Most common cause of hypothyroid?
Hashimoto
What do you ee on biopsy of hashiomtos?
Tx of it
Lymphocytic infiltrates and fibrosis
Tx with levo forever
Cretinism scan?
Decreased uptake. IT is too late to save it, so Tx is TO THYROID REPLACEMENT
Subacute thyroiditis is what
De Quarvain from viral stuff
First step to palpable thyroid?
TSH, Free T4, US to look for others
If hyperthyroid, do radioactive scan. If hot, treat as hyperthyroid.
IF COLD or anything euthyroid or hyperthyroid, do FNA
Do thyroid cancers make excess thyroid?
NOOOOO SO IF SCAN IS HOT, it is not cancer!!
What is a toxic adenoma?
Noninvasive! not cancer. Hot ndule is seen
What if FNA is benign thyroid nodule?
Repeat workup in a year to make sure not growing, if it did, repeat FNA
Most common cancer?
Papillary. Follicular variant can be invasive, but rare
MEdullary thyroid carcinoma release what?
PArafolilcular cells. Associated with MEN
Malignant thyroid tx?
Surgical resection followed by radioidone ablation!
Hypothyroidism can lead to high ldl and total cholesterol!
OH OK Right Brain Bonus
what does PTH tell kidney to do?
More calcium reasorption, less phosphate reabsorption
More 25-OH to be made to 1,25 OH vit D
Vit D helps reabsorb phosphate
Rickets X ray shows what?
Bowing at the knees, legs bent out sideways
Symptoms with hypercalcemia:
Bones Stones Mones and Psych overtones
Groans is constipation, N/V, ulcers (gastrin b/c high calcium), PANCREATITIS
Psych is lethargy, depression psychosis….
Treatment of secondary hyperparathyroidism
Limit oral phosphate, Phosphate binders with meals: CaCO3, or calcium acetate
If you limit phosphatemia, then there is less bone resorption!
Calcitriol helps reduce PTH secretion
Tx of hypoparathyroidism? It makes sense dude
Calcitriol (1,25 D3) b/c kidney can’t make this!
Calcium
What is Albright’s hereditary osteodystrophy? What does it look like?
From pseudohypoparathyroidism
Autosomal dominant with maternal imprinting (if from mom, they will have it!!, if from dad only partial)
findings: short, short 4th metacarpal, developmental delay, OBESITY
Tx: Calcium, Vit D Calcitriol
What is cinacalcet?
Mimics calcium so PTH is lowered!
Vit D deficiency does what to labs for Ca PTH and phosphate?
Low Ca, High PTH, low Phosphate
Cabergoline?
DA agonist used for prolactinoma is the better one
Tx of prolactinoma?
Cabergoline then promo, if those don’t work, then surgery
Dx of acromegaly?
IGF1 is more consistent.
Do oral glucose suppression test, then measure GH at 1 and 2 horus, if stays high, it is ACROMEGALY
Do pituitary MRI after that!!
Major complication of acromegaly?
HTN/DM can lead to cardiac failure. Also can have spinal cord compression
INSULIN RESISTANCE WITH IT!
Tx for acromegaly?
Surgery, if not successful, use somatostatin analog
Octreotide or lanreotide (inhibits GH secretion)
Can follow ILGF to see if it works
if no working, try cabergoline
PEGVISOMANT is if all that fails which is GH antagonist
Sheehan syndrome is what?
postpartum hemorhage with blood lose causing infarct of pituitary.
Lethargy, no lactation after delivery
No menses
May have fatigue, anorexia, weight loss
Empty sella is what?
It is empty on MRI, screen hormones. Often still functional hormones crunched up on there
Tx of hypopituitarism?
Replace deficient hormones
GH in children Hypogonadism give test or est maybe Pulstaile GnRH can help for preggers Hypothyrodism give Levo ACTH give cortisol!!!
Most common presentation in prolactinoma?
Hypogocnadism
Cushing complications
CV, dm, HTN, thromboembolic, infection, osteoporosis, avascular necrosis of hip
Dx of cushing
24 urinary cortisol. Late night salivary
Dex suppression test
Dexamethasone suprresion test
1 mg at night, if it lowers cortisol next morning, then pituitary was lowered an not due to intrinsic cause
If still high, try high dose and see if that lowers it and if cortisol is suppressed, it is pituitary, if not check ACTH. If high, it is ACTH making tumor (like small cell), if not, it is a adrenal tumor
Corticotrophin pituitary tumor tx?
Surgical removal and if not successful, do tradition
CONSIDER MIGHT NEED CORTISOL THEREPY LATER ON!
Conn syndrome is what?
Hyperaldosteronism.
Primary is from adrenal tumor
HTN, Hypokalemia and metabolic alkalosis?
Conn syndrome!
Secondary hyperaldosteronism is from what?
Secondary from increased activity of RAAS (renin and ACE action making more ang II).
Kidneys think low blood pressure, so renal artery stenosis, Left sided CHF, Nephrotic syndrome, Cirrhosis (less intravascular volume in the latter 2)
What does aldosterone to renin ratio tell you?
Conn syndrome (primary) is high aldosterone, low renin
Secondary is high aldosterone: high renin
PAC: PRA high is what?
Primary hyperaldosteronism
Plasma aldosterone concentration: Plasma renin activity
PAC low and PRA low?
Means stimulation of aldosterone receptor, consider cortisol or something like that!
Or lots of licorice (think people eating it from another country)
Tx of hyperaldosteronism?
Treat underlying cause, or surgery or spironolactone until definitive tx is done
Where is DHEAS made?
Only in adrenals
Tertiary adrenal insufficiency is what? From what?
Hypothalumus not making CRH. From chronic corticosteroid use
Increased skin pigmentation and hypotensive?
Easy to remember
Addisons.. primary. Autoimmune
EASY TO REMEMBER b/c POMC released and broken into ACTH and MSH (melanocyte stim hormone). So high ACTH and high MSH SO YHOU GET TAN
Eosinophilia sometimes happens with what adrenal issue?
Hypoaldosteronism
What is cosyntropin?
ACTH analog to stim aldosterone to determine if primary or not. WAS ON Q BANK
Adrenal insufficiency treatment
Glucocorticoids, mineralocotricoids (fludrocortisone)
Extra cortisol during stress (illness or MI or surgery or whatever(
Addisonian crisis is what?
history of adrenal insufficiency and SEVERE weakness fever, mental status change vascular collapse.
Get it b/c not met cortisol need during stress
Tx: glucose, hydrocortisone, can use vasopressors if in shock
Mnemonic for CAH defficiencies?
If starts with a 1 it causes hypertension
If ends in a one, you have virilization
17 alpha hydroxylase symptoms
Tx?
HTN, no sex hormones (does not end in a 1)
Ambiguous genitalia in boys
Amenorrhea in girls
Tx with cortisone to suppress ACTH
21 alph hydroxylase deficiency
No htn (Actually you have hypotension). SALT WASTING
Women have virilization (ends in 1) and female infants ambiguous genitalia
Boys can have precocious puberty
Dehydration and HYPOTENSION possible
Low Na and increased K+ with increased androgen
11 beta hydroxylase deficiency
Virilization, Hypertension
EXCESS deoxycorticosterone (has mineralocorticoid activity)
Newborn ambiguous genitalia?
Check serum potassium to treat quickly.
Treat with cortisol replacement!!!
Palpitations, chest pain, diaphoresis, headache?
PHEO
Pheo dx?
24 hour urine catecholamines: metanephrine, normetanephrine, VMA
Pheo tx?
Alpha blocker first, then beta blocker
PHENOXYBENZAMINE or PHENTOLAMINE first, then can give beta blockers
carvedilol or labetalol have weak alpha blocking affects
MEN mnemonic. RET proto oncogene THINK MEN 2a and 2B
MEN 1 PPP (diamond)
Parathyroid
Pituitary
Pancreas
MEN 2A PPM (square)
Parathyroid
Pheo
Medullary
MEN 2B PMM (triangle)
Pheo
Medulary
Mucosal neuroma
If you see ret, you think what?
MEN2a and MEN2b
