Endocrine Flashcards
MEN 1 tumors? Inheritance?
pancreas (endocrine tumors), pituitary, parathyroid; AD
Patients with acromegaly undergo cardiomegaly and __ heart failure. They also commonly develop __ (metabolic disorder)
diastolic; diabetes
Thyroid nodule with a low TSH - next step?
RAIU (radioactive iodine uptake test)
How do you diagnose diabetes with a fastng blood glucose?
bG greater than 125 on two occasions
When do you tx hypothyroidism?
symptomatic or TSH gt 10
In DKA tx, what do you need to do before giving insulin?
Check Potassium! Should be gt 4 before giving
2 hour glucose toelrance test: name the numbers for normal and diabetes
diabetes = greater than or equal to 200 normal = less than 140
Exopthalmos and pretibial myxedema, dx?
grave’s disease
Thyroid nodule + hx/o radiation to head and neck, what’s next step?
FNA
Afib with RVR, fever, hypotension, jaundice, dx?
Thyroid storm
Thyroid nodule with a normal TSH - next step?
Ultrasound (same for high TSH)
Fluid for DKA when the sugar comes towards normal?
D5 1/2 NS
What are the antibodies in type I diabetes (2)?
Anti-GAD and anti-IA-2
Best test for acromegaly? What’s the order of three tests you would order?
MRI; ILGF-1, glucose suppression test (expect GH to go down if normal), MRI
Acute pan hypopituitarism presents with these 4 symptoms due to __. Treat by __. Commonly caused by infxn, infarction, iatrogenic (surgery/radiation)
lethargy and coma due to decreased TSH; hypotension and tachycardia (due to decreased cortisol and reflex tachy); replacing hormones
Water deprivation tests fails to correct with ADH, what is diagnosis?
nephrogenic DI
What test do you get first for suspected acromegaly?
ILGF-1 (NOT growth hormone!!)
Thyroid nodule in a pt with weight loss, heat intolerance, and increased DTRs - what’s next step?
Get a TSH (probably not cancer)
You suspect Conn’s, both the aldo and renin are elevated, the A:R ratio is less than 10, dx? Name 2 causes
Renovascular HTN; Fibromuscular dysplasia (young woman, stent) and renal artery stenosis (old man)
What non-insulin class causes weight loss?
GLP-1s (exanatide and liraglutide)
Wide-spaced teeth, rings that don’t fit, hats too small, dx?
acromegaly
Most common cause of Addison’s disease in US? Worldwide?
Autoimmune; TB
Chronic pan hypopituitarism presents with __ and __. You diagnose it with __ and __. Tx by __. Commonly cause by autoimmune, deposition, cancer.
decreased libido (changes in menstruation) and decreased growth (chronic affects GH/FSH/LH since body sacrifices those to keep TSH and ACTH up); insulin stiulation test (growth hormone fails to rise) and MRI; Tx by replacing hormones and reversing underlying cause
A1c goal for tx of diabetes?
less than 7%
What is the benign side effect of metformin?
Diarrhea (self limiting)
What non-insulin class is weight neutral?
DPP4-inhibitiors (gliptins) (by inhibiting DPP4 they prevent breakdown of GLP-1)
Best diagnostic test for prolactinoma? First test when you suspect prolactinoma?
MRI; TSH/fT4 (then you get prolactin levels)
Medullary thyroid cancer - what should you associate with it (4)?
Calcitonin, C-cells (which produce calcitonin), MEN2A/2B, RET oncogene
How do you screen for Cushing’s syndrome?
Low-dose dexamethasone suppression
You suspect Conn’s, both the aldo and renin are not elevated, possible dx (2)?
Mimicker: CAH or licorice ingestion
Pregnancy, bloody delivery, altered mental status, hypotension, dx?
Sheehan’s
Water deprivation test corrects with restricting water, diagnosis?
psychogenic polydipsia
Initial fluid resuscitation for DKA?
normal saline or lactated ringers
Hypoglycemia after working out - what do you do?
Eat glucose
MRI incidentally finds no pituitary, diagnosis and tx?
Empty sella syndrome (benign) - reassurance (no tx needed - they still have a pituitary its just not located in the sella)
How do you tx SIADH?
Water restrict, fix the underlying condition
Thyroid nodule with a low TSH, “hot” nodule on RAIU - what’s the next step?
Treat hyperthyroidism (no biopsy)
CT scan for something else, finds adrenal incidentaloma, next step?
Rule out Conn’s, Cushings and pheo
You suspect Conn’s, the aldo is raised and the renin is lowered, A:R ratio greater than 30, dx? Next steps (3)? Tx?
primary hyperaldosteronism; salt suppression test (for definitive diagnosis); MRI (to look for adenoma = Conn’s vs hyperplasia); adrenal vein sampling (often side with out mass is the hyperfunctioning side); If tumor, resect!
An A1c of 6.0 means what? How do you treat?
Pre-diabetes; lifestyle modifications and metformin
Pericardial effusion, coma, hypotension, and hypothermia, dx?
Myxedema coma
MEN2A tumors? Gene?
Pheochromoctyoma + Medullary thyroid
+ Parathyroid; RET oncogene
MEN2B tumors? Gene?
Pheochromoctyoma + Medullary thyroid
+ Neuronal; RET oncogene
Headache, tachycardia, hypertension, perspiration - dx? Tx?
Pheochromocytoma; alpha adrenergic blockade, beta-blockade, resection (in that order!)
Hypoglycemia + normal c-peptide, dx?
Injxn of exogenous insulin
Painful thyroid, dx?
DeQuervain’s thyroiditis
What will you see on RAIU for thyroiditis?
No uptake (since in thyroiditis, only pre-formed T4 is released)
Picture of purple stretch marks or the back of the neck with a hump, dx?
Cushing’s syndrome
Has a pituitary mass, suddenly goes altered and hypotensive, dx?
Apoplexy (tumor outgrows blood supply and pituitary undergoes necrosis)
How do you diagnose DKA (4)?
BMP (bG, anion gap), U/A (ketones), serum ketones, ABG for acidosis
Water deprivation test corrects with ADH administration, dx?
central DI
What is the thyroid nodule size on ultrasound that automatically goes to FNA?
Size greater than 1 cm
Pathology shows orphan annie nuclei, diagnosis?
Papillary thyroid cancer
Which thyroid tumor has hematogenous spread? Which is locally invasive? Which has psammoma bodies? Which causes hypocalcemia?
follicular; anaplastic; papillary; medullary
How do you know when DKA is fully treated? HHS?
When the anion gap closes; follow the symptomatic improvement
First line therapy for prolactinomas?
Dopamine agonists (cabergoline > bromocriptine)
Hypoglycemia + high c-peptide - what’s the next test?
Secretagogue screen (differentiate btwn insulinoma and ingestion of sulfonylureas which cause increased endogenous insulin production)
What is the devastating side effect of metformin? Who shouldn’t get it (3)?
lactic acidosis; patients with CHF, CKD, liver disease
Pt in DKA and the gap closes, what do you do?
Bridge subQ insulin
What non-insulin class can cause hypoglycemia?
sulfonylureas
How do you screen for pheochromocytoma?
Urinary metanephrines and VMA
HTN and hypokalemia, dx?
Conn’s syndrome
How do you tx myxedema coma (3)?
warmed IV fluids, blankets, IV T4
How do you treat the Na in refractory SIADH?
demeclocycline, which induces nephrogenic diabetes insipidus
You suspect Conn’s syndrome, first step in diagnosis?
Aldo:Renin ratio
Treatment for central diabetes insipidus?
Intranasal desmopressin (DDAVP)
What’s the treatment for metastatic follicular carcinoma?
Radioactive iodine
Young woman with renovascular hypertension, dx and next step?
Fibromuscular dysplasia, stent her!
Cortisol low, cosyntropin stim test does not stimulate cortisol, dx and next step?
Adrenal failure (Addison’s), CT abdomen and give fludrocortisone and cortisol
What are the annual screening tests diabetics need?
Urinalysis (look for microalbuminuria), retina exam (look for retinopathy), monofilament foot screen (look for neuropathy)
Thyroid nodule with a low TSH, no hot nodule on RAIU - next step is?
U/S (then FNA, but first u/s)
It’s definitely Cushing’s Disease, but the MRI is negative, next step?
Inferior petrosal sinus sampling (it’s where the pituitary gland drains) (Cushing’s Disease = pituitary tumor)
Hypoglycemia and a coma - what do you do?
IV D50 (or IM glucagon if not at hospital)
Fasting glucose: name the numbers for normal and for diabetes
normal: less than 100
diabetes: greater than 125
How do you tx thyroid storm (4)?
IV fluids, propranolol (to control rate), PTU/methimazole (to decrease fT4), IV steroids (to reduce peripheral conversion of T4 to the more active T3)
What will you see on RAIU for a toxic adenoma?
cold thyroid, hot adenoma
What will you see on RAIU of Grave’s disease?
Whole thyroid is hot and enlarged
Galactorrhea and amenorrhea, dx?
prolactinemia (likely a prolactinoma)
