Endocrine Qs Flashcards
Tests that can diagnose DM?
Need each test x2:
1) fasting plasma glucose,
2) 2-hour postprandial glucose during an oral glucose tolerance test, or
3) hemoglobin A1c
In pregnant patients with hyperthyroidism,, use what drug? (during which time?)
Otherwise, risk?
propylthiouracil, rather than methimazole,
1st trimester
aplasia cutis (absence of a portion of skin on the scalp in a localized or widespread area) and choanal atresia
Management of prolactinomas during pregnancy?
formal visual field testing should be performed during each trimester
A type II DM presents with DKA. Before starting oral therapy (and stopping insulin), should check (2 options)?
fasting C-peptide and glucose OR a glucagon-stimulated C-peptide should be measured 7 to 14 days after the correction of the acidosis
Thyroid pathology that causes secondary amenorrhea? Mechanism?
Both hypothyroidism and hyperthyroidism
Hypothyroidism -> increased thyrotropin-releasing hormone through negative feedback -> stimulates prolactin secretion -> suppresses gonadotropin secretion.
Hyperthyroidism can cause rapid weight loss –> functional hypothalamic amenorrhea
Treatment of subacute granulomatous (de Quervain) thyroiditis?
Supportive with NSAIDs for pain and BBs in thyrotoxic phase
the need for pharmacologic therapy for postmenopausal bone loss is is based on?
10-year estimated fracture risk (20+% for a major osteoporotic fracture or 3+% for hip fracture).
Marker highly associated with Graves disease?
Thyroid-stimulating immunoglobulins
Requires repletion before serum calcium? Mechanism?
Magnesium. Low Mg levels impair parathyroid hormone secretion
Urine and serum calcium goals in patients with hypoparathyroidism?
urine calcium goal is less than 300 mg/24 hours
serum calcium goal is between 8.0 and 8.5 mg/dL
Normal TSH during pregnancy?
serum total T4 level?
- 03 to 2.5
1. 5x normal
In patients with primary hyperparathyroidism and concomitant vitamin D deficiency, 25-hydroxyvitamin D levels should be repleted to? Why?
30 ng/dL
to prevent further parathyroid hormone stimulation.
Pt with pheocromocytoma needs a CT scan. May need premedication if? Why?
Administering iodine contrast
could incite a hypertensive crisis if pt has not received α-blockade
Therapy for primary acromegaly?
transsphenoidal surgery
Role of chemo in thyroid cancer?
Traditional chemotherapeutic agents, such as doxorubicin, are generally ineffective in the management of differentiated thyroid cancer
Treatment of Hyperglycemia caused by chronic pancreatitis?
Insulin (no oral hypoglycemics since it a form of Type 1 DM)
Treatment of Microprolactinomas in asymptomatic patients?
none
Workup of primary hyperaldosteronism? If postive? If confirmed?
Aldosterone-plasma renin activity ratio –>
If positive, confirmatory testing with intravenous salt loading, fludrocortisone suppression testing, or captopril testing
adrenal imaging
Treatment for primary hyperaldosteronism?
Surgery if unilateral cause
Mineralocorticoid receptor antagonists (such as spironolactone) are indicated for patients with a bilateral cause of primary hyperaldosteronism and those with a unilateral cause who refuse or are not candidates for surgery.
A patients with multiple endocrine neoplasia type 2A needs thyroidectomy. Should undergo testing to?
exclude pheochromocytoma
When to use HD for hyperCa?
Ca>18 and neurologic symptoms or AKI
How do home ovulation kits work? Will give false positive in these pateints?
Measure LH spike
PCOS (baseline high LH)
A bisphosphonate drug holiday is indicated for patients who have been?
on bisphosphonate therapy for 3 to 5 years, have had no progression of the disease, and have MINIMAL risk factors for additional fractures
Patient with primary hyperparathyroidism. Who get surgery?
threshold for surgery.
-Total calcium >1SD bove upper limit of normal
Bone density in osteoporotic range
-age under 50
- AKI
