Endocrine Board Review 5th Edition Flashcards
Is LCAT deficiency associated with high LDL?
No
Is hypertriglyceridemia usually associated with increased or decreased HDL?
Decreased HDL
What is the difference in clinical features of LCAT deficiency and Tangier’s disease?
LCAT deficiency has renal involvement.
Tangier disease has tonsillar involvement
What does acute illness do to the lipid panel?
Causes marked reduction in circulating cholesterol.
What does an abnormal double tetracycline labelling bone scan indicate?
Adynamic bone disease
What should you do with the cinacalcet in adynamic bone disease?
Reduce the dose or stop it
What do you need before treating osteoporosis with denosumab in an ESRD patient who may have adynamic bone disease?
A bone biopsy
Does PTHrP cause increased 1,25-dihydroxyvitamin D?
No
What happens to 1,25-dihydroxyvitamin D levels in hyperparathyroidism?
They are increased
What do you need to check if a Looser zone is seen on a radiograph?
25-hydroxyvitamin D
When should the bottom of the total hip box be placed when measuring bone density?
About 10 pixels (1 cm) below the lesser trochanter
Is BMI or waist circumference more important when calculating risk stratification?
Waist circumference definitely modifies the risk.
Does the waist circumference override the BMI when assessing health risks of obesity?
No
Orlistat could reduce the level of cyclosporine, resulting in a flare in her psoriasis.
True or false?
True
Does orlistat affect the absorption of warfarin?
No
How does orlistat alter the anticoagulation in patients taking warfarin?
Alters absorption of vitamin K levels resulting in change in anticoagulation.
What does weight loss in men do to estrogen levels?
Decreases estrogen levels
What is the most common reason for patients on low calorie diets gaining weight?
Under-reporting calorie intake
What is the most sensitive diagnostic test for recurrent Cushing’s disease?
Late night salivary cortisol
Which adrenal lesions have Hounsfield units that are - 10 (very low)?
Adrenal myelipomas
What adrenal disorder are adrenal myelipomas associated with?
Congenital adrenal hyperplasia
Inhaled steroids are more likely to cause iatrogenic Cushing’s syndrome in patients that are on antiretroviral drugs that are inhibitors of ______.
CYP3A4
Which ratios are being compared in adrenal vein sampling to figure out lateralisation?
The aldosterone/cortisol ratios on each side are compared. Generally more than 4 times is considered lateralisation.
Which ratios are being compared in adrenal vein sampling to figure out proper positioning?
The adrenal cortisol to peripheral cortisol level should be more than 5 times.
Which normal adrenal gland is more likely to accumulate 123 I-MIBG during imaging?
Left adrenal gland
Because of the catabolic nature of severe hypercortisolism and metastatic disease, patients with ectopic ACTH syndrome often present with a cachectic, malnourished state.
True or false?
True
If a patient has legs that look like elephant legs then do they have hypothyroidism or hyperthyroidism secondary to Graves’ disease?
Graves’ disease
What does a thyroid hormone receptor beta mutation cause?
Thyroid hormone resistance (with high T4 and T3)
What does a thyrotropin receptor inactivating mutation cause?
Elevated TSH
Patient has:
- Severe mental retardation
- Congenital hypotonia progressing to spasticity
- Family history of similar problems in the males
- TFTs showing: normal TSH, lowish free T4 and high free T3 and total T3
Diagnosis?
Thyroid hormone transporter defect (X-linked)
What changes in TFTs do heparin and enoxaparin cause?
Increased free T4 but normal total T4
TSH is on the low side but normal
What changes in TFTs does furosemide cause?
Very high doses can cause displacement of thyroid hormone from the binding proteins.
What changes in TFTs does carbamazepine cause?
Low free T4 and total T4
TSH is normal
What changes in TFTs does lithium cause?
Usually associated with hypothyroidism; and only occasionally hyperthyroidism.
What changes in TFTs does estrogen cause?
Increase in total T3 and T4
Normal free T3 and T4 levels
How do you distinguish Graves’ disease from beta-hCG induced hyperthyroidism during pregnancy?
TSH-receptor antibody testing
In euthyroid sick syndrome is the TSH higher in the acute phase or when the patient is recovering?
When the patient is recovering.
How is resistance to thyroid hormone inherited?
Autosomal dominant pattern
If a mother has thyroid hormone resistance then does an affected fetus or a non-affected fetus have a better chance of survival?
Fetus with inherited thyroid hormone resistance has a better chance of survival.
What is central compartment lymph node dissection in thyroid cancer resection associated with?
Higher rate of post-operative hyperparathyroidism
Does central compartment lymph node dissection involve removing only abnormal-appearing lymph nodes?
No
Do parathyroid cysts exist?
Yes
What does the aspirate from a parathyroid cyst contain?
High levels of PTH
What happens to the thyroglobulin level in Graves’ disease?
Normal levels
What happens to the thyroglobulin level in thyroiditis?
Increased
What should you consider when patient feels worse after getting levothyroxine for auto-immune hypothyroidism?
Adrenal insufficiency
What do you have to worry about most with pancreatic diabetes?
Hypoglycemia
Do you absolutely have to stop metformin if the creatinine is 1.4?
No
Treatment with pioglitazone is associated with bone loss and increased fracture risk in women.
True or false?
True
Screening for silent CAD frequently detects disease but does not improve clinical outcomes.
True or false?
True
What is the difference between familial renal glucosuria and renal fanconi syndrome?
Famlial renal glucosuria just causes glucosuria, whereas renal fanconi syndrome has wasting of amino acids, glucose, phosphate, in addition to causing RTA and osteomalacia.
GnRH deficiency syndrome is also called…
Normosmic idiopathic hypogonadotrophic hypogonadism (nIHH)
Is the FSH level high or low in hypothalamic amenorrhea?
Low
Is the LH level high or low in hypothalamic amenorrhea?
Low
Is the estradiol level high or low in hypothalamic amenorrhea?
Low
Is the prolactin level high or low in hypothalamic amenorrhea?
Prolactin level is normal
What happens to gonadotrophin levels if testosterone is raised by exogenous testosterone?
They are suppressed
What is an important extra-gonadal manifestation of Kallman’s syndrome caused by KAL1 mutation?
Renal agenesis (do an abdominal ultrasound)
What kind of hypogonadism does Klinefelter’s syndrome cause - primary or secondary?
Primary
Is GnRH therapy better or gonadotrophin therapy better for fertility induction in men with hypogonadotropic hypogonadism (pituitary disease)?
Gonadotropin (FSH and LH) therapy
Does exogenous testosterone cause testicular enlargement in pre-pubertal boys?
No
What does diabetes mellitus do to SHBG levels?
Decreases them
What do systemic corticosteroids do to SHBG levels?
Decreases them
What is Reifenstein syndrome?
Partial androgen insensitivity
Patient has:
- Hypospadias
- Gynecomastia
- Elevated testosterone levels
Diagnosis?
Partial androgen insensitivity
Do patients with Klinefelter syndrome have hypospadias?
No
5 alpha-reductase deficiency (type 2) is diagnosed by an increased ratio of serum testosterone to dihydrotestosterone that is significantly greater than the _____ ratio seen in normal men.
10:1
Do 5 alpha-reductase inhibitors significantly raise testosterone levels?
No
Can hepatitis C cause high SHBG and total testosterone levels?
Yes
Should the hypothalmic-pituitary-gonadal axis be checked during an acute flare of chronic illness?
No
What happens to the PSA level in patients with 5 alpha-reductase inhibitors?
Decreases PSA
Should pre-pubertal boys who are hypogonadal with consitutional delay be treated with adult doses of testosterone?
No.
They need to be treated with lower doses of testosterone to avoid pre-mature closure of epiphyses and decreased adult height.
Exercise blunts counter-regulatory response to hypoglycemia.
True or false?
True
Exercise induced hypoglycemia can be delayed up to _____ hour after exercise.
8 - 12
Do pancreas only transplants have a higher survival rate than pancreas and kidney transplants, or pancreas after kidney transplant?
No
Does decline in renal function after pancreas transplant affect the decision to go ahead with the transplant?
No
Why would a patient with type 1 diabetes mellitus have orthostatic hypotension?
Cardiovascular autonomic neuropathy
Can acute anemic anemia worsen diabetic retinopathy?
Yes - it can cause retinal hypoxia.
What is dermatitis herpetiformis?
Chronic skin condition with fluid-filled blisters associated with Celiac disease.
If a patient with a prolactinoma wants to get pregnant then how long is the cabergoline continued for if her prolactin level is normal?
Until she gets pregnant.
What should you do if there is a discrepancy between the adenoma size and prolactin level?
Repeat the MRI scan
Can bromocriptine therapy treat acromegaly?
In less than 10% of cases so it is not usually used.
Is cabergoline effective for TSH-omas?
No
Is temozolomide effective for TSH-omas?
No
Patient has hypercalcemia and pituitary adenoma - what is the diagnosis?
MEN1
What shows up as pituitary stalk thickening on MRI?
Langerhans cell histiocytosis
How does a craniopharyngioma show up on a pituitary MRI?
As a mass lesion
