Endocrine Flashcards
Hyperthyroid symptoms
High TSH, T3, T4
Dx?
Pituitary adenoma
Secretes alpha subunit which acts like TSH
Palpitations, hypercalcemia, goiter, lid lag
Tx?
Palpitations d/t hyperthyroid are d/t excessive sympathetic tone
Goal is to decrease sympathetic tone
Tx with Beta blocker
High TSH
NL T4
Asymptomatic
What other test would be useful in helping to guide therapy?
Anti-TPO Subclinical hypthyroid doesn't always need to be treated Treat when 1. Antithyroid AB detected 2. ABN lipid profile 3. Symptomatic 4. Ovulatory or menstrual dysfunction
Risks of untreated hyperthyroidism?
Cardiac arrhythmia
Cardiomyopathy
osteoperosis
Kiddo presents with acute illness + tachycardia, tachypnea, hyponatremia, UA with SG of 1.004 but yet, his A1C is 5.2%. Why?
Stress hyperglycemia
not true DM, but his response to stress hormones in the setting of acute illness
female infant
ambiguous genitalia
hypoNA, hypoglycemia
hypotensive
21-hydroxylase deficiency
17 hydroxyprogesterone will be elevated
female infant with ambiguous genitalia
Fluid, salt retention
11Beta-hydroxylase deficiency
infant with NL female genitalia
Fluid, salt retention
17alpha-hydroxylase deficiency
Tx for congenital adrenal hyperplasia?
Chronic glucocorticoid and mineralocorticoid replacement
Will need vaginoplasty/clitiroplasty later in life
What is refeeding syndrome?
People with poor po intake have low intracellelar phosphate, but Sr phosphate is normal
When the patient gets dextrose with refeeding, insulin drives phos into the cell to make ATP
Causes sr phosphate to crash –> cardiac arrhythmia, seizure, rhabdo –> death
SIADH is associated with which cancer?
Small Cell Carcinoma
Typically seen as a perihilar mass on CXR
Large peripheral mass on CXR concerning for which cancer?
Large cell carcinoma
CXR with cavitary lesion in bronchus is concerning for which cancer?
Squamous cell carcinoma
Associated with hypercalcemia d/t PTHlP
Tx of SIADH
Water restriction
Hypervolemic hyponatremia
Ribflavin/bit B2 deficiency causes
Angular cheilosis, stomatitis
Thiamine/ Vit B1 deficiency causes?
Wet Beriberi (dilated cardiomyopathy, polyneuropathy) Wernicke-Korsakoff (neuroloog impairment, oculomotor dysfunction, ataxia, encephalopathy, amnesia)
Niacin/Vit B3 deficiency
Pellagra (photosensitive dermatitis, diarrhea, dementia)
Two most common supplements that affect absorption of levothyroxine?
Calcium and Iron
Take 3-4 hours after levothyroxine
Fatigue Weight loss myalgias hyper pigmented patches Decreased axillary and pubic hair Hyponatremia HyperK+ hyperchloremic metallic acidosis Dx?
Adrenal insufficiency (Addison's dz) Confirm dx with low am cholesterol and high ACTH
How do you define delayed puberty in males?
small testicles by age 14 (<4mL)
Get a bone age, FSH, LH, and testosterone
Also consider getting a Prolacting and TSH as high levels of these interfere with GnRH
Delayed male puberty with elevated FSH/HL
Primary delayed puberty
ICU patient with normal TSH/T4 but low T3
Euthyroid sick syndrome
d/t low peripheral conversion of T4 to T3
Nothing to do, repeat labs in a couple of months
Anemia loss of proprioception Brisk reflex loss of ankle jerk bald tongue
Vit b12 deficiency Often d/t low intrinsic factor in gastric mucosa Pernicious anemia (autoimmune)
In severe B12 deficiency, what should be monitored in the first few days of treatment?
BMP
@ risk of hypokalemia
d/t reuptake of K+ in RBC formation
Thyroid nodule
Low TSH
What next?
Iodine scintigraphy
If hot - treat hyperthyroidism
If cold - FNA
Tyroid nodule
NL or Elevated TSH
Next step?
FNA
Pt is dx’d with papillary thyroid cancer. What do you do next?
U/s of neck and lymph nodes to stage the cancer
If <1cm –> lobectomy
If >1cm –> excise thyroid
High parathyroid hormone
Hyper calcemia
Osteroperosis
What next?
Parathyroidectomy
Young patient Diabetes osteoperosis HTN Hypokalemia Dx?
Cushings syndrome
Dx - Overnight dexamethasone suppression test OR 24 hour urinary cortisol level
borderline low calcium
High urinary calcium
Tx?
Add thiazide diuretic to promote calcium retention
primary hyperparathyroidism
Gastric ulcer
pituitary dz
MEN neoplasia 1
parathyroid, pancreatic (gastronome), pituitary (prolactinoma)
Tx - parathyroidectomy
What makes acromegaly dangerous?
Cardiovascular dz
also increased risk of colon cancer
Hyponatremia
Low TSH
low T4
central hypothyroid
if someone has a low am cortisol, what to do next?
ACTH stim test
workup for adrenal insufficiency
early puberty (girls<8, boys <9) High LH/FSH
Central precocious puberty
Hypertension
Hypokalemia
consider?
Hyperaldosteronism (conn’s)
measure plasma aldosterone to renin ratio
what does amniodarone do to thyroid hormones?
decreases peripheral conversion of T4 to T3
So serum T4 can be high
normalizes over time
episodic headaches, diaphoresis, tachycardia
nl thyroid
what next?
get plasma metanephrine and 24 hr urine catecholamine and metanephrine to r/o pheo
s/p b/l adrenalectomy
Now with hemianopsia and hyperpigmentation
Dx?
Nelson’s syndrome
pituitary enlargement after a b/l adrenalectomy
happens because of loss of negative feedback from adrenal glucocorticoids
Cushing syndrome that has cortisol levels that do not decrease with dexamethasone depression
low acth
adrenal cause of Cushing
get a ct
how do OCPs interfere with thyroid hormone?
estrogen stimulates production of thyroid binding globulin (TBG)that soaks up peripheral thyroid hormone
usually need to increase levothyroxine dose with OCP use
Teenager
Normal boob development
amenorrhea, no pubic hair
Dx?
Androgen insensitivity
check testosterone levels
Young boy
acne
pubic hair
No testicular enlargement
Congential adrenal hyperplasia
Pt with seizures, muscle cramps, basal ganglia calcifications, cataracts HypoCa Hyper phos elevated PTH dx?
pseudohypoparathyroidism
what diabetes med can cause pulmonary edema in heart failure its?
pioglitazone
acts on PPAR-gamma and can cause fluid retention
Wha test can confirm diabetic neuropathy?
Tuning fork test
Loss of vibratory sense
hypothyroid pt gets pregnant. any changes to tx?
Increase levothyroxine dose
Check TSH q 4wks
when do you add d5 while a ska pt is on insulin gtt
<200
Hyperthyroidism mass in neck facial plethora and neck vein distension dysphagia dx?
Thyroid lymphoma
indications for bisphosphonates
h/o fragility fx
T score <2.5 on DEXA (osteoporosis)
T score -1 to -2.5 and FRAX score >20% (osteopenia)
erythematous scaly rasa with clearing in the center
Borders slightly elevated and crusty
angular cheilosis
Dx?
glucagonoma
pancreatic tumor with characteristic skin rash and mild diabetes
tend to met to the liver
Hypercalcemia FHx of hypercalcemia NL parathyroid Low urinary excretion of Calcium Dx?
Familial hypocalciuric hypercalcemia
Don’t need to do anything
hyperparathyroidism would have elevated urinary calcium
pt in cancer remission hot flashes osteoporosis High LH/FSH dx?
ovarian insufficiency
give estrogen patch
if they still have a uterus - need progestin as well
People with subclinical hypothyroidism have an increased risk of?
pregnancy complications (SABs, pre-e, SGA, placental aburption)
Hyperthyroid pt on methimazole gets preggo. Any changes?
Should change to propylthiouracil during the first trimester because methimazole has some teratogenic effects
Can then switch back to methimazoe for 2nd and 3rd trimesters
Female is amenorrhea
Low LH/FSH, increased alpha subunit
dx?
Nonfunctioning pituitary adenoma
A functioning adenoma would have high LH/FSH
tx - trans-sphenoid resection
What happens if a functioning prolactinoma goes untreated in a female?
At risk of osteoperosis 2/2 long term sex hormone exposure
Tx - Cabergoline (dopamine agonist)
Decreases prolactin levels and causes the tumor to shrink
Newborn screening finds a low T4 and high TSH on a 1 week old. What do you do and why?
Congenital hypothyroidism
Start on levothyroxine
should be done asap to prevent permanent neurologic injuries
A T1DM keeps having hypoglycemic episodes
Concerning for?
Adrenal insufficiency
Check cosyntropin stimulated cortisol levels
Also hx of weight loss, hyperkalemia, MAGA
