Endocrine IV Flashcards
What is the likely explanation for the abnormal laboratory values in a pregnant woman that experiences fatigue, anxiety, and difficulty sleeping with normal TSH and elevated total T4? Thyroid examination is benign.
Increased thyroid-binding globulin (TBG) level
estrogen increases level of TBG, resulting in elevated total T4 but normal free T4 (euthyroid state); her symptoms are unrelated
What is the likely source of an androgen-secreting tumor in a female with elevated testosterone and elevated dehydroepiandrosterone sulfate (DHEAS) levels?
Adrenal tumor
causes rapidly progressive hirsutism; androstenedione, DHEA, and testosterone are produced by both the ovaries and adrenals, while DHEAS is predominantly produced in the adrenals
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What is the likely source of an androgen-secreting tumor in a female with elevated testosterone and normal dehydroepiandrosterone sulfate (DHEAS) levels?
Ovaries (more common)
causes rapidly progressive hirsutism; androstenedione, DHEA, and testosterone are produced by both the ovaries and adrenals, while DHEAS is predominantly produced in the adrenals
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What is the major gluconeogenic amino acid in the liver?
Alanine
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What is the most beneficial therapy for reducing the progression of diabetic nephropathy?
Strict blood pressure control
some guidelines recommend a target BP of 130/80 mmHg, others recommend 140/90 mmHg
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What is the most common cause of primary adrenal insufficiency in developed countries?
Autoimmune adrenalitis
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What is the most common underlying cause of neuropathic ulcers?
diabetes mellitus
typically occur on the sole of the foot at weight-bearing areas (e.g. under head of first metatarsal)
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What is the most important contributing factor for diabetic foot ulcers?
Diabetic neuropathy
other important risk factors include previous foot ulceration, vascular disease, and foot deformity
What is the most important initial step in management of a patient with hyperosmolar hyperglycemic state?
Fluid replacement with normal saline
may switch to 0.45% saline after a few hours if corrected Na+ levels are high; IV insulin +/- K+ are important as well, but not as important initially
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What is the most sensitive test for differentiating adrenal adenoma and bilateral adrenal hyperplasia in patients without a discrete unilateral adrenal mass on imaging?
Adrenal venous sampling
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What is the most serious adverse effect associated with anti-thyroid drugs (e.g. methimazole, PTU)?
Agranulocytosis
patient’s on these drugs that develop a sore throat and fever should have their WBC count checked
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What is the next step in a patient with suspected acromegaly that is found to have elevated IGF-1 levels?
Oral glucose suppression test
normally, glucose rapidly suppresses GH secretion; in acromegaly, glucose will not suppress (and may increase) GH secretion
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What is the next step in diagnosis for a patient with myalgias, proximal muscle weakness, elevated creatine kinase, and delayed reflexes?
Measure TSH and T4 (to evaluate for hypothyroid myopathy)
other manifestations include fatigue and other symptoms of hypothyroidism (e.g. hair loss, cold intolerance)
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What is the next step in management for a diabetic patient taking metformin and nightly insulin glargine that presents with an elevated hemoglobin A1c despite normal fasting glucose levels?
Add rapid-acting mealtime insulin
this patient likely has postprandial hyperglycemia
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What is the next step in management for a patient taking PTU or methimazole that develops fever and sore throat?
Discontinuation of the drug, measure WBC count
fever and sore throat in patients on PTU/methimazole suggests agranulocytosis
What is the pathophysiology underlying hyperthyroid-induced bone loss?
Increased osteoclast activity
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