Endocrine II Flashcards
Primary hyperaldosteronism is characterized by […] plasma renin activity and […] plasma aldosterone concentration.
Primary hyperaldosteronism is characterized by low plasma renin activity and high plasma aldosterone concentration.
characterized by a PAC/PRA ratio > 20 and a PAC > 15 ng/dL
Prior to thyroidectomy, patients with suspected MEN2A or MEN2B should be screened for […].
Prior to thyroidectomy, patients with suspected MEN2A or MEN2B should be screened for pheochromocytoma.
e.g. via plasma fractionated metanephrine assay; patients may elect to undergo RET mutation testing as well
Psychiatric medications that are useful for pain management in diabetic neuropathy patients include TCAs, SNRIs, and […].
Psychiatric medications that are useful for pain management in diabetic neuropathy patients include TCAs, SNRIs, and anticonvulsants (e.g. gabapentin, pregabalin).
other treatment options include capsaicin and lidocaine
Screening for diabetes is recommended in patients with a sustained blood pressure > […] mmHg and may be considered in all patients > 45 years old.
Screening for diabetes is recommended in patients with a sustained blood pressure > 135/80 mmHg and may be considered in all patients > 45 years old.
oral glucose tolerance test is the most sensitive
Screening for diabetes is recommended in patients with a sustained blood pressure > 135/80 mmHg and may be considered in all patients > […] years old.
Screening for diabetes is recommended in patients with a sustained blood pressure > 135/80 mmHg and may be considered in all patients > 45 years old.
oral glucose tolerance test is the most sensitive
Secondary hyperaldosteronism is characterized by […] plasma renin activity and […] plasma aldosterone concentration.
Secondary hyperaldosteronism is characterized by high plasma renin activity and high plasma aldosterone concentration.
characterized by a PAC/PRA ratio ~ 10
The diagnosis of VIPoma is confirmed by a VIP level > […] pg/mL.
The diagnosis of VIPoma is confirmed by a VIP level > 75 pg/mL.
The initial step in evaluation of Cushing syndrome is confirmation of hypercortisolism via one of the following tests…
- […]
- […]
- […]
The initial step in evaluation of Cushing syndrome is confirmation of hypercortisolism via one of the following tests…
- 24-hour urine free cortisol (best initial test)
- Late-night salivary cortisol
- Overnight low-dose dexamethasone test
Tight blood glucose control in patients with diabetes is most likely to decrease risk of […]-vascular complications.
Tight blood glucose control in patients with diabetes is most likely to decrease risk of micro-vascular complications.
e.g. retinopathy and neuropathy; effect on macrovascular complications (e.g. MI, stroke) is uncertain
Untreated acromegaly can cause […] myocardial hypertrophy (concentric or eccentric).
Untreated acromegaly can cause concentric myocardial hypertrophy (concentric or eccentric).
also can cause diastolic dysfunction, LV dilation, and global hypokinesis; complications include HF and arrhythmia
What acid-base disturbance is associated with hyperaldosteronism?
Metabolic alkalosis
due to increased H+ secretion and increased HCO3- reabsorption
What additional risk factor(s) warrant initiation of statin therapy in a diabetic patient between age 40 - 75?
None. ALL diabetic patients should be started on statin therapy, regardless of other risk factors.
moderate- vs. high-dose statin therapy, however, does depend on risk factors
What are the best markers for indicating resolution of diabetic ketoacidosis?
Serum anion gap and beta-hydroxybutyrate levels
What cardiovascular effect of thyrotoxicosis causes systolic hypertension?
Increased myocardial contractility and heart rate
inotropic/chronotropic effects due to direct effects of T3 on cardiac myocytes and blood vessels, as well as increased sensitivity to catecholamines (upregulation of beta-1 receptors)
What class of diabetic drugs should be added to metformin in a patient with uncontrolled blood glucose that desires weight loss?
GLP-1 receptor agonists
sulfonylureas, thiazolidinediones, and insulin are associated with weight gain; metformin and DPP-4 inhibitors are weight neutral
What drug class may be used to treat hypercalcemia due to immobilization?
Bisphosphonates
What drug class should be added to a patients medications if they have diabetes and microalbuminuria?
ACE inhibitors
helpful in slowing progression of diabetic nephropathy by reducing intraglomerular hypertension
What drug is used to induce ovulation in patients with polycystic ovarian syndrome?
Clomiphene citrate
What electrolyte abnormality is typically the cause of hypocalcemia in an alcoholic patient?
Severe hypomagnesemia
severe hypomagnesemia causes decreased PTH release and resistance to PTH, resulting in hypoparathyroidism with low Ca2+ and low phosphorus (vs other causes of hypoparathyroidism)
What formula is used to calculate the “corrected Ca2+” in a patient with low albumin?
serum Ca2+ + 0.8(4 - serum albumin)
What formula is used to calculate the “corrected Na+” in a patient with severe hyperglycemia?
Na+ + 2 mEq/L for every 100 mg/dL glucose is over 100 mg/dL
e.g. if glucose is 600 mg/dL and Na+ is 130 mEq/L, corrected sodium is 140 mEq/L
What hormone level should be measured as part of the initial diagnostic workup in a patient with confirmed hypocalcemia?
Parathyroid hormone
What hypothalamic hormone is directly inhibited by prolactin?
GnRH
thus, prolactin indirectly inhibits FSH and LH production
What initial laboratory test is best to help determine the underlying etiology of hypercalcemia?
PTH levels
What initial tests should be performed in a patient with suspected adrenal insufficiency?
- […]
- […]
- […]
What initial tests should be performed in a patient with suspected adrenal insufficiency?
- Morning serum cortisol
- Plasma ACTH
- Cosyntropin stimulation test
low cortisol with high ACTH confirms primary adrenal insufficiency; cosyntropin stimulation test is much quicker than plasma ACTH and is usually ordered concurrently
What is a common complication of radioactive iodine when treating Graves disease?
Permanent hypothyroidism
the dose needed for treatment, as well the diffuse uptake of iodine in Graves disease, results in permanent hypothyroidism in >90% of patients
What is the appropriate definitive treatment for a patient with severe ophthalmopathy secondary to Grave’s disease?
Thyroidectomy
radioactive iodine is contraindicated in patients with severe ophthalmopathy
What is the best screening test for primary hyperaldosteronism?
Early-morning plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio
typically > 20:1 ratio of PAC:PRA with a total PAC > 15 ng/dL in primary hyperaldosteronism; diagnosis should be confirmed with adrenal suppression testing (e.g. aldosterone response to salt loading)
What is the first line treatment for irregular menstrual cycles in patients with polycystic ovarian syndrome?
Weight loss and OCPs
What is the initial management for an elderly patient with heat intolerance, sweating, and palpitations and a low TSH and high free T3/T4 on laboratory exam?
Beta blocker + anti-thyroid drugs (e.g. methimazole)
in patients with significant symptoms and thyroid hormone levels > 2-3x normal, pretreatment with anti-thyroid drugs is recommended prior to radioactive iodine (RAI can transiently worsen hyperthyroidism); pretreatment is also recommended for the elderly and those with significant comorbidities as they are at increased risk for complications
What is the initial step in evaluation of a newly discovered thyroid nodule?
TSH level and ultrasound
What is the initial treatment for a macroprolactinoma (> 10mm) or symptomatic microprolactinoma?
Dopamine agonists (e.g. cabergoline, bromocriptine)
may lower prolactin levels and reduce tumor size; patients who fail to respond or who have very large tumors (> 3 cm) should be considered for transsphenoidal resection
What is the initial treatment for a patient with an asymptomatic microprolactinoma (< 10mm)?
No treatment
What is the likely diagnosis in a chronic smoker that develops hypertension, hyperglycemia, and weight gain?
Cushing’s syndrome (likely ectopic production of ACTH from a small cell lung cancer)
What is the likely diagnosis in a female that develops proximal muscle weakness (e.g. hair combing, stair climbing) without pain, as well as hirsutism and hypertension?
Glucocorticoid-induced myopathy
due to glucocorticoid-induced muscle atrophy via direct catabolic effects of cortisol on skeletal muscle
What is the likely diagnosis in a middle-aged female that develops rapid-onset hirsutism and amenorrhea?
Androgen-secreting neoplasm (of ovaries or adrenal gland)
PCOS has a more gradual onset
What is the likely diagnosis in a middle-aged female with fatigue, GI symptoms, and skin hyperpigmentation?
Primary adrenal insufficiency (Addison disease)
skin hyperpigmentation and hyperkalemia help differentiate PAI from central adrenal insufficiency (e.g. Cushing’s)
In PAI, the pituitary is overproducing ACTH in an effort to stimulate the adrenals. The adrenals cannot respond (autoimmune damage) and the excess ACTH —> melanocortin.
In CushingDisease, the pituitary is also making excess ACTH, but it is being used by the adrenals to make excess glucocoorticoid, so melanocortin is NOT overproduced, which means no hyperpigmentation.
What is the likely diagnosis in a middle-aged patient that develops coarse facial features, digit enlargement, arthralgias, hypertension, and carpal tunnel syndrome?
Acromegaly
What is the likely diagnosis in a middle-aged woman with hip/shoulder weakness, muscle atrophy, weight loss, and tachycardia?
Hyperthyroidism
chronic hyperthyroid myopathy (proximal muscle weakness in the setting of hyperthyroidism); symptoms improve with treatment of hyperthyroidism
What is the likely diagnosis in a patient taking HCTZ, levothyroxine, and OTC mineral supplements (for osteoporosis) that develops symptomatic hypercalcemia, metabolic alkalosis, and AKI?
Milk-alkali syndrome
hypercalcemia causes renal vasoconstriction with decreased GFR and also causes diuresis, with hypovolemia and contraction alkalosis
