endocrine Flashcards
“thyroiditis”. What does RAIU look like?
preformed T4 –> infx insult –> thryoid splits and dumps T4!!!
- option a) thyroid reforms
- option b) thyroid shrivels up and dies –> hashimotos
RAIU is cold because no new T4 being formed during dump
how do you treat Grave’s?
methimazole or PTU
-if they have exopthalmous or pretibial myxedema they need steroids
when do you tx subclinical hypothyroidism?
when >10, or any hypothyroid sx
myxedema coma
hypotn
hypothermia
give them IV T4/T3
papillary thyroid CA on bx
orphan annie nuclei
- psammoma bodies
- microcalcifications
- often presents earlier with palpable non tender cervical lymphnodes
Most common!
follicular thyroid
looks like nl thyroid tissue so FNA can be inconclusive and it spreads HEMATOGENOUSLY and therefore usually does not show lymph node involvement
RAI ablation will kill all mets, but you should resect the thyroid first
medullary thryoid CA
c cells –> calcitonin –> dec calcium
-assoc with pheo and RET oncogene
anaplastic yhroid ca
very invasive ca that older people get
-spindle cells
toxic adenoma
gain of function mutation at TSH receptor
andrgen insensitiviy genotype
(testicular feminization)
46xy –> genotypically male, phenotypically female on the outside but uterus end in blind pouch
**they get breast development because test can perpiherally be converted to estrogen
confirmation of neuroblastoma?
young kiddo
mass crosses midline
homovanillc/vanyllamendlic acids in urine
n-myc overexpresion
describe mech of ED in male with pituitary tumor
prolactinoma –> inhibits GnRH –> dec LH –> dec testosterone from leydig cells
the basics of basics of apprach to thyroid nodule
1) TSH!!!!!!!!
2) then probably scintigraphy
3) then whatver is next
galactorrhea associated with hypothryoidism?
TRH stimulates prolactin
SIADH after neurosurgery
euvolemic*** hyponatremia with inappropriately high urine osm (>100)
***normal vitals, no edema or tacky membranes
conn’s syndrome dx
increase aldo:renin > 30
-will see metabolic alkalosis
most common cause of hypothyroidism in children
hashimotos –> lymphocyctic infiltrate around germinal centers
perinaud syndrome
from pinealoma –> most common= germinoma
- vertical gaze palsy
- pupils do not react to light be react to accomodation
**boys are at risk for precocious puberty –> germinoma –> bhCG –> leydig cells –> test
insulinoma findings
high insulin, low glucose, elevated c peptide
*often assciated with weight gain
what do you need to w/u when working up hyperparathyroid/ medullary thyroid canc?
majority of patients with MEN2 will develop medullary thyroid which is prevented with thyroidectomy, but you need to check for pheo which can cause intraop catechol surg
21b-oh deficiency
ambiguous genitalia with precocious puberty
- hypotension with high K and low Na
- high levels of 17 hydroxyprog
tx= hydrocortisone for cortisol replacement (decrease ACTH) and fludrocortisone which replaces aldosterone and correct BP/ lytes
next step in working up cushings after ACTH comes back high?
hi dose dexamethasone suppression test to determine if its central or ectopic
presentation of thyroglossal duct cyst. How does this different from branchial cleft cyst?
painless, firm, midline neck mass that moves with swallowing and tongue protrusion in a child
branchial cleft cysts are lateral, ant to SCM and do NOT move with swallowing
why do you do adrenal sampling before resection of adrenal tumor?
to ensure that sx are result of mass and that its not incidental finding
subacute thyroiditis
deQuervains= painful
- elevated ESR
- usually postviral process
phsysiologic thyroid changes of pregnancy
bhcg (shares a common a subunit with TSH) and so directly inc T4 and suppresses TSH
irritability, tachy, poor feeding/ weight gain in baby born to mom with Graves
thyrotoxicosis of the newborn:
- anti TSH ab cross the placenta
- treat with BB and methimoazole
secondary hyperthyroidism
high TSH, high T3/T4 –> scan for TSH secreting pituitary tumor
early secondary sexual developemtn with NRMAL bone age:
- isolated breast –> premature thelarche
- isolated pubic hair –> premature adrenarche
early secondary sexual development with ADVANCED bone age
central precocious puberty –> early activation of GNRH axis high FSH, LH from pulsatile GnRH
Peripheral precocious puberty will have low FSH/LH due to gonadal/adrenal release
antiemetic prokinetic drug used in diabetic gastroparesis
metacloprimide
differentiate small fiber from large fiber in diabetic polyneuropathy
small fiber= pstivie sx= pain, parasthesias, allodynia
large fiber=negative sx= numbness, loss of proprioception, loss of DTR
dx of metabolic syndrome
3/5:
- abdominal circ
- fasting gluc >110
- BP >130/80
- triglycerides >150
- HDL <40 (men), 50 (women)
best measures for resolution of DKA?
anion gap (bicarb) and betahydroxybutarate (produced by ketones)
how do you minimize effects of thyroid receptor antibodies on eyes in Graves when using radioactive ablation
glucocorticoids
good DM2 drug in addition to metformin for weight loss?
GLP1 agonist, also has lower risk f hypoglycemia
milk alkali syndrome
inc intake of ca with absorbable alkali in preps for patients with osteoporosis
explain neonatal hypoglycemia at birth from MGD pregnancy
fetus develops high insulin levels to deal with moms glucose, but glucose doesn’t cross placental barrier so as soon as the placenta is gone the fetus becomes hypoglycemic
effect of low mag in alcoholics
dec Ca 2/2 resistance to PTH and dec PTH
age of presentation and sx of G6pD
Von gerke (type 1 glycogen storage do)
- presents about 3 months with signs of hypoglycemia, lactic acidosis, uricemia
- hepatomegaly
lab values you’d expect in primary polydipsia
dilute urine –> Uosm < 1/2 plasma osm
hyponatremia –> <145
Na levels in: central DI, nephrogenic DI, primary polydipsia
nephrogenic DI–> usu normal
Central DI –> hypernatremia
primary polydipsia –> hyponatremia
