Endocrine Flashcards

1
Q

T3/T4 is low and TSH is up

A

primary hypothyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes Primary hypothyroidism

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

T3/T4 is LOW and TSH is low

A

Secondary hypothyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes secondary hypothyroid

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

primary hyperthyroidism (Graves)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe what happens in primary hyperthroidism

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

2nd Hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why does 2nd hyperthyroid occur?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of Thyroid storm

A

Methimazole, PTU BBlockers for sx relief IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Highly suspicious nodule on RAIU

A

Cold (no iodine uptake)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

signs of hyperarathyroidism

A

stones bones abdominal groans psychic moans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hyperparathyroidism is caused by what?

A

Excess PTH production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MC cause of primary hyperparathyroid

A

Parathyroid adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hyperparathyroidism results in what imbalance in the body?

A

Hypercalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

signs of hypocalcemia

A

Trousseau and Chvostek’s signs

perioral paresthesias

inc DTR

Carpopedal spasm

17
Q

Describe

A

Hypocalcemia

Prolonged QT interval

18
Q

Describe

Dx

A

Hypercalcemia

Short QT interval, long PR interval, QRS widening

19
Q

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

20
Q

Etiology of Rickets

A

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

21
Q

Tx for Rickets

A

vit D supplementation, and ca supplementation

22
Q

Addisions disease

A

Adrenal gland desttruction causing lack of cortisol AND aldosterone

23
Q

Difference between 2nd and 1ry Adrenocortical insuff.

A

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.

24
Q

Low ACTH + Low cortisol

A

Secondary adrenocortical insuff.

25
Tx ofr adrenocortical insuff.
Hormone replacement Glucocorticoids, mineralocorticoids in addisons
26
When do we use fludorcortisone in adrenocortical insuff.
When it is primary (addisons
27
Tx for Addisonian crisis
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
28
Cushing's Syndrome
Sx and sg related to cortisol excess
29
Cushing's Disease
Cushings syndrome cased specifically by Pituitary increase of ACTH secretion
30
Sx of Cushings
Central obesity moon facies buffalo hump SCV fat pads Extremity wasting Wt gain, hypokalemia acanthosis nigricans psychosis
31
Etiologies of cushings
Iatrogenic : long-term high dosecorticosteroid tx. benign pituitary adenoma or hyperplasia
32
Screening test for cushings
Low dose dexamethasone suppression (NO Suppression = Cushing) 24h urinary free cortisol levels (inc=cushi)
33
Differentiating tests for Cushings
High dose dexamethasone supp: no supp = cushing dz supp = Adrenal or ectopic ACTH producing tumor
34
Tx for cushings
Cushing dz - Transphenoidal surgery Ectopic or adrenal tumors - removal, ketaconazole in non operative Iatrogenc steroid tx - Gradual steroid withdrawal (to prevent addisonian crisis)
35