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EORE Peds > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Secondary (pituitary gland) and tertiary (hypothalamic) HPA endocrine disorders have labs in the same OR opposite direction

A

SAME direction

Ex: TSH-secreting pituitary adenoma = increased TSH and free T3/T4

Cushing’s disease (2/2 pituitary adenoma) = increased ACTH and increased cortisol levels

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2
Q

Primary endocrine disorders (d/o where target organ = main problem) have labs in same direction or opposite direction

A

Have labs in OPPOSITE direction

Ex 1: Graves, toxic goiters, & toxic thyroid adenoma = increased free T3/T4 but DECREASED TSH - free T3/T4 feeds back on Hypothalamus & pituitary to shut down TRH/TSH release

Ex 2: Hashimoto’s thyroiditis = decreased free T3/T4 and INCREASED TSH

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3
Q

What is the best test for screening thyroid function

A

TSH levels

Best initial test for suspected thyroid disease.

Also used to follow pt on thyroid hormone tx - low TSH - decrease dose of levothyroxine, high TSH = increase dose of levothyroxine

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4
Q

When do you order free T4 level?

A

Orderd when TSH is abnormal to determine thyroid hyperfunction or hypofunction and in conjunction with TSH levels to monitor Grave’s

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5
Q

Antibodies present in Hashimoto’s thyroiditis

A

Anti-thyroid peroxidase Ab

Anti-thyroglobulin Ab

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6
Q

Ab present in Grave’s disease

A

Thyroid stimulating Ab (TSH receptor Ab)

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7
Q

RAIU Test- diffuse uptake

A

Grave’s disease

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8
Q

RAIU Test - Decreased uptake

A

Thyroiditis (hashimoto’s)

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9
Q

RAIU Test - Hot nodule

A

Toxic adenoma

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10
Q

RAIU Test - Multiple nodules

A

Toxic multinodular goiter

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11
Q

RAIU Test - cold nodules

A

Rule out malignancy

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12
Q

Elevated TSH

Subsequent low FT4

A

Primary hypothyroidism

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13
Q

Elevated TSH

Subsequent high FT4

A

Secondary TSH-mediated hyperthyroidism

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14
Q

Elevated TSH

Subsequent normal FT4

A

Subclinical hypothyroidism

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15
Q

Low TSH

Low FT4

A

Secondary or tertiary hypothyroidism (rare) - usually pituitary issue or drug-induced

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16
Q

Low TSH

High FT4

A

Primary hyperthyroidism, thyrotoxicosis (target organ pumping out too much FT4) –> check RAIU to identify cause - diffuse uptake = Grave’s disease

17
Q

Management of subclinical hypothyroidism

A

Subclinical = High TSH, normal FT4

Tx: Levothyroxine IF pt develops hyperlipidemia, TSH > 20, or hypothyroid symptoms

18
Q

Etiologies Hypothyroidism

A 
Iodine deficiency 
Hashimoto's thyroiditis
Postpartum thyroiditis
Pituitary or hypothalamic hypothyroidism
Cretinism 
Reidel's thyroiditis
19
Q

Etiologies hyperthyroidism

A 
Grave's disease
Toxic multi-nodular goiter
TSH-secreting pituitary adenoma 
Excess intake of T3, T4
Iatrogenic thyrotoxicosis
20
Q

CP Hypothyroidism

A 
Decreased BMR 
Cold intolerance
Dry, thick, rough skin 
Loss of outer 1/3 eyebrow
Goiter 
Nonpitting edema (myxedema) 
Hypoactivity (fatigue, sluggish, memory loss, depression) 
Constipation, anorexia
Bradycardia 
Menorrhagia 
Hypoglycemia
21
Q

CP Hyperthyroidism

A 
Increased BMR 
Heat intolerance 
Weight loss (despite inc appetite) 
Diarrhea, hyper-defecation 
Tachycardia, palpitations, high output heart failure 
Scanty periods, gynecomastia
Hyperglycemia 
Skin: warm, moist, soft, fine hair, alopecia, easy bruising

Hyperactivity (anxiety, fine tremors, nervousness, weakness, increased SANS)

22
Q

Cretenism

A

Congenital hypothyroidism - 2/2 maternal hypothyroidism or infant hypo-pituitarism

23
Q

Cretenism CP

A

Macroglossia, hoarse cry, coarse facial features, umbilical hernia, weight gain

Mental development abnl may develop if not corrected

24
Q

Etiology hypercalcemia

A

> 90% of cases caused by primary hyperparathyoidism or malignancy

Familial hypercalciuric hypercalcemia

Vitamin D excess

25
Q

CP Hypercalcemia

A

Most pt are asx +/- arrhythmias

Moans - psych - weak, fatigue, AMS, dec DTR, depression or psychosis

Groans - ileus, constipation (dec contraction of m. of GIT) nausea, vomiting

Bones - painful bones, fx (2/2 bone remodeling)

Stones - kidney stones 2/2 hypercalciuria

26
Q

EKG Hypercalcemia

A

Shortened QT interval
Prolonged PR interval
QRS widening

27
Q

Tx Hypercalcemia

A

VOLUME expansion - IV fulids

Furosemide (dec Ca2+) - AVOID thiazide diruetics = inc calcium

Calcitonin (tones down Ca2+)
BIsphosphonates in severe cases (IV pamidronate)

Steroids (if vitamin D excess, malignancy (myeloma), granulomas)

Mild - no treatment needed for mild hypocalcemia - treat underlying cause

28
Q

Signs Hypoglycemia

A

Sweating, tremors, palpitations, nervousness, tachycardia

CNS: Headache, lightheadedness, confusion, slurred speech, dizziness

29
Q

Gold standard dx diabetes mellitis

A

Fasting plasma glucose >125

Fasting minimum 8 hours
Test done on TWO occasions

30
Q

Gold standard dx gestational diabetes

A

3 hour glucose tolerance test

31
Q

HgbA1C > ____ = DM

A

greater than or equal to 6.5%

EORE Peds (3 decks)

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