Endocrine

Question 1

T3/T4 is low and TSH is up

Answer 1

primary hypothyroid

Question 2

What causes Primary hypothyroidism

Answer 2

Autoimmued dz (hashimotos) Thyroid can’t release T3/T4. T3/T4 acts as a negative feedback to the pituitary so when it is low the pituitary will think there isn’t enough TSH so will pump out more Resulting in High TSH and Low T3/T4

Question 3

T3/T4 is LOW and TSH is low

Answer 3

Secondary hypothyroid

Question 4

What causes secondary hypothyroid

Answer 4

The pituitary isn’t producing enough TSH so the thyroid isn’t being told to produce T3/T4. This is because the problem is with the feedback response. T3/T4 although low is not getting the message through to the pituitary to produce more TSH

Question 5

If you have a low TSH and FT4 what should you do next?

Answer 5

Test all the other hormones. Secondary hypothyroid is concerning for pituitary hypothalamic dysfunction. MRI of the brain should be done too

Question 6

TSI is high, TRH is low, TSH is low and T3/T4 is markedly elevated

Answer 6

primary hyperthyroidism (Graves)

Question 7

describe what happens in primary hyperthroidism

Answer 7

An excess of thyroid stimulating immunoglobulins bind to TSH receptors and stimulate them causing an increase of T3T4. The T3/T4 then tells the pituitary to dec production of TSH and the hypothalamus to dec production of TRH

Question 8

TSI is nml, TRH is low, TSH is markedly elevated as well as T3/T4

Answer 8

2nd Hyperthyroidism

Question 9

Why does 2nd hyperthyroid occur?

Answer 9

TSH secreting adenoma releases tons of TSH regardless of feedback loop. T3/T4 is produced en masse which tells the hypothalamus to dec. TRH

Question 10

Management of Thyroid storm

Answer 10

Methimazole, PTU BBlockers for sx relief IV fluids

Question 11

Highly suspicious nodule on RAIU

Answer 11

Cold (no iodine uptake)

Question 12

signs of hyperarathyroidism

Answer 12

stones bones abdominal groans psychic moans

Question 13

Hyperparathyroidism is caused by what?

Answer 13

Excess PTH production

Question 14

MC cause of primary hyperparathyroid

Answer 14

Parathyroid adenoma

Question 15

Hyperparathyroidism results in what imbalance in the body?

Answer 15

Hypercalcemia

Question 16

signs of hypocalcemia

Answer 16

Trousseau and Chvostek’s signs

perioral paresthesias

inc DTR

Carpopedal spasm

Question 17

Describe

Answer 17

Hypocalcemia

Prolonged QT interval

Question 18

Describe

Dx

Answer 18

Hypercalcemia

Short QT interval, long PR interval, QRS widening

Question 19

In a child w/ Delayed fontanel closure, growth retardation, delayed dentition, costal cartilage enlargement and bowing of long bones what do you think?

Answer 19

Rickets

Question 20

Etiology of Rickets

Answer 20

Vid D deficiency leads to dec calcium and phosphate and soft bones

Question 21

Tx for Rickets

Answer 21

vit D supplementation, and ca supplementation

Question 22

Addisions disease

Answer 22

Adrenal gland desttruction causing lack of cortisol AND aldosterone

Question 23

Difference between 2nd and 1ry Adrenocortical insuff.

Answer 23

2ry usually has intact aldosterone function

Because of this Addisons (1ry) has additional sx of - Hyperpigmentation, horthostatic hypotension, hyperkalemia, hyponatremia, and dec libido (sex hromones) in women.

Question 24

Low ACTH + Low cortisol

Answer 24

Secondary adrenocortical insuff.

Question 25

Tx ofr adrenocortical insuff.

Answer 25

Hormone replacement

Glucocorticoids, mineralocorticoids in addisons

Question 26

When do we use fludorcortisone in adrenocortical insuff.

Answer 26

When it is primary (addisons

Question 27

Tx for Addisonian crisis

Answer 27

IV fluids to correct hypotension, and hypovolemia (D5NS if hypoglyc)

Glucocorticoids (dexamethasone if undx, hydrocortisone if Add known)

Reversal of lyte abnor. (Hyponat, hyperka, hypogly, hypercal)

Fludricortisone

Question 28

Cushing’s Syndrome

Answer 28

Sx and sg related to cortisol excess

Question 29

Cushing’s Disease

Answer 29

Cushings syndrome cased specifically by Pituitary increase of ACTH secretion

Question 30

Sx of Cushings

Answer 30

Central obesity

moon facies

buffalo hump

SCV fat pads

Extremity wasting

Wt gain, hypokalemia

acanthosis nigricans

psychosis

Question 31

Etiologies of cushings

Answer 31

Iatrogenic : long-term high dosecorticosteroid tx.

benign pituitary adenoma or hyperplasia

Question 32

Screening test for cushings

Answer 32

Low dose dexamethasone suppression (NO Suppression = Cushing)

24h urinary free cortisol levels (inc=cushi)

Question 33

Differentiating tests for Cushings

Answer 33

High dose dexamethasone supp:

no supp = cushing dz

supp = Adrenal or ectopic ACTH producing tumor

Question 34

Tx for cushings

Answer 34

Cushing dz - Transphenoidal surgery

Ectopic or adrenal tumors - removal, ketaconazole in non operative

Iatrogenc steroid tx - Gradual steroid withdrawal (to prevent addisonian crisis)