Endocrine Pathology - Hyper & Hypothyroidism - Hyper & Hypoadrenalism

Question 1

what is caused by untreated, long standing hypothyroidism?

Answer 1

Myxedema coma -> hypothermia, bradycardia, hypotension, organ failure, altered mental status

-treat -> give T3, T4

Question 2

what is the most sensitive lab test to look for primary hypothyroidism?

Answer 2

TSH

-if secondary hypothyroidism due to surgery, pituitary tumor, etc. -> check free T4 levels

Question 3

most common cause of primary hypothyroidism?

Answer 3

Hashimoto’s disease

Question 4

most common cause of hyperthyroidism?

Answer 4

Graves disease

Question 5

Graves disease

Answer 5

autoimmune (Abs activating TSH receptor) -> hyperthyroidism, opthalmopathy, dermopathy (elephant skin)

Question 6

what do you use to treat hyperthyroidism in 1st trimester pregnancy?

Answer 6

Propylthiouracil (PTU) -> low placental transfer

-risk of hepatitis and agranulocytosis

Question 7

what do you use to treat hyperthyroidism in 2nd-3rd trimester?

Answer 7

Methimazole -> teratogen

Question 8

what radioactive iodine is used for hyperthyroidism?

Answer 8

131-I***

Question 9

untreated, prolonged hyperthyroidism

Answer 9

THYROID STORM
-fever, A-fib, CHF, seizures, mental status change

treat: beta blockers, antithyroids, steroids

Question 10

Riedel’s thyroiditis

Answer 10

fibrotic replacement of thyroid tissue -> compression, adherence

Question 11

what is the most common malignancy of the thyroid?

Answer 11

Papillary Thyroid Carcinoma**

Question 12

the best way to diagnose thyroid nodules

Answer 12

FNA

Question 13

Cushing syndrome

Answer 13

• excess cortisol
• STRIAE, MOON FACE, DORSAL FAT PAD
• treat w/ surgery (main), radiation, ketoconazole, metyrapone, cabergoline

Question 14

what do you want to do before imaging someone (ex. in cushing disease or hyperaldosteronism)

Answer 14

BIOCHEMICAL DIAGNOSIS BEFORE IMAGING

Question 15

how do you distinguish b/w pituitary ACTH and ectopic ACTH production?

Answer 15

inferior petrosal sinus sampling

Question 16

what is the morning plasma aldosterone to renin ratio***

Answer 16

ratio >20:1

Question 17

primary hyperaldosteronism

Answer 17

-HIGH aldosterone, LOW renin

Question 18

secondary hyperaldosteronism

Answer 18

-HIGH aldosterone, HIGH renin

Question 19

apparent mineralcorticoid excess

Answer 19

-LOW aldosterone, LOW renin

Question 20

adrenal insufficiency (Addison’s disease)

Answer 20

• due to autoimmune destruction or TB**

- HYPERPIGMENTATION -> high ACTH due to loss of cortisol neg. feedback…POMC

Question 21

most common deficiency in congenital adrenal hyperplasia

Answer 21

21-hydroxylase deficiency**

• can’t produce aldosterone or cortisol
• shunt towards androgen path -> VIRILIZATION and SALT WASTING
• treat: give cortisol to suppress CRH, ACTH