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Step 2 CK > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Causes of panhypopituitarism

A

Anything that damages the brain

  • Tumor
  • Infection
  • Trauma
  • Stroke
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2
Q

In what order are hormones lost in the pituitary

A

GH, and LH, FSH first

ACTH last

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3
Q

Results of LH, FSH deficiencies

A

W - Amenorrhea
M - No testosterone or sperm, ED, decreased muscle
Both have decreased libido, body hair

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4
Q

Kallman syndrome points

A

Decreased GnRH causing decreased LH, FSH
Anosmia
Renal agenesis (50%)

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5
Q

Presentation of GH deficiency

A

Children - Short stature

Adults - Central obesity, Increased LDL, chol, Reduced lean muscle

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6
Q

Features of pituitary apoplexy

A

Prior adenoma
HA
Changing MS
Send to ICU for hormone replacement

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7
Q

What is Sheehan

A

Postpartum pituitary necrosis

Can’t lactate

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8
Q

Confirmatory test for low TSH and thyroxine

A

Decreased TSH response to TRH

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9
Q

Confirmatory test for decreased ACTH and cortisol

A

Normal response to cosyntropin stimulation
No response w/ CRH
Elevated cortisol excludes pituitary problem

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10
Q

Confirmatory test for Low GH

A

No response to arginine

No response to GHRH

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11
Q

Confirmatory test for low prolactin

A

No response to TRH

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12
Q

Failure of GH to rise in response to insulin

A

Pituitary insufficiency

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13
Q

What does metyrapone do

A

ACTH levels rise

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14
Q

Hormonal problems in empty sella

A

NONE

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15
Q

What is diabetes insipidus

A

Decrease in ADH amount or function on kidneys

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16
Q

Causes of central DI

A

Any destruction

  • Stroke
  • Trauma
  • Hypoxia
  • Infiltration
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17
Q

Causes of nephrogenic DI

A

Chronic pyelo
Amyloidosis
Myeloma
Sickle cell

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18
Q

Drugs inducing NDI

A

Li
Demeclocycline
Colchicine

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19
Q

Metabolic changes inducing NDI

A

Hypercalcemia

Hypokalemia

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20
Q

Presentation of DI

A

High volume urine
Excessive thirst
Volume depletion
Hypernatremia

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21
Q

What causes neuro sx in SI

A

Hypernatremia

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22
Q

What does water deprivation test show in DI

A

Urine osmolality doesn’t increase

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23
Q

Vasopressin effect in CDI

A

Decrease urine volume

Increase urine osmolality

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24
Q

Vasopressin effect in NDI

A

Nothing

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25
Q

Obscure manifestation of NDI

A

Loss of access to water

- NPO before surgery

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26
Q

Rx CDI

A

Long term desmopressin

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27
Q

Rx NDI

A

Treat underlying cause

HCTZ, amiloride, NSAIDs

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28
Q

What is acromegaly

A

Overproduction of GH

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29
Q

MCC acromegaly

A

Pituitary adenoma

Can be part of MEN

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30
Q

2 Conditions causing B/L carpal tunnel syndrome

A

Acromegaly

Hypothyroidism

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31
Q

Features of Acromegaly

A 
B/L carpal tunnel
Increasing hat/shoe/ring size
Coarse facial features
Macroglossia
Colon polyps
HTN
Cardiomegaly/CHF
Bitemporal hemianopsia
ED
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32
Q

Best initial test for acromegaly

A

IGF-1

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33
Q

Most accurate test for acromegaly

A

Glucose suppression test

NL - glucose suppresses GH

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34
Q

What additional tests must be done for acromegaly

A

Prolactin (cosecreted)

MRI (after labs)

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35
Q

Rx acromegaly

A 
Surgery - transphenoidal resection
Meds
- Octreotide (rx of choice)
- Cabergoline (inhibit GH)
- Pegvisomant (GHr antagonist)
Radiotherapy - Non-responsive to meds/surg
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36
Q

MCC of hyperprolactinemia

A

Functional adenoma (prolactinoma)

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37
Q

What must always be r/o as cause of hyperprolactinemia

A

Hypothyroidism

- High TRH leads to prolactin secretion

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38
Q

ONLY CCB to raise prolactin

A

Verapamil

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39
Q

Physiological causes of hyperprolactinemia

A

Pregnancy, nursing
Intense exercise, stress
Renal insufficiency

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40
Q

Drugs raising prolactin levels

A 
Antipsychotics
Methyldopa
Metoclopromide
Opioids
TCAs
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41
Q

Presentation of hyperprolactinemia

A

W - Amenorrhea, galactorrhea, infertility

M - ED, decreased libido, visual disturbances

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42
Q

First Dx test in hyperprolactinemia

A

Check prolactin levels

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43
Q

Other tests in hyperprolactinemia

A 
Exclude pregnancy
BUN/Cr
LFTs
Exclude thyroid and drugs
MRI
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44
Q

Rx hyperprolactinemia

A

DA agaonists - Cabergoline
Transphenoid surgery - No med response
Radiation - Last resort

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45
Q

Who to aggressively rx for hyperprolactinemia

A

Pts of childbearing age to prevent infertility

Men

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46
Q

Complication of transphenoidal resection for hyperprolactinemia

A

30% get panhypopituitarism

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47
Q

Cause of hypothyroidism

A

Failure of gland from burnt out Hashimoto’s thyroiditis

Rare- Dietary def iodine, Amiodarone, Li

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48
Q

When to immediately treat hypothyroidism

A

TSH 2x NL AND NL T4

TSH

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49
Q

AKA Antithyroid peroxidase

A

Antithyroglobulin

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50
Q

Features of hypothyroidism

A 
Brady
Constipation
Wt gain
Fatigue, lethargy, coma
↓ DTRs
Cold intolerance
Hypothermia
Pseudodementia
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51
Q

Features of hyperthyroidism

A 
Tachy, palpitations, arrhythmia
Diarrhea
Wt loss
Anxiety, restlessness
↑ DTRs
Heat intolerance
Fever
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52
Q

Best initial test for thyroid disorders

A

TSH

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53
Q

What to do when TSH is suppressed

A

Measure T4

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54
Q

What is seen in exogenous T4 ingestion

A

Decreased TBG

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55
Q

Rx hypothyroidism

A

Lifelong thyroxine

Secondary hypothyroid - Add hydrocortisone

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56
Q

Diagnosis hyperthyroidism w/ proptosis and skin findings

A

Graves

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57
Q

Diagnosis hyperthyroidism w/ tender thyroid

A

Subacute

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58
Q

Diagnosis hyperthyroidism w/ nontender, normal exam

A

Painless thyroiditis

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59
Q

Diagnosis hyperthyroidism w/ Involuted gland (not palpable)

A

Exogenous thyroid use

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60
Q

Diagnosis hyperthyroidism w/ high TSH

A

Pituitary adenoma

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61
Q

TSH receptor Abs are in

A

Graves

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62
Q

Features of Graves

A 
Women, 40s
Exopthalmos (can get worse w/ rx)
High output cardiac failure
Pretibial myxedema
RAIU - diffuse uptake
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63
Q

Features of subacute thyroiditis

A

Elevated ESR
May spontaneously resolve
Rx w/ ASA, steroids

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64
Q

Rx graves

A

Radioactive iodine ablation

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65
Q

Rx painless thyroiditis

66
Q

Rx pituitary adenoma

67
Q

Rx Thyroid storm

A 
Propranolol
Methimazole > PTU
Iodinated contrast - block peripheral conversion
Steroids
Radioactive iodine
68
Q

Thyroid storm in pregnancy

A

Surgery > RAI ablation

69
Q

Features of thyroid storm

A

Fever > 104
CNS sx
Cardiac sx

70
Q

Rx graves opthalmopathy

A

Steroids
Radiation if nonresponsive
Surgical decompression

71
Q

First step in hyperfunctioning thyroid nodule

A

TSH, T4 levels

U/S to evaluate size

72
Q

Dx tests in euthyroid thyroid nodule

A

Bx if >1cm w/ fine needle aspiration

No need to U/S or RAIU

73
Q

Non-functioning nodule w/ Hx head/neck radiation

A

CA until proven otherwise

74
Q

MC CA thyroid

A

Papillary

Rx total thyroidectomy

75
Q

FNA shows follicular cells

A

Remove whole nodule

Can’t differentiate between adenoma and carcinoma

76
Q

Features of anaplastic thyroid CA

A

Older pts
Worst prognosis
Rare

77
Q

Thyroid CA w/ FHx

78
Q

MCC hypercalcemia

A

Primary hyperparathyroidism

79
Q

2nd MCC hypercalcemia

A

Malignancy (PTHrP)

80
Q

Other causes of hypercalcemia

A 
Vit D tox
Sarcoid
HCTZ
Hyperthyroidism
Mets, MM
Prolongued immobilization
81
Q

Acute Sx in hypercalcemia

A

Confusion
Stupor
Lethargy
Constipation

82
Q

Cardio manifestation of hypercalcemia

83
Q

Bone manifestation of hypercalcemia

A

Osteoporosis

84
Q

Renal manifestation of hypercalcemia

A

Stones
NDI
Renal insufficiency

85
Q

Rx hypercalcemia

A

Saline hydration at high volume
Long term bisphosponates
Short term calcitonin
Prednisone - sarcoid, granulomatous

86
Q

Drug inhibits PTH release

87
Q

Causes of primary parathyroidism

A

Solitary adenoma MCC
4-gland hyperplasia
Parathyroid malignancy

88
Q

Sx hyperparathyroidism

A

Osteoporosis
Nephtolithiasis and renal insufficiency
Muscle weakness, anorexia, N/V, abd pain
PUD

89
Q

Dx tests in hyperparathyroidism

A

High Ca, PTH, Cl, BUN/Cr, ALP
Low PO4
Short QT

90
Q

Rx hyperparathyroidism

A

Surgical removal

Cincalcet if surgery not an option

91
Q

What to watch for post op in hyperparathyroidism

A

Hypocalcemia

92
Q

MCC hypocalcemia

A

Complication of prior neck surgery

93
Q

Other causes of hypocalcemia

A 
Hypomagnesemia
Renal failure
VIt D deficiency
Genetic disorders
Fat malabsorption
Low albumin
94
Q

Signs of hypocalcemia

A 
Chovstek
Spasm
Perioral numbness
Mental irritability
Seizures
Tetany
95
Q

Dx tests for hypocalcemia

A

Prolongued QT on EKG

Slit lamp exam shows cataracts

96
Q

Rx hypocalcemia

A

Replace Ca and Vit D

97
Q

What is Cushing syndrome

A

Hypercortisolism

Overproduction of ACTH

98
Q

MCC hypercortisolism

A

Iatrogenic

99
Q

Other causes of cushing syndrome

A

Pituitary overproduction (Cushing disease)
Adrenal overproduction
Unknown source
Ectopic

100
Q

Features of Cushing

A 
Fat redistribution - moon face, buffalo hump
Skin - striae, easy bruising
Osteoporosis
HTN
Menstrual disorders, ED
Cognitive disturbance
Polyuria
101
Q

Best initial test for presence of hypercortisolism

A

24hr urine cortisol

102
Q

Secondary test for presence of hypercortisolism

A

1mg overnight dexamethasone suppression test

103
Q

Most specific test for presence of hypercortisolism

A

24hr urine cortisol

104
Q

Best initial test for the cause of hypercortisolism

A

ACTH levels

105
Q

Cushing w/ elevated ACTH

A

Pituitary or Ectopic

106
Q

Cushing w/ decreased ACTH

A

Adrenal source

107
Q

Cushing w/ elevated ACTH suppressed by dexamethasone

A

Pituitary source

108
Q

Cushing w/ elevated ACTH not suppressed by dexamethasone…what now?

A

Ectopic or CA

  • MRI brain
  • Petrosal sinus sample
  • Chest scan
109
Q

Rx hypercortisolism

A

Surgically remove source

110
Q

Workup of incidentaloma

A

Metanepherines
Renin, aldosterone
Dexamethasone suppression test

111
Q

What is Addison’s disease

A

Chronic hypoaldosteronism

112
Q

MCC addison’s

A

Autoimmune

113
Q

Less common causes of Addison’s

A

Infection (TB)
Adrenoleukodystrophy
Mets

114
Q

Causes of acute adrenal crisis

A 
Hemorrhage
Surgery
Hypotension
Trauma
Sudden removal of steroids
115
Q

Presentation of Addison’s

A 
Fever
Altered MS
N/V
Anorexia
Hypotension
Hyponatremia
Hyperkalemia
Hyperpigmentation
116
Q

Specific finding in Addison’s

A

Eosinophilia

117
Q

Most specific test for adrenal function

A

Cosyntropin

No change in Addison’s

118
Q

Rx Addison’s

A

Replace steroids
Fludrocortisone
Mineralocorticoids

119
Q

First thing to do in acute adrenal crisis

A

Give Steroids

120
Q

What is primary hyperaldosteronism

A

Autonomous overproduction of aldosterone despite high BP and low renin

121
Q

What causes secondary hyperaldosteronism

A

Decreased intravascular volume

  • Dehydration
  • Edema → Increased renin
  • Hypotension
122
Q

Who gets secondary hyperaldosteronism

A

Under 30, over 60
Not controlled w/ 2 HTN meds
Characteristic findings or labs

123
Q

Important findings in primary hyperaldosteronism

A

High BP
Low K
High aldosterone
Low renin

124
Q

Best initial test for primary hyperaldosteronism

A

Ratio of plasma aldosterone to renin

125
Q

Most accurate test for primary hyperaldosteronism

A

High aldosterone from venous blood from adrenal showing unilateral adenoma

126
Q

Rx primary hyperaldosteronism

A

Unilateral adenoma - resect

Bilateral hyperplasia - spironolactone/eplerenone

127
Q

Spironolactone AE

A

Gynecomastia

Decreased libido

128
Q

Pheochromocytoma rule of 10s

A

10%

  • Children
  • B/L
  • Malignant
  • Recur
129
Q

Features of pheochromocytoma

A

Episodic HTN
HA
Sweating
Palpitations and tremor

130
Q

Best initial test pheochromocytoma

A

Plasma metanephrines

131
Q

Alternate tests for pheochromocytoma

A

24hr urine metanephrines

VMA

132
Q

When is MIBG scanning used

A

Locates pheochromocytoma outside of adrenal

133
Q

Rx Pheochromocytoma

A

BIT - Phenoxybenzamine/phentolamine esp pre-op
BBs, CCBs, IVF
Surgical removal

134
Q

What is DM

A

Fasting glc >125 on 2 occasions

135
Q

Features of DM I

A

Childhood onset
IDDM
Insulin deficiency

136
Q

Features of DM II

A

Adult onset
NIDDM - resistance
Obesity

137
Q

DM presentation

A

Polyuria, Polydipsia

Decreased wound healing

138
Q

Dx test for DM

A

Fasting glc >125 on 2 occasions separated by 1-2wks
Glc > 200 w/ sx
Increased glc on glc tolerance testing
HbA1c >6.5

139
Q

Best initial drug therapy for DM

140
Q

Goal of oral hypoglycemics

141
Q

Mechanism of metformin

A

Block gluconeogenesis

142
Q

Contraindication to glitazones

143
Q

Contraindication metformin

A

Renal dysfunction

Can cause metabolic acidosis

144
Q

Mechanism of nateglinide/repaglinide

A

Stimulate insulin release

145
Q

Mechanism of alpha glucosidase inhibitors

A

Block glc absorption in the bowel

146
Q

Mechanism of pramlintide

A

Decrease gastric emptying, glucagon, appetite

147
Q

Glc in HHNS

148
Q

Glc in DKA

149
Q

Presentation of DKA

A 
Hyperventilation
Altered MS
Metab acid
Hyperkalemia
Increased anion gap
Ketones
150
Q

Who gets DKA

A

I > II

Precipitated by infection, MI, stress

151
Q

Rx DKA

A

High volume saline
Insulin
K when serum K NL

152
Q

Most accurate measure of severity of DKA

A

Low serum bicarb

153
Q

All DM pts should receive

A 
Pneumococcal vaccine
Yearly eye exam
Statins - LDL >100
ACEi/ARB - BP > 130/80
Aspirin - age >30
Foot exam
154
Q

CV complications in DM

A

MI
Stroke
CHF

155
Q

Renal complications in DM

A

Microalbuminuria

Levels of albumin have elevated to 30-300 per 24hrs

156
Q

Screening for microalbuminuria in DM

157
Q

Rx microalbuminuria in DM

158
Q

Rx DM gastroparesis

A

Metoclopromide

Erythromycin

159
Q

Retinopathy in DM

A

Proliferative retinopathy

160
Q

Screening of DM retinopathy

A

I - 5yrs after dx, then yearly

II - yearly

161
Q

Mechanism of neuropathy in DM

A

Damage to the vasonervosum

162
Q

Rx DM neuropathy

A

Pregabalin
Gabapentin
TCAs

Step 2 CK (21 decks)

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