Endocrine Flashcards
Prolactinoma
A tumor that produces prolactin. Causes galactorrhea, loss of peripheral vision, decreased libido. Can also be caused by meds, hypothyroidism.
How to treat prolactinoma
Bromocriptine or surgery
How does hypothyroidism cause prolactinoma?
Because TRH (increased in hypothyroidism) stimulates prolactin release from anterior pituitary
Hormones produced by anterior pituitary
ACTH, TSH, GH, LH/FSH
Hormones produced by the posterior pituitary?
Oxytocin and ADH.
Acromegaly
Tumor producing GH. Causes gigantism in children, causes acromegaly in adults with diabetes, diastolic heart failure
How to diagnose acromegaly?
Look at IGF-1 level, confirm with MRI, also glucose suppression test
Glucose suppression test
Glucose challenge, GH should decrease. In acromegaly it doesnt.
How to treat acromegaly?
Octreotide or surgery.
Acute hypopituitarism caused by? Presentation?
Infection, infarction (sheehan’s, apoplexy), surgery, radiation
Presentation: lethargy, coma, hypotension.
Empty sella syndrome
Pituitary is outside sella but still functions.
How to treat empty sella syndrome?
Do nothing
Chronic hypopituitarism caused by?
Autoimmune disease, deposition, cancer
Presents with decreased libido, decreased GH. Much less severe.
How to diagnose chronic hypopituitarism
Insulin stimulation test, with insulin, GH and epi should increase
SIADH
Brain lesion produces lots of ADH, water retained, very concentrated urine, decrease in serum osms.
How to treat SIADH
Demeclocycline, vaptans, stop taking drug, water restriction
Diabetes insipidus
Polydipsia, polyuria, normal BG, diagnose with water deprivation test.
How to treat central diabetes insipidus?
Vasopressin
How to treat nephrogenic diabetes insipidus?
Gentle diuresis.
How to conduct water dep test?
Deprive water, measure U osm. if increases, then polygenic polydipsia. Then add ADH, if U osm increases, then Central DI. If it doesn’t then nephrogenic DI.
Symptoms of hyperthyroidism
Tachycardia, diarrhea, increased DTRs, heat intolerance, weight loss, +/- afib
How to diagnose hyperthyroidism
Decreased TSH, increased free T4, increased radioactive iodine uptake.
Graves disease
Autoimmune with antibody stimulation, diffuse growth of thyroid with diffuse radioactive iodine uptake. Exopthalmos and pretibial myxedema.
Thyroid storm
Shock, fever, delirium after a stress.
How to treat thyroid storm?
IVF + cooling blankets, PTU/Methimazole, B blocker, IV steroids.
Then surgery and iodine ablation.
Thyroiditis
Transient hyperthyroidism followed by hypothyroidism. Can heal or can become hashimotos.
Hypothyroidism
Bradycardia, constipation, decreased DTRs, cold intolerance, increased weight.
Caused by hashimotos, iatrogenic
Myxedema coma
Shock, cold, coma
Treat with IVF, warm blankets, T4 and T3.
How to work up thyroid nodules
If the patient is elderly or has radiation exposure in the past, do an FNA. Otherwise check a TSH/T4.
If TSH and T4 is normal, do an FNA, if TSH is down, do an RAIU scan.
If RAIU is positive, then resect the hot nodule.
If RAIU is negative, do a FNA.
Papillary carcinoma
Orphan annie eyes, psammoma bodies. Most common. Tx resect
Follicular carcinoma
FNA may appear normal, hematogenous spread. Treat with I2 ablation
Medullary carcinoma
C cells produce calcitonin. Common in MEN2A/@B.
Anaplastic carcinoma
Elderly, fatal
