Endocrine Flashcards
What is the most common cause of hypothyroidism?
Hashimoto thyroiditis
What are the lab findings in Hashimoto thyroiditis?
High TSH, low T4, antibodies to thyroid peroxidase (TPO)
Exophthalmos, pretibial myxoedema, and low TSH describes what disease?
Graves disease
What is the most common cause of Cushing syndrome?
Iatrogenic corticosteroid administration (Cushing Disease is the second most common)
A patient post-thyroidectomy presents with signs of hypocalcemia, increased phosphorus. Why?
Hypoparathyroidism (iatrogenic)
“Stones, bones, groans, psychiatric overtones” are signs and symptoms of what?
Hypercalcemia
Hypertension, hypokalemia, and metabolic alkalosis are signs of what?
Primary hyperaldosteronism (due to Conn syndrome or bilateral adrenal hyperplasia)
A patient presents with: tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.
Pheochromocytoma
What is first line for treating pheochromocytoma, alpha- or beta-antagonists?
ALPHA-antagonist (phenoxybenzamine)
A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI)
What is the treatment for central DI?
Administration of DDAVP and free-water restriction
A postop patient with significant pain presents with: hyponatremia and normal volume status.
SIADH due to stress
What anti diabetic agent is associated with lactic acidosis?
Metformin
A patient presents with: weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show: hyponatremia and hyperkalemia. What is the diagnosis, and what is the treatment?
Primary adrenal insufficiency (Addison Disease)
Treatment: glucocorticoids, mineralocorticoids, and IV fluids
What is the HBA1C goal for patients with DM?
<7.0 %
What is the treatment for DKA?
How do you monitor response to treatment?
Fluids, insulin, electrolyte replacement (potassium, phosphorus)
Bicarb rarely used unless pH < 6.9
Treat initiating event
Monitor response to treatment by closure of anion gap
What condition presents with: bone pain, hearing loss, and increased alkaline phosphatase?
Paget disease
Increased IGF-1
Acromegaly
What lesion creates: galactorrhea, amenorrhea, biltemporal hemianopsia?
Prolactinoma
What presents with: increased serum 17-hydroxyprogesterone?
Congenital adrenal hyperplasia (21-hydroxylase deficiency)
Triad of: pancreas, pituitary, parathyroid tumors
MEN1 syndrome
What are the typical lab findings in DKA?
High serum glucose Metabolic acidosis Increased urine and serum ketones High anion gap Normal serum osmolality
What are the typical lab findings in HHS?
Very high serum glucose No acidosis No ketons Normal anion gap High serum osmolality
What is the treatment for HHS?
Aggressive fluids, electrolyte replacement, insulin
Treat initiating event
What is the criteria for metabolic syndrome?
"WEIGHHT" (3/5 = Dx) Waist Expanded Impaired Glucose HTN HDL (low) Triglycerides (high)
What is the difference between hyperthyroidism and thyrotoxicosis?
Hyperthyroidism: a state of increased synthesis of T3/T4
Thyrotoxicosis: a site of increased levels of T3/4
Note: Graves Disease is the autoimmune form of hyperthyroidism, caused by thyroid stimulating antibodies increasing synthesis of T3/T4
What is the acute, life-threatening form of thyrotoxicosis, that may present with: AFib, fever, delirium?
What is the treatment?
Thyroid Storm
Treatment: antithyroid drugs (methimazole, propylthiouracil), then iodine, IV esmolol, steroids, admit to ICU
What condition causes: severe hypothyroidism, decreased mental status, hypothermia, hypotension, bradycardia, hypoventilation?
What is the treatment?
Myxoedema coma
Treatment: admit to ICU, treat urgently with IV levothyroxine, IV hydrocortisone (if adrenal insufficiency has not been excluded)
Is sub-acute thyroiditis painful?
Yes!
Presents with a tender thyroid (all other forms associated with painless goiter)
Are HYPERfunctioning (“hot”) thyroid nodules malignant?
No
What is the most common form of thyroid carcinoma?
Papillary
75-80%
What are the features of papillary thyroid carcinoma?
“Most Popular is Papillary”
Papillae (branching) Palpable lymph nodes "Pupil" nuclei (Orphan Annie nuclei) Psammoma bodies within lesion Postive Prognosis
What blood level should you check if you suspect Medullary thyroid carcinoma?
Calcitonin Levels
What are the four main types of thyroid carcinoma?
- Papillary (lymphatic spread)
- Follicular (hematologic spread)
- Medullary (consider MEN2A, 2B)
- Anaplastic (BAD)
What is the most common cause of fractures in thin, elderly women?
Osteoporosis
What is caused by a mineralization defect often due to severe Vit D deficiency?
It presents with bone pain, decreased calcium/phosporus, and secondary hyperparathyroidism.
OsteoMALACIA (not osteoporosis)
Osteoporosis will have normal calcium, phosphate, parathyroid hormone levels
What condition causes a “mosaic” lamellar bone pattern on x-ray?
Paget Disease
What bone disease causes increased serum Alk Phos with normal calcium and phosphate levels?
Paget’s Disease
Note: if increased alk phase, but normal GGT, think BONE etiology, not liver etiology
Hyperparathyroidism due to:
a single hyper functioning adenoma (80%), parathyroid hyperplasia (15%), parathyroid carcinoma (5%)
Primary hyperparathyroidism
high PTH, high calcium, low PO4
Hyperparathyroidism due to: renal insufficiency (due to decreased production of 1-25 dihydroxyvitamin D), calcium deficiency, or Vit D deficiency
Secondary hyperparathyroidism
high PTH, low calcium, high PO4 if renal failure
Hyperparathyroidism due to:
dialysis (seen in patients with long-standing secondary hyperparathyroidism that leads to hyperplasia of parathyroid glands)
Tertiary hyperparathyroidism
high PTH, high calcium, high PO4
What is the treatment for acute hypercalcemia?
IV fluids ++++
Loop diuretics (lasix)
IV Bisphosphonates
How does cortisol secretion respond to the dexamethasone test in patients with Cushing Disease?
Cortisol section remains elected with the low-dose (1mg) dexamethasone test, but is suppressed with the high-dose (8 mg) dexamethasone test.
What hormone disturbance causes the inability to concentrate urine in Diabetes Insipidus?
ADH
Central DI (ADH deficiency) Nephrogenic DI (ADH resistance)
What causes euvolemic hyponatremia ia SIADH?
Persistent ADH release independent of serum osmolality
What is the cornerstone of SIADH treatment?
Fluid restriction
What is the difference between primary Adrenal Insufficiency and secondary/tertiary Adrenal Insufficiency?
Primary (Addison Disease)
Increased skin pigmentation (due to increased ACTH), decreased glucocorticoids, decreased mineralcoritocids
- Need both glucocorticoid and mineralocorticoid replacement
Secondary/Tertiary
Decreased glucocorticoids (low ACTH, no skin hyper pigmentation)
- Only need glucocorticoid replacement
What is the Pheochromocytoma rule of 10s?
10% extra-adrenal 10% bilateral 10% malignant 10% occur in kids 10% familial
What are the 5 Ps of Pheochromocytoma?
Pressure (BP) Pain (headache) Perspiration Palpitations Pallor
What is Conn Syndrome?
Hyperaldosteronism, excessive secretion of aldosterone from zona glomerulosa of adrenal cortex, due to unilateral adrenal adenoma
What is the most common cause of congenital adrenal hyperplasia?
21-hydroxylase deficiency
inherited enzyme defect that impairs cortisol synthesis and results in accumulation of cortisol precursors
What lab test is diagnostic of 21-hydrozylase deficiency causing congenital adrenal hyperplasia?
Elevated serum 17-hydroxyprogesterone level
MEN 1 (3Ps)
MEN 2A (2Ps)
MEN 2B (1P)
MEN 1: Pituitary, parathyroid, pancreas
MEN2A: Parathyroids, pheochromocytoma
MEN2B: Pheochromocytoma
What MEN syndromes are associated with medullary thyroid carcinoma?
MEN 2A, 2B
What mutation causes MEN2A,B?
RET proto-oncogene
