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Internal Medicine > Endocrine Error List > Flashcards

Endocrine Error List Flashcards

1
Q

What is Cushings Disease

A

High Cortisol caused by excess ACTH secretion

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2
Q

What is Cushings Syndrome

A

Sigs and sx related to Cortisol excess

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3
Q

Sx of Cushings Disease

A 
Central Trunk Obesity
Moon Facies
Buffallo Hump
Supraclavicular Fat Pads
Wasting Extremities
Striae
HTN
Weight Gain
Osteoporosis, Hypokalemia, Acanthosis Nigricans, Hirtuism
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4
Q

Dx of Cushings Disease (1st step)

A

Test to see that you have elevated Cortisol
24 hour urine Salivary
Low Dose Dexamethasone

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5
Q

What do the results of the Low Dose Dexamethasone tell you

A

The normal response is Cortisol Suppression

No Suppression = Cushings Syndrome

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6
Q

Dx of Cushings Disease (2nd Step)

A

Measure ACTH
If elevated ACTH: Dependent
If Normal or Reduced: Independent
If Independent it means the adrenal glands are going crazy (adrenal tumor), so scan the adrenals and take out the tumor
If Dependent it means Cortisol is being secreted as a response to high ACTH. Now you need to figure out where it’s coming from. Could be Pituitary tumor or Ectopic Tumor

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7
Q

Dx of Cushing’s Disease (3rd Step - Where is high ACTH coming from)

A

High Dose Dexamethasone
If Cortisol is suppressed it means excess ACTH is coming from a Pituitary Tumor (adrenal glands are responding normally to suppression)
If Cortisol is NOT suppressed, it means ACTH is coming from an ectopic location (mutated cells)

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8
Q

Tx of Cushing’s Disease

A

Transphenoidal Surugery

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9
Q

Tx of Cushings due to Ectopic or Adrenal Tumor

A

Remove Tumor

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10
Q

Tx of Cushings if due to exogenous cause (like excess steroid use)

A

Withdraw GRADUALLY to avoid Addison Crisis

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11
Q

What is Primary Alodsteronism

A

Increased aldosterone that is INDEPENDENT from Renin

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12
Q

What is the role of Aldosterone

A

Retains water and salt

Works via RAAS and responds to Renin production

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13
Q

What is Conn Syndrome

A

An Adrenal Aldosteronoma

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14
Q

Sx of Primary Aldosteronism

A

Hypokalemia: Proximal muscle weakness, polyuria, fatigue
Hypertension: Headaches, Diastolic BP tends to be more elevated than Systolic

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15
Q

Dx of Primary Aldosteronism

A

Hypokalemia with metabolic Alkalosis
Aldosterone:Renin Ration Screening
If ARR >20 and plasma Aldosterone >20 and low plasma renin levels = Primary

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16
Q

Tx of Primary Aldosteronism

A

Conn Syndrome: Remove Adrenal Aldosteronoma + Spironolactone

Hyperplasia: Spironolactone, Ace-I, CCB

17
Q

What is Diabetes Insipidus

A

Either no ADH or no response to ADH

18
Q

What are the 2 causes for Diabetes Insipidus

A

Central: Not enough ADH secreted
Nephrogenic: Something is wrong with the kidney’s in not sensing ADH

19
Q

What drug is the most common cause of Nephrogenic Diabetes Insipidus

A

Lithium

20
Q

Sx of Diabetes Insipidus

A

Polyuria, Polydipsia, Hypernateremia if severe

21
Q

Dx of Diabetes Insipidus

A

Clinical
Fluid Deprivation Test Establishes DI. Normal response will be to concentrate urine. If urine continues to be diluted, you have DI
Desmopressin stimulation establishes cause. Concentrated urine or reduced urine output = Central (kidneys respond appropriately to ADH)
Dilute urine and continued large volumes = Nephrogenic

22
Q

Tx of Diabetes Insipidus

A

Central: Desmopressin, Carbamazepine
Nephrogenic: Sodium/Protein Restriction, Hydrochlorothiazide, Indomethacin (NSAID)

23
Q

What is Hypothyroidism

A

No T3/T4 = Slow Sluggish

24
Q

What is T3/T4 used for

A

Metabolism
Low T3/T3 = Slow Sluggish
High T3/T4 = Excited

25
Q

What is the most common cause of Hypothyroidism in the United States

A

Hashimoto (Autoimmune)

26
Q

What is the most common cause of Hypothyroidism in the World

A

Iodine Deficiency

27
Q

What is De Quervain’s and tx

A

A viral infection that leads to a PAINFUL thyroid (no autoantibodies)
Tx: ASA for pain and inflammation

28
Q

What is Acute Thyroiditis and tx

A

A bacterial infection that causes painful and fluctuant thyroid
Tx: Abx, drainage if abscess present

29
Q

What are sx of Hypothyroidism

A

Fatigue, Slow, Weight Gain, Cold Intolerant, Pale, Cool, Dry, Coarse Hair, Constipation, Periorbital Edema, Bradycardia, Decreased CO, slow DTR

30
Q

Dx of Hypothyroidism

A

High TSH, Low T3/T4

Positive thyroid antibodies present in Hashimotos

31
Q

Tx of Hypothyroidism

A

Levothyroxine (T4)

Iodine

32
Q

What is a Pheochromocytoma

A

A Catecholamine-Secreting adrenal tumor

Secretes Norepinephrine and Epinephrine autonomously and intermittently

33
Q

Sx of Pheochromocotyoma

A

HTN, Palpitations, Headaches, Excess Sweating

34
Q

Dx of Pheochromoctyoma

A

Increased 24 hour urinary catecholamines including metabolites (Metanephrine and Vanillylmandelic Acid)
MRI or CT of abdomen to visual Adrenal Tumor

35
Q

Tx of Pheochromocytoma

A

Complete Adrenalectomy
Need to give Alpha-Blockers before surgery
(Phenyoxybenzamine or Phentolamine) for 7-14 days followed by Beta Blockers

36
Q

Why do you need to give Alpha blockers before surgery for pheochromocytoma

A

When you do surgery, you’re going to aggravate the tumor and release catecholamines, this is going to cause a spike in BP which can be life-threatening in surgery

37
Q

What are the 4 types of Thyroid Cancers. Which one is better/worse/least/most aggressive

A

Papillary: Least Aggressive
Follicular: More Aggressive, good prognosis
Medullary: Low Cure Rate
Anaplastic: Most Aggressive, Rapid Growth, Poor Prognosis

38
Q

Tx for Thyroid Cancers

A

Papillary: Thyroidectomy
Follicular: Thyroidectomy
Medullary: Thyroidectomy, Calcitonin
Anaplastic: Chemo, Radiation

If you remove the thyroid you’ll need to give Levothyroxine for life

Internal Medicine (16 decks)

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