Endocrine Flashcards
1
Q
what most often causes hyperparathyroidism?
A
parathyroid adenoma
2
Q
s/s of hyperparathyroidism
A
moans, groans, stones, bones
3
Q
dx hyperparathyroidism
A
elevated serum Ca
PTH assay
4
Q
tx hyperparathyroidism
A
NS + furosemide
5
Q
most common cause of hypoparathyroidism
A
iatrogenic: post-thyroidectomy
6
Q
what deficiency may cause development of hypoparathyroidism?
A
Mg
7
Q
s/s of hypoparathyroidism
A
muscle cramps, carpopedal spasms, chvosteks & trousseaus sign, hyperactive DTR
8
Q
dx hypoparathyroidism
A
decreased serum Ca, elevated PO4
EKG: QT prolongation
9
Q
tx hypoparathyroidism
A
calcium gluconate
oral calcium, vit d, mg
10
Q
causes of hyperthyroidism
A
graves
hot/toxic nodule
11
Q
s/s hyperthyroidism
A
irritability, heat intolerance, anxiety, tachycardia
12
Q
dx hyperthyroidism
A
elevated T3/T4
decreased TSH
13
Q
tx hyperthyroidism
A
propanolol for sxs
methimiazole & PTH
RAI is definitive tx
14
Q
what is Graves & who is it more common in?
A
autoimmune hyperthyroidism
8x more common in women (onset 20-40)
15
Q
what are clinical manifestations of Graves?
A
proptosis/exopthalmosis
orange skinned
16
Q
causes of hypothyroidism
A
autoimmune -> Hashimotos
iatrogenic -> thyroidectomy
17
Q
s/s of hypothyroidism
A
cold intolerance, fatigue, bradycardia, constipation
18
Q
what will the thyroid be like in hypothyroidism
A
diffusely enlarged, firm, finely nodular thyroid
19
Q
what does congenital hypothyroidism cause
A
mental retardation -> cretinism
20
Q
dx hypothyroidism
A
decreased T3/T4
elevated TSH
21
Q
tx hypothyroidism
A
levothyroxine
22
Q
what is cushings
A
excess cortisol
23
Q
causes of cushings
A
endogenous: tumor secreting excess cortisol or ACTH
exogenous: drugs
24
Q
what is cushings syndrome
A
adrenal tumor
25
what is cushings disease
pituitary tumor
26
s/s of cushings
central obesity, moon facies, striae, buffalo hump, DM/glucose intolerance, thin extremities, HTN
27
dx cushings
elevated AM cortisol with loss of diurnal pattern
| Dexamethasone suppression test
28
tx cushings
stop drug
| remove tumor
29
what is addison's disease
adrenal insufficiency
| autoimmune destruction of adrenal glands
30
s/s of addison's disease
hyperpigmentation, palmar creases, fatigue, weakness, arthralgias, reduction in axillary & pubic hair
31
dx addison's disease
low AM cortisol level
ab CT: small, non-calcified adrenals
cosyntropin stimulation test
32
tx addison's disease
glucocorticoid replacement
33
how much must you increase maintenance cortisol during periods of stress
8-10x
34
what may precipitate acute adrenal insufficiency/crisis
abrupt stop of corticosteroids
35
s/s of acute adrenal insufficiency
confusion, diarrhea, temp > 40, hypotension, cyanosis, hemodynamic collaps
36
patient w/ hypotension/shock unresponsive to IV fluids & pressors
acute adrenal insufficiency
37
tx acute adrenal insufficiency
rapid infusion of isotonic fluids & IV hydrocortisone
38
what is pheochromocytoma
rare adrenal tumor that secretes NE/EPI
39
s/s pheochromocytoma
sustained HTN, palpitations, HA, excessive sweating
40
dx pheochromocytoma
24 hour urine for catecholamines & metanephrines
41
tx pheochromocytoma
laparoscopic removal of tumor
42
what is pagets disease
focal ares of excessive osteoclast-mediated bone resorption preceding disorganized osteoblast-mediated bone repair
43
what does the bone look like in pagets disease
mosaic/jigsaw puzzle
44
s/s of pagets disease
usually asymptomatic
45
dx of pagets disease
x-ray w/ characteristic bone deformities
46
tx pagets disease
NSAIDS for pain
| bisphosphonates
47
what is nephrogenic diabetes insipidus
inability for the kidneys to respond to ADH
48
s/s DI
polyuria, intense thirst
49
dx DI
vasopression challenge
50
what causes acromegaly/gigantism
excess GH, usually from a pituitary adenoma
51
effects of GH are mediated by...
IGF-1 produciton in the liver
52
s/s of excess GH
before closure epiphysis: gigantism
| after closure: acromegaly
53
s/s of acromegaly
enlarged hands, feet, jaw, coarse facial features, bones of skull enlarge, deep voice
54
associated findings w/ acromegaly/gigantism
HTN, cardiomyopathy, insulin resistance/DM
55
dx acromegaly/gigantism
serum IGF-1 increased 5x
56
tx acromegaly/gigantism
transphenoidal microsurgery
57
what is the most common cause of hyperpituitarism
pituitary adenoma
58
s/s of hyperprolactinemia
high proactive levels suppress GnRh -> decreases LH/FSH -> hypogonatropic hypogonadism
females: oligomenorrhea, glactorrhea, infertility
59
tx hyperprolactinemia
dopamine agonists
60
what is the most common cause of hypoglycemia
insulin & sulfonylureas
61
s/s hypoglycemia
sweating, tachycardia, hunger, nausea
62
what might mask the symptoms hypoglycemia
beta blockers
63
dx of hypoglycemia
BS
64
tx hypoglycemia
simple sugars (diabetics should always carry)
glucagon injection
IV glucose
65
DKA is more common in T1DM or T2DM
T1DM
66
phys behind DKA
lack of insulin leads to rapid breakdown of energy stores from muscle & fat -> excess ketoacids
67
what is usually the trigger to DKA
something that requires an increased amount of insulin
68
s/s DKA
decreased mentation, N/V, coma
| fruity smell from volatile ketones
69
dx DKA
BS > 300, low pH, volume depletion & electrolyte loss, metabolic acidosis w/ increased anion gap, total body K is low
70
tx DKA
insulin + IV fluids
71
who is at risk for developing nonketotic hyperosmolar coma
elderly w/ T2DM
72
pathophys of NKHC
adequate circulating insulin to prevent fat breakdown, but not enough to control hyperglycemia
73
tx NKHC
fluid replacement & insulin by infusion
74
what is osteoporosis
compromised bone strength predisposing to an increased risk of fracture
75
osteoporosis leads to an increased bone resorption, especially of _____ bone
trabecular
76
when does bone density peak
young adults, early 20s
77
when is physiology bone loss accelerated
first 5-10 years post menopause
78
definition of osteopenia
1-2.5 SD below peak bone density
79
definition of osteoporosis
greater than 2.5 SB below peak density
80
dx osteoporosis
DEXA scan
81
can you reverse established osteoporosis?
no, you can increased BD, decreased fractures, halt/slow progression
82
when do you screen for osteoporosis?
all patients at increased risk including early post menopause + risk factors (FH, malnourished, alcoholism, renal failure), older than 65
83
tx for osteoporosis
bisphosphonates
84
what do bisphosphonates do?
inhibit osteoclastic bone resorption
85
what is important when prescribing bisphosphonates?
dental care
86
insulin ____ fat
| insulin ____ protein synthesis
spares fat
| promotes protein synthesis
87
what causes T1DM
autoimmune -> presence of islet cell antibodies
| causes destruction of beta cells
88
s/s of diabetes
polyphagia, polydipsia, polyuria
89
tx for T1DM
insulin
90
pathophys of T2DM
circulating insulin prevents ketoacidosis, but not hyperglycemia
91
what does the constant state of hyperglycemia in T2DM cause
causes increased insulin resistance & eventual destruction of beta cells
92
what is common in people with T2DM & a major factor for insulin resistance?
central obesity
93
what does hepatic insensitivity in T2DM cause?
increased gluconeogenesis
94
what does glucotoxicity in T2DM cause?
chronic hyperglycemia that worsens peripheral insulin resistance & eventually destroyed beta cells permanently
95
what does metabolic syndrome increase your risk of & by how much
atherosclerosis
| 3x
96
what are the 5 factors of metabolic syndrome
1. central obesity
2. HTN (> 135/85)
3. hyperglycemia (> 110)
4. elevated Trig (>150)
5. decreased HDL (women
97
what are some long term complications of DM
retinopathy, neuropathy, nephropathy, proteinuria, HTN, atherosclerosis, PVD
98
what two classes make up the insulin secretagogues
sulfonylureas
| meglitinides
99
where do the insulin secretagogues act
they close the Katp channels & promote insulin secretion
100
sulfonylureas stimulate the release of _____
somatostatin
101
SE of the insulin secretagogues
hypoglycemia & wt gain
102
what are 4 actions of biguanides
decreases hepatic glucose produciton
improves insulin sensitivity
improves lipid profiles
decreases carb absorption from the gut
103
biguanides may impair hepatic metabolism of _____
lactic acid
104
C/I for biguanides
renal insufficiency, liver failure, major surgery
105
most common SE for biguanides
GI issues
106
site of action for TZDs
muslce, fate, liver cells
107
what are 3 actions for TZDs
improve insulin sensitivity
increase glucose uptake
decrease hepatic glucose production & glycogenolysis
108
what do you need to check before starting TZDs
LFTs
109
what is the onset of action for TZDs like
slow, 6-14 weeks
110
C/I for TZDs
hepatic disease & HF
111
what are 2 actions for alpha-glucosidase inhibitors
inhibits intestinal hydrolysis of complex carbs
| decreases postprandial digestion
112
main SE of alpha-glucosidase inhibitors
flatulence, diarrhea, ab pain
113
GLP-1 agonist is an ___ mimetic
incretin
114
what are 3 actions of GLP-1 agonist?
promotes insulin secretion in presence of glucose
slows gastric emptying
promotes satiety
115
what is an alternative to insulin without weight gain?
GLP-1 agonists
116
what is normally secreted w/ insulin?
amylin
117
what are 3 actions of amylin analogues?
modulates post prandial glucose
suppressed glucagon secretion
slows gastric emptying
