Endocrine Flashcards
1
Q
Which “ast” does PTH stimulate?
A
osteoclast
2
Q
What 2 places can absorb calcium?
A
bowel
kidney
3
Q
MC cause of primary hyperparathyroidism?
A
benign parathyroid adenoma
4
Q
causes of hypercalcemia?
A
hyperparathyroidism kidney failure malignancy milk-alkali TB sarcoidosis multiple myeloma meds (thiazides, lithium) prolonged bed rest adrenal insufficiency
5
Q
What are the clinical manifestations of hypercalcemia?
A
stones (kidney)
bones (jaw fracture)
groans (psych)
moans (abd)
6
Q
Dx to confirm primary hyperparathyroidism?
A
increased PTH and ca
phosphorus is normal
7
Q
what can cause secondary hyperparathyroidism?
A
decreased vit D/ca
hyperphosphatemia
renal failure
8
Q
hypercalcemia can cause what heart changes?
A
prolonged PR (contraction) shortened QT (repolarization) asystole bradycardia heart block
9
Q
what is a congenital cause of hypothyroidism
A
digeorge
10
Q
what is cvhostek sign?
A
tap on the facial nerve => eye, nose, mouth spasm
11
Q
what sort of reflexia does hypocalcemia cause
A
hyperreflexia
12
Q
troussea sign?
A
spasm of the hand/wrist with compression of the forearm from hypocalcemia
13
Q
what are symptoms of hypocalcemia?
A
lethargy anxiety parkinsoniansim mental R personality change blurred vision
14
Q
EKG change of hypocalcemia
A
prolonged qt
t wave changes
15
Q
tx of tetany?
A
airway
slow IV of calcium gluconate
16
Q
what is PTH used to tx?
A
osteoporosis
not for hypoparathyroidism
17
Q
level of TSH in primary hypothyroid?
A
high
18
Q
causes of hyperthyroid
A
graves #1 toxic multinodular goiter #2 hashimoto amiodarone excess I pituitary tumor pregnancy exogenous thyroid hormone
19
Q
what antibodies are in graves?
A
peroxidase
thyroglobulin
20
Q
can radio-iodine therapy be done in pregnancy
A
no
21
Q
initial tx for hyperthyroid symptoms
A
bb
22
Q
PTU or methimazole is used in pregnancy? which is generally preferred
A
PTU
methimazole
23
Q
tx afibb in hyperthyroid?
A
need to be euthyroid to be able to fix it
digoxin
bb with caution
need to anticoagulate
24
Q
what is a thyroid storm?
A
hyperthyroidism triggered by stress
ie pregnancy, illness, surgery, trauma
25
what antibodies are in hypothyroidism
anti-tsh
26
30% of what pts have hypothyroidism?
down
27
best screening test for hypothyroidism?
tsh
28
before init levothyroxine what should you check for?
angina and adrenal insufficiency
29
mc cause of thyroiditis? (infection)
staph aureus
30
what is subacute painful thyroiditis?
peaks in summer
| young, middle aged F
31
course of subacute painful thyroiditis?
thyrotoxicosis => hypothyroid => euthyroid in <12 months
32
tx for subacute painful thyroiditis?
aspirin
33
drug => thyroiditis in 20% of patients
amiodarone
34
an asymptomatic, hard woody thyroid?
fibrous thyroiditis
35
which thyroid cysts are painful?
suppurative ie staph
36
how common are thyroid nodules?
1/12-15 of young women have them
37
ant pituitary releases what?
```
TSH
ACTH
prolactin
GH
LH
TSH
```
38
post pituitary releases what?
oxytocin
| ADH
39
what inhibits prolactin?
dopamine
40
what inhibitis TSH and GH?
somatostatin
41
what does TRH release?
TSH
| prolactin
42
screen test for GH excess?
serum IGF-1
43
imaging choice for increased GH?
MRI
| looking for pituitary adenoma
44
if you are checking IGF-1 for excess GH what are you also checking for?
prolactin
common for a pituitary adenoma to secrete both GH and prolactin
45
tx of increased GH?
somatostatin analog
46
what is pegvisomat?
GH receptor antagonist
47
what causes diabetes insipidus?
loss of ADH or insensitivity to it
48
central DI responds to what?
desmopressin
| vasopressin ie ADH analog
49
what is osmolality in DI?
serum is high
| urine is low
50
tx of nephrogenic DI
indomethacin alone or with
| HCTZ, desmopressin analog, amiloride
51
what criteria are a part of metabolic syndrome?
```
low HDL
high trigs
increased waist
insulin resistance
BP
```
52
% of diabetics that have retinopathy
30%
53
complications of DM
```
retinopathy
neuropathy
nephropathy
CAD
poor healing
(more)
```
54
1 unit of insulin is roughly how many carbs
15 grams
55
where is regular insulin most rapidly absorbed
abdomen
56
how long does regular insulin
last 5-8 hours
57
at what Cr is metformin CI?
>1.5
58
pioglitazone is associated with what?
bladder cancer
| is a thiazoliredione
59
GLP-1 SE?
pancreatitis
| nausea
60
whipple triad?
hypoglycemia symptoms
(sweating, palp, anx, tremulousness)
immediate recovery with glucose
BS < 45
61
xanthelasma =
xanthoma affecting the eyelid
62
USPSTF recommends lipid screening at what age?
45
63
what do you monitor with statins?
liver enzymes
64
cushing disease is caused by what?
ACTH secreting adenoma (pituitary)
syndrome = signs of excess cortisol
65
most specific signs of cushing syndrome
proximal muscle wasting
pigmented striae
backache, HA
66
dx cushings
1) cortisol excess by dexamethasone test
| <5 ug/dL excludes cushings
67
MC cause of addison's
autoimmune destruction of gland
68
what infection can cause addison's?
tb
69
does addisons or cushings cause hyperpigmentation
addisons
70
electrolytes in addisons?
```
hyperkalemia
hyponatremia
low glucose
increased calcium
decreased BUN
```
71
how would addisonian crisis present?
hypotensive
pain (abd/back)
v/d
altered mental status
72
dx addison's
low 8 am cortisol < 3 ug/dL and increased ACTH
73
what is DHEA used to tx?
dehydroepiandrosterone
Addisons
74
tx of addisonian crisis?
IV saline
glucose
glucocorticoids
75
mc presentation of hyperparathyroidism is what
asymptomatic
76
klinefelter syndrome has what genetic abnormality?
extra x
77
symptoms of severe cramps, extremity parasthesias, lethargy- think what electrolyte which direction?
hypocalcemia
could be hypoparathyroidism
78
enlargement of the thyroid gland in graves looks like what?
diffuse enlargement
79
for a pt on a steroid for adrenal insufficiency...
how do you dose it during an illness?
how do you dose during a surgery?
```
illness = double
surgery = 5-10 fold
```
80
tx for diabetes insipidis?
desmopressin
81
a tophus represents what?
underlying gout
82
what insulin do you give a diabetic in ketoacidosis?
regular insulin
83
what EKG waves are associated with hyperkalemia?
u waves
84
initial dx study for a thyroid nodule
FNA
85
tx of hyperkalemia
calcium
loop diuretic
86
In tertiary disorder which organ is the problem (endocrine)? Secondary? Primary?
3) hypothalamus
2) pituitary
1) target organ
87
best thyroid screening test?
TSH
88
which antibody is specific for graves?
thyroid stimulating antibody
89
in a pt with subclinical hypothyroidism when must you tx with levothyroxine?
if pt develops hyperlipidemia
if the TSH increases over 20
they have symptoms of hypthyroidism
90
what is cretinism and how do you manage it?
developmental hypothyroidsim
manage with levothyroxine
can be from mom hypothyroid or from infant hypopituitarism
91
what is a euthyroid?
abnormal thyroid levels but thyroid gland is normal
| seen with illness, surgery, sepsis, cardiac disease
92
how does a person in a thyroid storm present?
hypermetabolic state:
| palpitations, afibb, fever, nausea, vomiting, psychosis, tremors, tachy,
93
management of thyroid storm:
1) PTU IV or methimazole (PTU inh peripheral conversion)
2) beta blocker, iv sodium iodide (decreases coversion)
3) IV glucocorticoids (decreases conversion), fluids, cardiac monitoring, cooling blankets
94
what do you avoid giving in a thyroid storm for fever?
aspirin
| because it increases 4-3 conversion
95
management of myxedema crisis:
levothyroxine IV
passive warming
normal saline
in adrenal insufficiency give steroids
96
what is commonly seen with older women with long standing hypothyroidism in the winter?
myxedema crisis
97
what does RAIU test show for graves?
diffuse uptake
98
If you see ophthalmopathy and a hyperthyroidism what is the cause of the hyperthyroidism?
graves
| will see lid lag and proptosis
99
Besides opthalmopathy what manifestation is exclusive to graves?
pretibial myxedmea
| ie nonpitting, edematous pink to brown plaques/nodeuls on the shin
100
tx of graves
radioactive iodine- will need hormone replacement
if pregnant- PTU (iodine ablation CI)
bb for symptoms
if unresponsive thyroidectomy
101
why can a toxic adenoma cause dyspnea, dysphagia, stridor and hoarseness?
it can cause laryngeal compression
102
SE of PTU and methimazole
agranulocytosis
| hepatitis
103
what hyperthyroid disorder can cause bitemporal hemianopsia
pituitary adenoma
104
antibodies present in hashimoto's?
thyroid antibody:
thyroglobulin ab
antimicrosomial
thyroid peroxidase ab
same antibodies present in silent lymphocytic thyroiditis, post-partum thyroiditis
105
treatment for lymphocytic thyroiditis
aspirin
| lasts for 12-18 months whereas hashimoto's is permanent
106
what is the cause of de quervain's thyroiditis
mc post-viral
107
which hypothyroid disorders are painful
de quervain's
| acute (supportive) thyroiditis
108
pt with increased ESR, a painful thyroid, no thyroid ab, and hyperthyroid.
de quervain's
109
what are three meds that can cause thyroiditis?
amiodarone
lithium
alpha interferon
110
tx of medication induced thyroiditis
stop med
| can do steroids
111
mc cause of acute thyroiditis?
staph aureus
112
riedel's thyroid is what kind of thyroid?
fibrous thyroid
113
what med may increase t4 requirements?
cholestyramine
| prevents reabsorption of bile
114
best initial test for thyroid nodule
FNA
115
mc type of thyroid nodular?
follicular adenoma
| follicular = frumpy
116
what % of thyroid nodules are benign?
90%
117
what do you do if a FNA of a thyroid nodule is undeterminate? (10% are)
benign?
malignant?
radioactive uptake scan
benign- prob needs meds in a couple years
malignant- excise
118
how often do you check a suspicious thyroid nodule?
q 6-12 months
119
mc type of thyroid cancer
papillary carcinoma
| "papillary= popular"
120
put the 4 types off thyroid carcinomas in increasing order of worse prognosis
papillary
follicular
medullary
anaplastic
121
which thyroid cancer is associated with MEN2?
| radiation? iodine deficiency?
MEN2- medullary
radiation- papillary
iodine- follicular
122
which thyroid cancer secretes calcitonin?
medullary
123
which thyroid cancer requires radiation and chemo and is not amenable to surgical resection?
anaplastic
124
mc cause of primary hyperparathyroidism? secondary?
parathyroid adenoma
secondary- kidney failure from lack of vit d=> ca
125
what are reflexes in hyperparathyroidism
decreased deep tendon
126
dx of 1 hyperparathyroidism?
hypercalcemia
increased PTH
decreased phosphate
calcium in urine (24 hour collection)
127
tx of hypercalcemia
iv fluids
| furosemide
128
signs of hypoparathyroidism?
decreased calcium
decrease PTH
increased phosphate
increased deep tendon reflexes, tetany
carpopedal spasms
trousseau's sign- flexed hand
chvostek's sign- facial spasm with tapping
129
mc pathologic fracture of osteoporosis?
vertebral
130
what are the risks of tx osteoporosis with estrogen in women?
```
stroke
CAD
endometrial cancer
breast cancer
DVTs
```
131
blue-tinted sclerae and presenile deafness goes with what disease?
osteogenesis imperfecta
132
chronic renal disease causes what bone pathologies?
osteitis fibrosis cystica
osteomalacia
from lack of conversion of vit D
133
why does CKD cause bone pathologies?
kidney don't convert vit D to active form, decreased ca absorption and ca levels, which increased PTH
PTH causes osteoclasts to release ca into the blood bone is weakened
134
what labs are off in CKD in relation to bones?
decreased Ca
increased phosphate P04 because it can't excrete it
increased PTH
135
how do you manage renal osteodystrophy?
phosphate binders
Ca
active vit D
cinacalcet lowers PTH levels
136
how is osteomalacia different than osteoporosis?
osteomalacia= lack of vit D, corticol thinning (osteoid demineralization) "soft"
osteoporosis= bone breakdown > bone formation, mineral and matrix loss proportional "brittle"
137
tx of osteomalacia
vit D ergocalciferol
| d2
138
MC of adrenocortical insufficiency overall? primary?
exogenous use
primary ie adrenal gland problem = addison's = autoimmune
2ry and 3ry are uncommon
139
what infections causes adrenal insufficiency?
TB
HIV
(cause calcification)
there are others
140
in 2ry and 3ry adrenal insufficiency why is aldosterone normal but cortisol low?
RAAS system provides aldosterone and it's just converted by the adrenal gland (which is still working because the problem is 2ry or 3ry)
so symptoms are due to lack of cortisol
remember aldosterone controls salt
141
in primary adrenal insufficiency what causes the symptoms?
lack of
aldosterone
sex hormones
increased ACTH
142
first line tx in established 2ry adrenal insufficiency?
hydrocortisone
interferes with testing so use prednisone/dexamethasone if not dx
aldosterone maintained by RAAS
143
tx for addisons?
glucocorticoid + mineralcorticoid
hydrocortisone + fludrocortisone
144
mc cause of cushing's overall?
exogenous
145
mc endogenous cause of cushings?
pituitary adenoma
146
a low dose dexamethasone test does what?
dx cushings
| ie there is no suppresion
147
a high dose dexamethasone test does what?
differentiates cushing's from an adrenal/ectopic ACTH releasing tumor
148
cushing disease vs syndrome
disease = from pituitary increased ACTH ie 1 specific cause
syndrome = increased cortisol ie general
149
what are two common causes of hyperaldosteronism?
```
renal artery stenosis (from increased renin)
adrenal aldosteronoma (conn's syndrome)
```
150
what are the 2 main clinical manifestations of hyperaldosteronism?
hypertension
| hypokalemia
151
how to dx hyperaldosteronism?
1. hypokalemia with metabolic alkalosis (losing K and H for Na)
2. saline infusion test- will not suppress aldosterone = definitive test
3. aldosterone to renin ration: if aldo> R is >20 its 1ry
if renin levels are high then its 2ry
4. CT/MRI to look for extra-adrenal mass
152
what are the symptoms of pheochromocytoma?
```
htn
PHE
palpiations
headache
excessive sweating
```
153
how do you dx pheochromocytoma?
24 hour urinary catecholamines
154
what do you give perioperatively when removing a pheochromocytoma?
phenoxybenzamine or phentolamine
ie alpha blockers
also "phe"
155
how often are pheochromocytoma's benign?
90%
156
tsh deficiency in infancy is called what?
cretinism
157
mc type of anterior pituitary tumor
prolactinoma
158
study of choice to look for anterior pituitary tumors
MRI
159
primary tx for prolactinoma?
medical
| bromocriptine or cabergoline (dopanie agonists inh prolactin)
160
name 2 dopamine agonists
cabergoline
| bromocriptine
161
what does dopamine inhibit
prolactin
162
gynecomastia is due mainly to what hormones?
increased estrogen
| decreased androgens
163
how do you dx gynecomastia
its clinical
164
medical tx of gynecomastia?
SERMs ie tamoxifen
or
aromatase inh
165
mc cause of end stage renal disease =
dm
166
tx for unconscious diabetic?
IV bolus D50
or
inject glucagon SQ
167
when do you start an ACE in DM?
if microabluminuria
168
rapid acting insulins: onset and duration
novolog
humalog
15-30 min
3-4 hours
169
short acting insulin: onset and duration
regular
30-1hr
4-6 hour
170
intermediate insulin: onset and duration
NPH
2-4 hours
16-20 hrs
171
long acting insulin: onset and duration
lantus, levemir
4 for lantus
6-8 for levemir
24-36 hours
172
dawn phenomenon
rise in glucose between 2-8 am
needs bedtime NPH and avoid carbs at night
173
somogyi effect
hypoclycemia at night followed by hyperglycemia from growth hormone surge
avoid NPH at night, have snack
174
management of DKA?
1. fluid of NS .9% until hypotension resolves, then .45% normal saline, then D5 1/2 NS when blood glucose gets to 250
2. regular insulin
3. K replacement
175
MEN 1 has what tumors?
the P's
| pancreas, parathyroid, pituitary
176
what tumors are in MEN2?
parathyroid
medullary thyroid
pheochromocytoma
parathyroid is in 1 & 2
177
what drug is a common cause of nephrogenic diabetes insipidus?
lithium
178
Is central or nephrogenic Diabetes insipidus MC?
central
head trauma
decreased ADH production
179
what differentiates between central or nephrogenic DI?
desmopressin test
180
tx of nephrogenic DI?
hydrochlorothiazide
181
mc symptom of paget's disease?
bone pain
182
what lab is elevated in paget's disease?
ALP
183
tx for paget's disease?
bisphosphonates
it inh osteoclast activity which stop bone remodeling
184
SE of bisphosphonates
esophagitis
| femur fracture
185
what hormone primarily regulates water?
ADH
