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Endocrine Flashcards

1
Q

Hyperparathyroidism cause

A

adenomas, hyperplasia, carcinoma; renal failure, milk-alkali syndrome, multiple myeloma, sarcoidosis, TB, medications (HCTZ, Ca, Vit D), Hodgkin lymphoma, adrenal insufficiency, hyperthyroidism); low calcium -> PTH secretion -> osteoclast activity -> inc serum calcium

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2
Q

Hyperparathyroidism s/s

A

thirst, anorexia, N/V, abdominal pain, constipation, fatigue, anemia, weight loss, PUD, pancreatitis, HTN, depressed deep tendon reflexes; kidney stones, bone pain, inc abdominal absorption, abdominal cramps/groans, irritability, psychosis, depression (moans)

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3
Q

Hyperparathyroidism dx

A

CMP (Ca >10.5, phosphate <2.5); urine calcium secretion, PTH >55 (elevated Ca, low PTH, malignancy); imaging (US/CT/MRI), EKG (prolonged PR, short QT, brady, heart block)

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4
Q

Hyperparathyroidism tx

A

drink fluids, keep active, avoid HCTZ, vit A & D, Ca antacids; IV hydration, bisphosphonates (acute crisis); parathyroidectomy

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5
Q

Hypoparathyroidism cause

A

S/P parathyroidectomy/thyroidectomy; autoimmune, metal toxicity (Wilson disease, hemochromatosis), thyroiditis, hypomagnesemia (chronic alcoholism), congenital (DiGeorge syndrome)

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6
Q

Hypoparathyroidism s/s

A

tetany, carpopedal spasms, muscle/abdominal cramps, paresthesias, teeth/nail/hair defects, hyperreflexia, convulsions; Chvostek sign (contraction of face by tapping facial nerve), Trousseau sign (spasm of hand/wrist w/ compression to forearm); lethargy, anxiety, parkinsonism

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7
Q

Hypoparathyroidism dx

A

decreased PTH; CMP (decreased Ca, increased phosphate); EKG (prolonged QT, T wave abnormalities); imaging (bone mineral density changes)

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8
Q

Hypoparathyroidism tx

A

Vit D 8-8.6 mg, Ca 1-2g/day, Magnesium supplementation (correct hypocalcemia); avoid phenothiazines, furosemide; IV Calcium gluconate (emergency tetany); recombinant human PTH (teriparatide)

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9
Q

Hyperthyroidism cause

A

Grave’s disease (autoimmune), toxic multinodular goiter, Hashimoto’s, pituitary tumor, excess iodine, amiodarone

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10
Q

Hyperthyroidism s/s

A

weight loss, anxiety, warm skin, onycholysis, menstrual irregularity, tachycardia, palpitations, brittle hair, hyperreflexia; exophthalmos, lid lag w/ downward gaze, infiltrative ophthalmopathy (Graves); atrial fibrillation, hypercalcemia, osteoporosis, impotence, nephrocalcinosis, decreased libido, gynecomastia, decreased sperm count, clubbing, finger swelling

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11
Q

Hyperthyroidism dx

A

TSH (low); T3/T4 (elevated); Graves (peroxidase antibodies, thyroglobulin); MRI/CT, radioactive thyroid uptake (Graves, toxic multinodular goiter)

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12
Q

Hyperthyroidism tx

A

B-blocker (propranolol), propylthiouracil (PTU, DOC preg), methimazole (MMI); radioactive iodine ablation (Graves); thyroidectomy; IV methylprednisolone (ophthalmopathy); digoxin, warfarin (afib)

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13
Q

Thyroid Storm (extreme Hyperthyroidism) cause

A

illness, sepsis, trauma, surgery, RAI administration, pregnancy

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14
Q

Thyroid Storm (extreme Hyperthyroidism) s/s

A

high fever, tachycardia, agitation, sweating, tremor, instability, delirium, vomiting, diarrhea

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15
Q

Thyroid Storm (extreme Hyperthyroidism) dx

A

TSH (low); T3/T4 (high); not determinate (clinical best)

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16
Q

Thyroid Storm (extreme Hyperthyroidism) tx

A

ICU admission; PTU, IV hydrocortisone, propranolol; avoid IV dextrose/carbs

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17
Q

Hypothyroidism cause

A

Graves, Hashimotos; autoimmune (pernicious anemia, rheumatoid arthritis, SLE, Sjogren syndrome, myasthenia gravis); Sheehan syndrome; iodine therapy, thyroidectomy, iodine deficient diet, amyloidosis, lymphoma, scleroderma, lithium, amiodarone

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18
Q

Hypothyroidism s/s

A

weakness, dry/coarse skin, lethargy, slow speech, cold intolerance, eyelid edema, forgetfulness, facial edema, constipation, coarse hair, weight gain, facial dullness, depression, anemia, bradycardia, hyporeflexia; palpable enlarged thyroid; myxedema (tibial nonpitting fluid retention); dec GI motility

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19
Q

Hypothyroidism dx

A

TSH (high); T4 (low); (low T4, normal TSH -> secondary); autoimmune (antithyroid peroxidase, antithyroglobulin antibodies)

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20
Q

Hypothyroidism tx

A

levothyroxine 25-200 mcg/day

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21
Q

Myxedema Crisis (5 H’s) cause

A

sepsis, cardiac disease, respiratory distress, CNS disease, cold exposure, drug use

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22
Q

Myxedema Crisis (5 H’s) s/s

A

obtundation, CO2 retention, coma, AMS; hypothermia, hypoventilation, hyponatremia, hypoglycemia, hypotension, rhabdomyolysis, acute kidney injury

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23
Q

Myxedema Crisis (5 H’s) dx

A

clinical; TSH (high)

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24
Q

Myxedema Crisis (5 H’s) tx

A

ICU admission; Thyroxine IV bolus 300-400 mcg, then 50-100 mcg/day; avoid morphine

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25
Q

Suppurative Thyroiditis cause

A

gram-positive bacteria (staph aureus)

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26
Q

Suppurative Thyroiditis s/s

A

tender thyroid gland, fever, pharyngitis, overlying erythema

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27
Q

Suppurative Thyroiditis dx

A

fine needle aspiration w/ gram stain/culture; WBC (high), ESR (high)

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28
Q

Suppurative Thyroiditis tx

A

medications for underlying cause; surgical drainage w/ fluctuation

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29
Q

Subacute Painful Thyroiditis (de Quervain’s, granulomatous, giant cell) cause

A

preceding viral illness (coxsackie virus, EBV, mumps, measles, adenovirus, echovirus, influenza); worse in summer

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30
Q

Subacute Painful Thyroiditis (de Quervain’s, granulomatous, giant cell) s/s

A

very tender thyroid gland; fever, fatigue, dysphagia, otalgia (persist for months)

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31
Q

Subacute Painful Thyroiditis (de Quervain’s, granulomatous, giant cell) dx

A

ESR (high), antithyroid antibody titers (low); thyrotoxicosis initially presents, followed by hypothyroidism/resumption of euthyroid in 12 months

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32
Q

Subacute Painful Thyroiditis (de Quervain’s, granulomatous, giant cell) tx

A

ASA; b-blockers (lessen symptoms)

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33
Q

Drug Induced Thyroiditis cause

A

amiodarone

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34
Q

Drug Induced Thyroiditis s/s

A

hyperthyroidism symptoms, followed by hypothyroid symptoms

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35
Q

Drug Induced Thyroiditis dx

A

T4 (elevation), TSH (low) during first month of Tx

36
Q

Drug Induced Thyroiditis tx

A

remove amiodarone

37
Q

Hashimoto Thyroiditis (Chronic Lymphocytic) cause

A

sporadic in children; familial; north American diet

38
Q

Hashimoto Thyroiditis (Chronic Lymphocytic)

A

diffusely enlarged thyroid w/ firm small nodules; progresses to hypothyroidism

39
Q

Hashimoto Thyroiditis (Chronic Lymphocytic)

A

detectable thyrotropin receptor-blocking antibodies, antithyroid peroxidase

40
Q

Hashimoto Thyroiditis (Chronic Lymphocytic)

A

levothyroxine (once hypo)

41
Q

Fibrous Thyroiditis (Riedel) cause

A

dense fibrous tissue development; sclerosing cholangitis, retroperitoneal fibrosis, orbital pseudotumor

42
Q

Fibrous Thyroiditis (Riedel) s/s

A

asymmetric, hard, “woody” thyroid

43
Q

Fibrous Thyroiditis (Riedel) dx

A

biopsy (r/o carcinoma); RAIU (decreased), thyroid antibodies present

44
Q

Fibrous Thyroiditis (Riedel) tx

A

long-term Tamoxifen

45
Q

Cushing Syndrome (hypercortisolism) cause

A

ACTH-secreting pituitary microadenoma; corticosteroid use, adreno cortical tumors, non-pituitary ACTH-producing tumors

46
Q

Cushing Syndrome (hypercortisolism) s/s

A

central obesity, HTN, thirst, polyuria, with or without glycosuria; buffalo hump, moon facies, supraclavicular pads; proximal muscle weakness, pigmented striae; back ache, headache, oligomenorrhea/amenorrhea/ED; osteoporosis, fracture, kidney stones; impaired wound healing, acne, bruisability, skin infection; psychosis

47
Q

Cushing Syndrome (hypercortisolism) dx

A

24hr urine collection (free cortisol >125); overnight dexamethasone suppression test, ACTH <20 (adrenal tumor), higher levels of ACTH (ectopic origin); MRI/CT

48
Q

Cushing Syndrome (hypercortisolism) tx

A

transsphenoidal selective resection; irradiation, gamma knife radiosurgery, bilateral adrenalectomy; Mitotane, metyrapone, ketoconazole (suppress high cortisol); octreotide (suppress ACTH)

49
Q

Addison’s Disease (Adrenocortical Insufficiency) cause

A

autoimmune destruction; polyglandular autoimmune syndrome, genetic disorders (adrenoleukodystrophy), TB; infection, trauma, surgery, stress, cancer, scleroderma, hemochromatosis, cessation of corticosteroid meds (adrenal crisis)

50
Q

Addison’s Disease (Adrenocortical Insufficiency) s/s

A

hyperpigmentation of skin (tanned), fatigue, weakness, anorexia, weight loss, irritability/anxiety; emotional changes, myalgias, arthralgias, GI symptoms, amenorrhea, sensory hypersensitivities; orthostatic hypotension, delayed deep tendon reflexes; small heart, hyperplasia of lymph tissue, scant axillary/pubic hair, hypogonadism; hypotension, acute abdominal/back pain, N/V/D, dehydration, AMS (addisonian crisis)

51
Q

Addison’s Disease (Adrenocortical Insufficiency) dx

A

low 8:00 AM plasma cortisol <3, ACTH >200 vs ACTH suppression test (diagnostic); CMP (hyperkalemia, hyponatremia, hypoglycemia, hypercalcemia, low BUN); antiadrenal antibodies, low DHEA levels

52
Q

Addison’s Disease (Adrenocortical Insufficiency) tx

A

corticosteroids (hydrocortisone, prednisone) and mineralocorticoids (fludrocortisone acetate); DHEA prn; IV saline, glucose, glucocorticoids (addisonian crisis)

53
Q

Prolactinoma (Pituitary Adenoma) cause

A

dopamine deficiency/receptor problem

54
Q

Prolactinoma (Pituitary Adenoma) s/s

A

oligomenorrhea/amenorrhea, galactorrhea, infertility, decreased libido

55
Q

Prolactinoma (Pituitary Adenoma) dx

A

prolactin (high), dopamine (low); MRI

56
Q

Prolactinoma (Pituitary Adenoma) tx

A

transsphenoidal surgery; dopamine agonist (bromocriptine, cabergoline)

57
Q

Somatotropinoma (Pituitary Adenoma) cause

A

growth hormone secreting adenoma

58
Q

Somatotropinoma (Pituitary Adenoma) s/s

A

acromegaly, gigantism; DM, glucose intolerance

59
Q

Somatotropinoma (Pituitary Adenoma) dx

A

oral glucose suppression test (increase in GH levels); MRI

60
Q

Somatotropinoma (Pituitary Adenoma) tx

A

transsphenoidal surgery; TSS + bromocriptine, octreotide

61
Q

Aderenocorticotropinoma (Pituitary Adenoma) cause

A

secretes ACTH

62
Q

Aderenocorticotropinoma (Pituitary Adenoma) s/s

A

Cushing disease, hyperpigmentation

63
Q

Aderenocorticotropinoma (Pituitary Adenoma) dx

64
Q

TSH Secreting Adenoma (Pituitary Adenoma) cause

A

secrete TSH

65
Q

TSH Secreting Adenoma (Pituitary Adenoma) s/s

A

Thyrotoxicosis

66
Q

TSH Secreting Adenoma (Pituitary Adenoma) dx

A

increase in TSH, T4, T3; MRI

67
Q

FSH/LH secreting Adenoma (Pituitary Adenoma) cause

A

secrete FSH/LH; rare

68
Q

FSH/LH secreting Adenoma (Pituitary Adenoma) s/s

A

menstrual irregularities, ovarian cysts, menopause

69
Q

FSH/LH secreting Adenoma (Pituitary Adenoma) dx

A

FSH/LH; MRI

70
Q

FSH/LH secreting Adenoma (Pituitary Adenoma) tx

A

hormone regulation (BC)

71
Q

Diabetes Insipidus (low vasopressin) cause

A

deficiency/resistance of vasopressin (ADH); genetic, sporadic; tumor, encephalopathy, infection, metastatic disease
■ Central: head trauma, brain surgery; inherited; lack “osmostat”
■ Nephrogenic: chronic renal failure, lithium toxicity, hypercalcemia, hypokalemia

72
Q

Diabetes Insipidus (low vasopressin) s/s

A

polydipsia, large volume polyuria, dilute urine; intense thirst w/ fluid intake of 2-20 L/day, craving for ice water

73
Q

Diabetes Insipidus (low vasopressin) dx

A

serum osmolality (high), urine osmolality (low); ADH levels (hypothalamic low, nephrogenic high); supervised vasopressin challenge test; MRI

74
Q

Diabetes Insipidus (low vasopressin tx

A

Desmopressin acetate; HCTZ w/ potassium or amiloride (central), indomethacin w/ HCTZ, desmopressin, amiloride (nephrogenic)

75
Q

Diabetes Mellitus Type 1 cause

A

autoimmune; insulin deficiency, insulinopenia, absence of insulin (no response to B cells)

76
Q

Diabetes Mellitus Type 1 s/s

A

polydipsia, polyuria, nocturia, rapid weight loss, blurred vision, weakness, paresthesias; fruity breath, anorexia, N/V, dehydration, stupor, coma (DKA)

77
Q

Diabetes Mellitus Type 1 dx

A

random glucose/GTT >200, HA1C >6.5; ABG, ketones in urine (DKA)

78
Q

Diabetes Mellitus Type 1 tx

A

diet; 1 unit insulin for 10-15g carbs; ASA, foot care, hygiene
■ Rapid acting insulin: peak in 60-90 min, 4-5 hrs, preprandial
■ Regular insulin: peaks in 2-4hrs, lasts 5-8hrs, IV for DKA
■ NPH long acting insulin: lasts 24hrs, 2 injections/day
■ Basal insulin: glargine, detemir; peakless

79
Q

Diabetes Mellitus Type 2 cause

A

family hx; insulin resistance; hyperosmolar, nonketotic states

80
Q

Diabetes Mellitus Type 2 s/s

A

polyuria, polydipsia, fatigue, pruritus, infections, blurred vision; overweight, obesity

81
Q

Diabetes Mellitus Type 2 dx

A

random glucose/GTT >200; HAIC >6.5; ABG, ketones in urine (DKA)

82
Q

Diabetes Mellitus Type 2 tx

A

diet, weight loss; metformin, insulin, glyburide, etc; ASA, annual ophthalmologic exams, annual UA

83
Q

Hyperlipidemia cause

A

primary; familial; secondary (DM, alcohol, obesity, sedentary lifestyle, renal/liver disease)

84
Q

Hyperlipidemia s/s

A

eruptive/tendinous xanthomas, lipemia retinalis (cream colored retinal vessels w/ TG >2000, pancreatitis TG >1000), premature arcus senilis; coronary artery disease

85
Q

Hyperlipidemia dx

A

Cholesterol (>200), Triglycerides (>150), LDL (>160), HDL (<40)

86
Q

Hyperlipidemia tx

A

lifestyle changes, smoking cessation, Statins (1st line)
■ Statins (simvastatin, atorvastatin): lower LDL, TG (ADE: myalgia, GI effects)
■ Niacin: lower VLDL, LDL, TG; raise HDL (flushing w/o ASA)
■ Bile acid sequestrants (Cholestyramine, colesevelam)
■ Fibric Acid derivatives (gemfibrozil): lower TG; raise HDL (induces gallstones, hepatitis, myositis)

Internal Medicine (9 decks)

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