Endocrine

Question 1

How is cushings distinguished from the simple obesity of metabolic syndrome?

Answer 1

You check the anabolic changes (found in cushings)

Question 2

S/s that point away from metabolic syndrome and to cushings?

Answer 2

Osteopenia
Thin skin
3+ ecchymoses >1cm

With these 3 findings probability is 90%

Question 3

S/s of cushings?

Answer 3

• obesity
• HTN
• DM2
• hirsutism
• thin skin
• osteopenia
• ecchymoses
• elevated urinary free cortisol (24 hr urine)

Question 4

Pt with cushings symptoms but urinary cortisol is low or zero?

Answer 4

Look for exogenous glucocorticoids

- plasma corticotropin levels are suppressed

Question 5

Pseudo cushings?

Answer 5

Alcohol induced pseudo cushings

Question 6

Common cause of cushing syndrome?

Answer 6

Adrenal tumor

- surgery

Question 7

What common cushing test is actually not good at detecting?

Answer 7

Dexmethasone suppression test

Question 8

What biochemical tests are needed for cushings?

Answer 8

• urinary free cortisol
• plasma corticotropin
• plasma cortisol

Question 9

MC type of secretory pituitary tumor?

Answer 9

Prolactinomas

Question 10

Male Pt presentation for prolactinoma?

Answer 10

Middle aged
Decreased libido
ED
Headaches
Testicular size decrease
Sellar mass on optic chiasm
Prolactin levels = high

No

• wt change
• gynecomastia
• fatigue

Question 11

Prolactinoma prognosis?

Answer 11

Typically benign

- though can be part of multiple endocrine neoplasm type 1 syndrome

Question 12

Female presentation for prolactinoma?

Answer 12

Oligoamenorrhea
Infertility
Galactorrhea
Low bone density (2/2 estrogen deficiency)

Question 13

Causes of hyperprolactinemia?

Answer 13

Post partum 
- Nursing 6 wks 
-  non nursing 2-3 wks
Renal failure
- clearance issue
Hepatic failure
- clearance issue
HYPOthyroid
- neurogenic stimulation
Chest wall injury
Nipple stimulation 
Pituitary tumors 
Prolactinomas 
Meds

Question 14

Meds that cause hyperprolactinemia?

Answer 14

Antidepressants
Antipsychotics
- risperidone
Dopaminergic blockers
- metoclopramid
Antihypertensive agents
Opiats
H2-receptor blockers

Question 15

Indications for therapy if pt has prolactinoma?

Answer 15

Microadenoma
Enlarging microadenoma
Infertility
Bothersume galactorrhea
Gynecomastia
Testosterone deficiency
Oligomenorrhea/amenorrhea
Acne and hirsutism 

Macroadenomas almost always require therapy, microadenomas dont always require therapy

Question 16

What is the primary therapy for micro and macro adenomas?

Answer 16

Dopamine agonists

Question 17

MOA of dopamine agonists in prolactanomas?

Answer 17

Normalize prolactin levels
Restore reproductive function
Reverse galactorrhea
Decrease tumor size

Question 18

Dopamine agonist?

Answer 18

Bromocriptine
Cabergoline

Cabergoline has fewer side effects and is more effective

Question 19

Main goals of therapy for prolactanoma?

Answer 19

Normalizing hormones
Preventing mass effect
Fix visual field compromise

There is no evidence that continued elevation of prolactin is harmful if these are avoided

Question 20

Therapy for prolactonoma if meds fail?

Answer 20

Neuro surgery (transsphenoidal) or radiation therapy

Microadenoams 80-90% effective
Macroadenomas 50% effective

Question 21

Pregnancy and prolactonomas?

Answer 21

Increased estrogen increases prolactin levels -> lactotroph hyperplasia

It poses a risk

Question 22

What meds are pregnancy safe for prolactonomas?

Answer 22

Bromocriptine is not associated w birth defects

Question 23

Indications for neurosurgery in patients with prolactinomas?

Answer 23

• Increasing tumor size (w med therapy)
• pituitary apoplexy
• inability to tolerate dopamine agonist therapy
• Dopamine agonist resistant macroadenoma
• Dopamine agonist resistant microadenoma (if pregnancy desired)
• persistent chiasmal compression despite optimal med therapy
• medically unresponsive cystic prolactinoma
• CSF leakage w dopamine agonist
• macroadenoma in pt w psych (cant take dopamine)

Question 24

Thyroid nodules in children?

Answer 24

Less common than adults but the malignancy rate is much higher

FNA is unreliable in kids so surgery is prob best option

Question 25

Prevalence of thyroid nodules?

Answer 25

Palpable 4-7% in adults

Incidentallomas - found in 40% of pax w thyroid US

Found on 36-50% of pax on autopsy

Question 26

How common is thyroid cancer?

Answer 26

1% of all malagnancies

1.5% -17% in nodules found

However: rate of malignancy for palpable nodule w hx of radiation - 20-50%

Question 27

Thyroid nodule presentation?

Answer 27

Palpated on exam
Protrusion of neck
Compression sx
- difficulty swallowing
- choking sensation

Question 28

Primary goal in evaluating a thyroid nodule?

Answer 28

Determine malignancy

Question 29

Hot nodules?

Answer 29

Produce thyroid hormone

- unlikely to be malignant

Question 30

You have a thyroid nodule, what do you need to do in a workup?

Answer 30

Check TSH
Perform US
Radionuclide scintigraphy (tech 99)
- hot vs cold nodule

Question 31

Overactive thyroid gland causes?

Answer 31

Toxic multinodular goiter

Question 32

Cold nodule?

Answer 32

14-22% chance of malignancy

Question 33

What nodules need to be biopsied?

Answer 33

Those > 1cm get a FNA

If they have a lot then you can sample 3 or so

Any size if encapsular invasion by the lesion
- shows lymphadenopathy

Hx of head and neck irration

Hx of thyroid cancer

Hx of MEN 2

Question 34

Nodules you dont need to biopsy?

Answer 34

Hyperfunctioning nodules

Question 35

Tx for thyroid nodules?

Answer 35

1st line
- Radioactive idione 131 ablation

If path report looks like cancer
- surgery

If path report looks benign

• Repeat US 18 months later
• if they grow repeat at 3-5 yrs

Question 36

Who is at an increased risk for developing thyroid nodules?

Answer 36

Pregnant women

- though cancer risk is no higher