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Endocrine Flashcards

1
Q

prolcatinoma basics

A

benign
men - decreased libido, macroadenoma, bitemporal hemaniopsia
women - amenorrhea + galactorrhea - microadenoma

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2
Q

dx of prolactinoma

A

check meds –> check TSH –> normal –> check prolactin level –> if elevated –> MRI

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3
Q

tx of prolactinoma

A

dopamine agonist - carbergoline > bromocriptine

sx only if tumor unresponsive to meds or >3cm

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4
Q

Acromegaly basics

A

benign GH secreting tumor, increased risk for cancer
kids - gigantism
adults - big hands, feet, face, visceral organs (diastolic HF), diabetes

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5
Q

dx of acromegaly

A

increased ILGF-1 –> glucose suppression test –> (+) –> MRI

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6
Q

glucose suppression test explained

A 
give pt glucose you expect: 
insulin to go down 
epi to go up 
cortisol to go up 
growth hormone to go up - but here it doesnt change
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7
Q

Acute or sudden hypopituitarism

A

path - infection, infarction, iatrogenic
(Sheehans, apoplexy (big tumor))

hypotensive, tachy - lack of cortisol
lethargy, coma - lack of T4

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8
Q

dx and tx of acute hypopituitarism

A

dx - cortisol levels, T4 levels

tx - replace hormones

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9
Q

chronic hypopituitarism

A

path - autoimmune, deposition dz ( sarcoidosis, etc), tumor

prioritize ACTH and TSH so stop making FSH/LH –> decreased libido, fatigability, menstrual issues

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10
Q

dx and tx of chronic hypopituiraism

A

dx - insulin stim test - similiar to glucose stim test - no Change in GH –> MRI

tx- replace hormones and fix underyling dz

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11
Q

empty stella

A

pituitary gland out of place
pt asymptomatic
dx - MRI
tx - nothing

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12
Q

SIADH

A

path - brain lesion, small cell lung cancer - exogenous ADH production

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13
Q

dx of SIADH

A

increase Urine Osm and increased Urine Na

decreased serum Osm - due to continuous absorption of water

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14
Q

tx of SIADH

A

water restriction -> doesnt work –> democlocycline (which basically induces DI)

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15
Q

causes of nephrogenic DI

A

democlocycline or lithium ADR

leads to decreased ADH

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16
Q

presentation of DI

A

polydipsia
polyphagia
nml blood glucose
no glucose in urine

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17
Q

dx of DI

A

water deprivation test

  • deprive them of water
  • > pts urine osm goes up = psychogenic
  • > no change –> give ADH
  • –> urine osm goes up = central DI
  • –> no change in urine osm = nephrogenic Di
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18
Q

tx of central DI

A

DDAVP - vasopressin

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19
Q

tx of nephrogenic DI

A

gentle diuresis with HCTZ +/- amilioride

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20
Q

basic hyperthyroidism symptoms

A

tachycardia
heat intolerance
increased DTR
weight loss

diarrhea
afib

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21
Q

dx of hyperthryoidism

A

TSH decreased

T4 increased

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22
Q

TSH decreased

T4 decreased

A

central thyroid issue TRH issue

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23
Q

Graves dz

A

thyroid stimulating abs –> increased growth and activity

diffuse increased RAIU

exopthalmus, tibial myxedema

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24
Q

Thyroiditis Painless

A

painless
due to preformed T4 –> gets released due to inflammation –> spills T4 –> initial transient Hyperthyroidism state –> goes normal or hypothyroidism (Hashimotos)

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25
Q

Painless Thyroiditis RAIU

A

cold nothing

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26
Q

Mutlinodular goiter

toxic adenoma

A

RAIU - active in multiple nodules or toxic adenoma

Both of these make T4 –> –> T4 increased –> decreased TSH

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27
Q

Other causes of hyperthyroidism

A

facticious

stroma ovarii

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28
Q

radioactive ablation can treat which types of hyperthyrodism

A

multinodular goiter
toxic adenoma
facticious
stroma ovaria

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29
Q

tx of graves

A

thionomides - PTU or methimazole

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30
Q

thyroid storm presentation

A

severe hyperthyroidism
medical emergency

afib, shock severe fever, toxic, hypotensive, AMS

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31
Q

tx of thyroid storm

A

1 - cool IVF and cool blankets
2 - propranolol
3 - PTU or methimazole
4 - steroids

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32
Q

Hypothyroidism

A

decreased T4
Increased TSH

MCC - Iatrogenic
Hashimoto (TPO - Ab = Dx)

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33
Q

Subclinical hypothyroidism

A

T4 down
TSH Up
no symptoms

tx - if TSH >9 or if symptoms start
tx - same leveothyroxine

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34
Q

tx of hypothyroidism

A

levothyroxine

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35
Q

hypothyroidism symptoms

A

bradycardia
constipation
weight gain

cold intolerance
decreased DTR
heavy periods
carpal tunnel syndrome

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36
Q

Myxedema Coma

A

coma, hypothermic, hypotension

tx - warm IVF, warm blankets –> IV T4 –> doesnt work IV T3

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37
Q

Subquevervains thyroiditis

A

painful

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38
Q

risk factors for thyroid cancer

A

pts who have received head and neck radiation

history of cancer - HL, family hx
hoarseness
Age <20 with nodule
Age >60 with nodule

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39
Q

Physical exam findings suspicous of thyroid cancer

A

fixed
firm
hard nodule
nontender Lymphadenopathy

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40
Q

U/S findings suspicious of thyroid cancer

A

solid mass
hyperechogenic
size >2cm

microcalcified
irregular borders

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41
Q

thyroid nodule workup

A

check TSH

  • > low -> RAIU - > hot -> tx
  • > low > RAIU -> cold -> U/S -> FNA

-> high or nml –> U/S –>
> 1cm - FNA
< 1cm - U/S - repeat U/S in 6-12mo

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42
Q

Papillary Thyroid cancer

A

MCC
orphan annie nuclei
tx - resect

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43
Q

Follicular Thyroid Cancer

A

looks like thyroid tissue on biopsy
spreads hematogenously

tx - radioactive iodine ablation

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44
Q

medullary thyroid cancer

A

c-cells (parafollicular cells)
produces calcitonin
MEN2A, MEN2B - Ret oncogene - pheochromocytoma

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45
Q

Anaplastic Thyroid Cancer

A

elderly
locally invasive
rapidly fatal

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46
Q

layers of the adrenal gland outside in

A

glomerulata - aldosterone
fasculata - cortisol
reticularis - testosterone
medulla - catecholamines

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47
Q

Cushing syndrome

path

A

cortisol excess
ACTH dependent
ACTH independent

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48
Q

pt presentation of Cushing syndrome

A

HTN, Obese, DM
bad acne - (moon facies)
truncal obesity (buffalo hump)
stretch marks (purple striae)

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49
Q

workup of cushing syndrome

A

low - dose dexa suppression test –> fails to suppress –> cushing syndrome –>

ACTH –>

  • > nml -> adrenal tumor –> CT/MRI –> resect
  • > elevated -> High dose dexa suppress
  • —-> suppressed –> cushing dz -> pit tumor -> resect
  • —-> fails to suppress - >ectopic -> pan CT
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50
Q

Cushing Syndrome - dx criteria

A

1 - low dose dexa suppression
2- 24 hr urine
3 - late night salivary cortisol

need 2/3

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51
Q

causes of cushing syndrome

A

small cell lung cancer
ingestion steroids - cortisol excess
primary pituitary tumor producing cortisol

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52
Q

Addisons Dz

A

path - autoimmune dz (mcc in US) or TB (mcc worldwide)

pt - acute - hypotensive, N/V Coma - hemorrhage
- chronic - orthrostatic hypotension, hyperpigmentation increased K, decreased Na

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53
Q

addisons workup

A

cortisol AM –> low cortisol –> cosyntrpin stim test

  • –> no change –> adrenal gland –> CT/MRI adrenals -> replace both cortisol and fludrocortisone
  • –> rises –> Ant pituitary issue –> MRI –> replace cortisol
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54
Q

tx of adrenal gland tumors causing addisons

A

cortisol and fludrocortison

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55
Q

basics on renin system

A

renin (system in TAL) –> ang II –> makes adosterone –> inserts channels in collecting ducts –> reabsorb Na and expels K and reabsorbs H20

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56
Q

path of conn syndrome

A

Primary Tumor
renovascular
- fibromuscular dysplasia (young women)
- atherosclerosis dz (old man)

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57
Q

pt presentation of conn syndrome

A

HTN - secondary - refractory to medications

hypokalemia

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58
Q

workup of conn syndrome

A

check aldo : renin

  • -> (-) aldo and (-) renin –> mimicker -> CAH or licorice
  • -> (+) aldo and (+) renin <10 –> renovascular HTN –> FMD (stent) or AS (no stent)

–> (+) aldo and (-)Renin, >30 –> Conn syndrome –> salt suppression –> fails –> MRI –> adrenal venous sampling —> resect

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59
Q

pheochromocytoma

A 
catecholamine secreting tumor of medulla 
p - paroxysmal 
p - pain (HA) 
p - pressure (HTN) 
p - palpitations (tachy) 
p - perspiration
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60
Q

dx of pheochromocytoma

A

plasma free catecholamines (faster)
or
24hr urine metenephrines, VMA (more sensitive)

then –> CT/MRI abd –> adrenal vein sampling

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61
Q

tx of pheochromocytoma

A

pre op management
1st - alpha blockade
2nd - beta blockade
3rd - resect

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62
Q

incidentiloma

A

path - unknown
asymptomatic
r/o - conn, cushing, pheo – 24hr urine

tx - <4cm - obs
>4cm - resect
functioning - resect

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63
Q

who needs to be screened for DM

A

> 45 y/o
BMI >25
HTN pts

64
Q

types of screeing

A

Random BGx1 + symptoms
Fasting BG x2
2hr Oral glucose tolerance test x1
HgbA1c

65
Q

random BG screen + symptoms

A

> 200 = DM

66
Q

fasting BG x2

A

> 125 = DM
100 - 125 = pre diabetes
<100 = nml

67
Q

2hr oral GTT

A 
>200 = DM 
140-200 = pre diabets 
<140 = nml
68
Q

HgbA1c

A

> 6.5 = DM
5.7 - 6.4 = pre diabetes
<5.7 = nml

69
Q

contraindications to metformin

A

CKD
CHF
Liver Disease

70
Q

Type I DM

A

polydipsia
polyuria
increased BG

dx - GAD (best) or IA-2 antibodies

tx - insulin

71
Q

pre diabetes tx

A

lifestyle and metformin

72
Q

diabets tx breakdown

A

1) life style + metfomin
2) add 2nd agent
3) add insulin

  • If HgbA1C > 9% go straight to step 3
73
Q

Hgb A1C goal for DM

A

< 7 %

74
Q

affects of HgbA1c on:

  • oral meds
  • insulin
A

oral meds - decreased it 3%

insulin - decrease 7%

75
Q

complications of DM

A

eye - retinopathy - annual eye exams - laser ablation
kidney - nephropathy - U/A - microalbumin:Cr - ACE-I
feet - neuropathy - monofilament - gabapentin

76
Q

biguande

A

meformin - example
adr - diarrhea
c/i - chf, ckd, lactic acidosis

77
Q

sulfonylurea

A

glypizide
adr - hypoglycemia
c/i - ckd

78
Q

tzd group

A

glitazones
adr - chf
c/i - weight gain

79
Q

DDP4-I

A

gliptins

weight neutral

80
Q

Alphaglucosidase I

A

acarbose

adr - diarrhea/flatulence

81
Q

GLP-1

A

tides

promote weight loss

82
Q

SGLT-1 Inhibitors

A

glifozines

adr - euglycemic DKA

83
Q

Long Acting Insulin

A

Glargine
Determir
QHS

Basal

84
Q

NPH
Regular Insulin
timeline

A

NPH - intermediate

Regular - Rapid acting - given IV

85
Q

Rapid Acting Insulin

A

Lispro
Aspart
Glusine
QAC

(ex; humlog)

86
Q

Starting an insulin regiment in type 2 DM

A

start with long acting insulin (0.1units/kg) –> check sugar in am -> keep titrating until AM glucose is controlled

If goal is not reached –> add short acting insulin with big meal

87
Q

Best way to manage insulin in the hospital

A

basal bolus + sliding scale insulin

88
Q

Total Daily Insulin

A
  1. 5units/kg
    - 50% basal
    - 50% bolus - 1/3 breakfast, 1/3 lunch, 1/3 dinner
  2. 3units/kg
    - >1.5
    - age >65
    - BG < 130
89
Q

causes of diabetic hypoglycemia

A

sepsis
not eating enough
iatrogenic
exercise

90
Q

symptoms of diabetic hypoglycemia

A

palpitations
diaphoresis
pre syncope

awake -> po glucose
coma - > IV - D50

dx - <70

91
Q

causes of non diabetic hypoglycemia

A

insulinoma

facticous

92
Q

work up of non diabetic hypoglycemia

A

check BG, c-peptide, pro insulin, secretogogue screen

93
Q

hypoglycemia
decreased c-peptide
increased insulin

A

factious - exogenous insulin administration

94
Q

hypoglycemia
increased c-peptide
increased insulin

A

next step check sulfonlyurea screen

  • –> (+) –> faking it
  • —> (-) —> perform 72hr fast –> CT/MRI abdomen –> insulinoma
95
Q

DKA

basics and presentation

A 
type I DM 
DM coma - AMS 
ketones 
acidosis 
n/v
96
Q

dx of DKA

A

BG 300-500
urine (+) ketones
ABG - acidosis
BMP - anion gap metabolic acidosis

97
Q

tx of DKA

A

first fluids
check K if >4.0
insuline 10 units –> insulin drip
—> BG falls –> 5% dextrose fluids –> gap falls –> sub q insulin

98
Q

HHS basics

A

type II DM
DM coma
no ketones
no acidosis

99
Q

dx and tx of HHS

A

BG 800-1000
no ketones
no acidosis
no gap

tx IVF and IV insulin

100
Q

MEN1

A 
pituitary 
parathyroidism - primary - increased Ca
pancreatic 
- zollinger ellison - ulcers
or 
- insuinoma - hypogycemia
101
Q

MEN 2A

A

P- pheochromocytoma
M- medullary thyroid cancer
P- parathyroidism

RET oncogene

102
Q

MEN2B

A

pheochromocytoma
medullary thyroid cancer
neuronal tumors or marfanoid habitus

RET oncogene

103
Q

multinodular toxic goiter RAIU

A

patchy uptake

104
Q

ADR of thionamides and MOA

A

agranulocytosis

MOA - inhibit hormone synthesis - PTU also inhibits peripheral conversion of T4–> T3

105
Q

subacute viral thyroiditis RAIU

A

decreased RAIU

106
Q

subacute lymphocytic thyroditis
painful thyroiditis
silient thyroiditis

A

decreased RAIU

107
Q

FNA is not reliable in what thyroid cancer

A

follicular

108
Q

cold nodules vs hot nodules

A

cold nodules - malignant

hot nodules - functioning - not malignant

109
Q

MCC of death in pts with acromegaly

A

cardiomyopathy

110
Q

dx labs of acromegaly

A

increased IGF-1
increased BG
increased TGLs
increased PO4

111
Q

if after surgery GH tumor is still causing issues tx =

A

octreotide or somatostatin

both suppress GH secretion

112
Q

craniopharyngioma

A

remnant of rathkes pouch

calcification of supresellar region in brain imaging

113
Q

causes of central DI

A

idiopathic (50%)
trauma - surgery or head trauma
tumors, syphillis , TB, sarcoidosis

114
Q

causes of nephrogenic DI

A 
MCC - chronic lithium use 
hypercalcemia 
pyelonephritis 
demeclocycline 
even congenital
115
Q

ADH level in central DI

A

low

116
Q

causes of SIADH

A 
neoplasms (small cell Lung ca) 
CNS disorders - stroke, head trauma, infection 
pulm disorders 
ventilators with (+) pressure 
post op
117
Q

meds that causes SIADH

A

vincristine
SSRIs
oxytocin
desmopressin

118
Q

major characteristics of SIADH

A

hyponatremia
volume expansion without edema
natriuresis
hypouricemia and low back pain

119
Q

central pontine myelinolysis

A

occurs when you increase Na too rapidly

120
Q

pseudohyoparathyroidism

A

end organ resistance to PTH
low calcium
high PO4
increased PTH

121
Q

chvostek sign

A

low Ca

taping of facial N elicits contraction of facial muscles

122
Q

trousseaus signs

A

low Ca

inflating BP cuff greater then systolic pressure for greater than 3min leading to carpal spasms

123
Q

other signs of hypocalcemia

A

increased QT interval
basal ganglia calcifications
grand mal seizures

124
Q

QT interval in hypercalcemia

A

shortened QT interval

125
Q

mcc of hypercalcemia in an outpatient setting

A

primary hyperparathyroidism

126
Q

surgical indications for primary hyperaparathyroidism

A 
<50 y/o 
marked decrease in bone mass
nephrolithiasis 
renal insufficiency 
urine Ca >400 for 24hrs
127
Q

mcc of cushing syndrome

A

iatrogenic - due to prescrubed prednisone or other steroids

2nd MCC = ACTH secreting adenoma of pituitary

128
Q

effects of cortisol

A

impaired collagen production
enhanced protein catabolism
anti insulin effects (leads to glucose intolerance)
impaired immunity
enhances catecholamine activity (leading to HTN)

129
Q

other causes of cushing syndrome

A

small cell carcinomas
bronchial carcinoid
thymomas

130
Q

only pts with Cushing dz not cushing syndrome will have

A

hyperpigmentation

131
Q

cushing dz

dx labs

A

increased cortisol
increased ACTH
no suppression at low dose dex methasone
YES suppression at high dose dexa methasone

132
Q

adrenal tumor causing cushing syndrome

dx labs

A

increased cortisol
low ACTH
no suppression at low dose dexa
no suppression at high dose dexa

133
Q

primary hyperaldosteronism

A

excessive aldosterone production by the adrenal glands - independent of the renin angio system

excessive mineralcorticoids increase the activity of Na/K pumps in CT

HYPOKALEMIA and HTN

excess aldoserone –> secretion of hydrogen ions –> metabolic alkalsosis

134
Q

infusion of saline in nml pts leads to what affect on aldosterone

A

decreased aldosterone BUT in primary hyperaldosteronism –> after saline infusion aldosterone is increased

135
Q

adrenal crisis

A

severe hypotension
cardiovascular collapse
acute abdomen appearance

tx - IV hydrocortisone and IVF

136
Q

most common clinical findings of Addisons dz

A 
weight loss 
weakness 
abd pain 
nausea
postural hypotension 
hypoglycemia
137
Q

CAH

A

90% due to 21 hydroxylase def
decreased cortisol, decreased aldosterone
Low Na
high K

increased ACTH –> build up of cortisol and aldosterone precursors –> synthesis of androgens –> DHEA and testosterone production –> virilization in females

138
Q

dx of CAH

A

increased levels of 17 hydroxprogesterone

139
Q

largest risk factor for DM

A

obesity –> increased FFAs –> make muscles more insulin resistant –> reducing glucose uptake

obesity exacerbates insulin resistance through this

140
Q

characteristic lipid profile of a pt with insulin resistance

A

High TGLs

Low HDL

141
Q

somogyi effect

A

rebounds response to nocturnal hypoglycemia leading to AM hyperglycemia

142
Q

Goals in treating DM pts

A 
HgbA1c <7% 
BP goal <130/85
LDL <100
HDL >40 
Fasting BG <130 
posprandrial BG <180
143
Q

pathophys of peripheal neuropathy in DM

A

microscopic vasculitis leading to axonal ischemia

144
Q

metformin MOA

A

blocks gluconeogenesis

145
Q

diabetic nephropathy

A

mcc of ESRD
nodular glomerular sclerosis (kimmelstiel Wilson)
hyaline deposition in one area of glomeruli

146
Q

definition of microalbumin

A

30 to 300mg/day

albumin: creatine ration (0.02 -0.20)

147
Q

DM pts are more susceptible to

A

radiocontrast induced ARF

hydrate well beforehand

148
Q

fundoscopic exam in DM

A

hemorrhages
exudates
microaneurysms
and venous dilations

149
Q

leading cause of vision loss in DM pts

A

edema of the macula which is exacerbated by HTN

150
Q

in DKA when do you stop IV insulin

A

continue IV insulin until anion gapcloses and metabolic acidosis is corrected –> then begin to decrease insuline –> then give subcu insuline + add 5% dextrose so pt doesnt become hypoglycemic

151
Q

serum sodium decreased 1.6 per every

A

100 increase in BG

152
Q

complications of DKA

A

cerebral edema - occurs if glucose levels drop too fast

hypercholermic nonanion gap metabolic acidosis - too much fluids too fast

153
Q

insulinoma

A 
tumor of beta cells 
MEN I 
benign 
increased insulin 
increased c-peptide
154
Q

tx of zollinger ellison

A

high dose PPI and surgery

155
Q

glucagonaoma

A

glucagon producing tumor in pancreas

necrotizing migratory erythema

156
Q

somatostatinoma

A

malignant pancreatic tumor

triad
1 gallstones
2 diabetes
3 steatorrhea

Step 2 Rotation Cards (14 decks)

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