ENDOCRINE

Question 1

What can occur from a very traumatic birth regarding growth hormone?

Answer 1

GH deficiency – why we check the growth charts

Question 2

What happens to growth hormones in hypopituitarism?

Answer 2

Children – serious growth disturbance

Question 3

What might GnRh cause?

Answer 3

lack of sexual organ development

Question 4

If you’re considering a growth hormone deficiency, what do you check?

Answer 4

GH levels, provocative tests, and imaging

Question 5

What type of provocative test could stimulate growth hormone levels, and see if you’re getting the proper response?

Answer 5

Insulin

Question 6

After giving growth hormone and getting levels normalized, when do we need to monitor levels again

Answer 6

Once growth is completed

Question 7

What is acromegaly?

Answer 7

When excessive growth hormone is released

Question 8

What causes acromegaly?

Answer 8

Almost always from a pituitary adenoma

Question 9

What is specific about the adenoma of gigantism?

Answer 9

Develops BEFORE closure of epiphyses

Question 10

What is specific about the adenoma of acromegaly?

Answer 10

Develops AFTER closure of epiphyses

Question 11

How do we treat excessive growth hormone?

Answer 11

Somatostatin

Question 12

What does prolactin do?

Answer 12

Induces lactation during pregnancy

Question 13

What controls prolactin?

Answer 13

Always being inhibited by dopamine

Question 14

What is the role of thyroid hormone, especially at birth?

Answer 14

Crucial for cell differentiation – if absent at birth can cause severe mental retardation = “creatinism”

Question 15

What must you always check on PE in someone you suspect with a thyroid disorder?

Answer 15

visual/eyes, weight, scalp/hair, neck, skin, heart, abdomen, extremities, reflexes and thyroid exam neuro

Question 16

What’s the normal range for TSH?

Answer 16

0.27-4.2

Question 17

If TSH is low, what does that usually indicate?

Answer 17

Hyperthyroidism (at the gland level = primary)

Question 18

If TSH is high, what does that usually indicate?

Answer 18

Hypothyroidism

Question 19

What would cause hypothyroidism?

Answer 19

Congenital = In utero exposure to radioiodine

Acquired (later in life) = Hashimoto’s, irradiation, too much iodine

Question 20

If a child presents with a thick tongue, hypotonia, large fontanel’s, dry skin, with a hoarse cry, and constipation, what diagnosis do you think?

Answer 20

Hypothyroidism

Question 21

What is hypothyroidism?

Answer 21

Autoimmune, AKA Hashimoto’s Thyroiditis

Question 22

What labs would we get for hypothyroidism?

Answer 22

TSH, decreased T4, and anti-thyroid anti-bodies (for Hashimoto’s specifically)

Question 23

How do we prevent and treat congenital hypothyroidism?

Answer 23

Early detection – required at birth!

Replacement therapy (10-15uq/day of Levothyroxine)

Continue to monitor!

Question 24

If a patient presents with unexplained weight loss, fatigue, who often feels hot and anxious – what diagnosis are you thinking?

Answer 24

Hyperthyroidism

Question 25

What else is hyperthyroidism known as?

Answer 25

Thyrotoxicosis

Question 26

What is the most common etiology of hyperthyroidism?

Answer 26

Graves disease

Question 27

What are other etiologies for hyperthyroidism?

Answer 27

Toxic (“hot”) adenomas, early phase hasimoto’s (from stored hormone), factitious (excessive thyroid hormone intake), TSH adenoma, or amiodarone

Question 28

What is Graves disease?

Answer 28

Autoimmune disease, caused by TSH-receptor antibody (IgG) causes hypersecretion, hypertrophy, and hyperplasia of the thyroid (goiter)

Question 29

What 2 signs & symptoms are unique to Graves disease?

Answer 29

Opthalmopathy – Proptosis with lid-lag, conjunctival inflammation and corneal drying Dermopathy – pre-tibial areas leading to edema, thickened skin (pre-tibial myxedema) Along with tachycardia, tremor, brisk DTR, and accelerated growth

Question 30

How can we treat Graves disease?

Answer 30

MUST have an endocrinologist consult Propranolol (heart) Thiourea drugs = Propylthiouricil (PTU) or Methimazole – inhibits thyroid peroxidase and block organification of iodine.

Question 31

What is the definitive treatment of choice for Grave’s disease in the US?

Answer 31

Radioactive iodine (131I) – destroy overactive thyroid tissue (when it doesn’t resolve)

Question 32

When would thyroid surgery be indicated?

Answer 32

Graves in children

Question 33

What would cause thyroiditis?

Answer 33

Bacterial infection (so think fevers, chills, sore throat, and very tender thyroid)

Question 34

What is parathyroid important for?

Answer 34

Calcium & phosphate metabolism (along with Vit. D, calcitonin, and Mg)

Question 35

If a patient presents with muscle cramps, irritability, tetany, seizures, and parasthesias of the hands & feet, what diagnosis are you thinking?

Answer 35

Hypoparathyroidism

Question 36

What is hypoparathyroidism and what causes it?

Answer 36

LOW ionized calcium, most commonly after a thyroidectomy (or congenital)

Question 37

What PE signs do we look for hypoparathyroidism?

Answer 37

Chvostek (face) & Trousseau (BP cuff with contracture)

Question 38

What can develop with hypoparathyroidism?

Answer 38

Chronic magnesium deficiency

Question 39

What labs would you order for hypoparathyroidism?

Answer 39

Total serum & ionized Ca – LOW PO4 – High Urine Ca – LOW Magnesium! ECG: Prolonged Q-T

Question 40

If you see low Ca levels on lab work, what other diagnosis would you think of besides hypoparathyroidism?

Answer 40

Malabsorption, Vitamin D deficiency, and Hypomagnesemia

Question 41

How do you treat hypoparathyroidism?

Answer 41

Acute – IV calcium Chronic – oral Calcium Magnesium supplement if needed

Question 42

If you have a problem absorbing calcium into the system (you don’t have a problem with producing it), what diagnosis?

Answer 42

Ricketts

Question 43

What can form on the back of the neck with diabetes?

Answer 43

Acanthosis Nigrans (velvety, hyperpigmented plaque)

Question 44

What is occurring in Type 1 diabetes?

Answer 44

Auto-immune destruction of Beta-cells in the pancreas. Mainly due to islet cell antibodies

Question 45

What are clinical findings for Type 1 DM?

Answer 45

Polyuria, thirst, weight loss, dehydration, polyphagia, ketoacidosis, hyperosmolality

Question 46

What’s the fasting BG level that diagnosis diabetes?

Answer 46

>126 & A1c >6.5

Question 47

What labs do you usually see with DKA?

Answer 47

BS >300 pH less than 7.3 bicarb is low (increased anion gap! Lab test = ABG) total body K is low

Question 48

What causes DKA?

Answer 48

Not enough insulin, leading to increased blood glucose & LOTS of fat & protein breakdown May have lots of nausea, vomiting, and diarrhea

Question 49

How do you treat DKA?

Answer 49

Give FLUIDS! Give insulin once you know K levels

Question 50

What diagnosis are we concerned about in kids, how do we treat it?

Answer 50

Type 2 DM! Lifestyle changes (diet & exercise)

Question 51

What is metabolic syndrome? What does metabolic syndrome lead to? What are some qualifying factors for it?

Answer 51

Insulin resistance syndrome Can lead to an increased risk of atherosclerosis Central obesity (>88cm or 35” in women, >102cm or 40” in men); hyperglycemia >110; Hypertension 135/85; Triglycerides >150; Low HDL

Question 52

Mullerian ducts develop into? Wolffian ducts develop into?

Answer 52

Wolffian = Male Mullerian = Female

Question 53

What diagnosis is associated with a deficiency in 21 alpha hydroxylase (deficiencies leading to cortisol or aldosterone issues)? What else is this diagnosis associated with?

Answer 53

Congenital adrenal hyperplasia Also associated with salt wasting

Question 54

if a child has ambiguous genitalia, what diagnosis? What about development later in life?

Answer 54

Ambiguous = Severe congenital adrenal hyperplasia Later development = Moderate congenital adrenal hyperplasia (or mild when they can’t get pregnant)

Question 55

if a child is genetically male, but has female genitalia, what is the diagnosis?

Answer 55

Complete androgen insensitivity syndrome

Question 56

What are inborn errors of metabolism?

Answer 56

Autosomal recessive disorders – deficiency in a single enzyme leading do a disruption in a metabolic pathway

Question 57

What are some examples of how a child would present with an inborn error of metabolism?

Answer 57

Zellwagger (high forehead with cherry spot in the eye), vomiting, abnormal tone, myopathy, dystonia

Question 58

What is it known as when blood is taken from the newborn to screen for tons of different things?

Answer 58

Tandem Mass Spectrometry (just a screen, not diagnostic)

Question 59

What will you often see on diagnostics with inborn errors?

Answer 59

Acid-Base disorder (since there is an increase in metabolites)