Endocrine Shit Flashcards
Women with galactorrhea + amenorrhea….dx? poss other symptoms? tx?
prolactinoma, poss: bitemporal hemianopia
tx: cabergoline(Dag)
Men with decreased libido + bitemporal hemianopia. dx? tx?
Prolactinoma!
tx: cabergoline(Dag)
Causes of Prolactinemia…
- D antagonist(antipsychotics) - disinhibits prolactin
2. elevated TSH - stimulates prolactin production
you see a person who you think has excess prolactin. what tests do you need to run?
- prolactin levels
- TSH levels (hyperthy = trig prolac produc)
- look at meds list (antipsychotics)
- MRI
When do you do surgery for prolactinoma?
when Dag(cabergoline > bromocriptine) fails. usually responds well to Dag but if not then go to surgery.
Child who is very very tall for his age + super high blood glucose. dx? tx?
acromegaly/gigantism!
dx: w/ ILGF-1 levels(GH is pulsitile) & confirm w/MRI
tx: surgery + octreotide(stop existing GH)
adult who has enlarged hands, feet, face and visceral organs + diabetes. dx? tx?
Acromegly!
dx: ILGF-1 levels(GH is pulsitile) & confirm w/MRI +/- failure to supress GH w/glucose tolerance test
tx: Surgery + octreotide(stops existing GH)
How do you treat excess GH?
surgery + ocretotide
Why isnt a GH level helpfull when you suspect acromegly? what test do you look at instead?
bc GH is pulsitile and will almost always appear normal! must look at ILGF-1 instead
What would you see in a glucose suppression tests w/acromegly? whats norm?
NORMAL: give glucose and watch for decreased in GH
+ test: give glucose and no decrease in GH
Adult with acrogmegly will likely die from…
heart probs
Post-partum women who now presents wiht hypotension, lethargy, coma… dx? tx?
Seehan’s syndrome = hypopituitarism.
dx: cort + T4 levels
tx: replace!
pt w/bitemporal hemi hx that now presents w/hypotension, lethargy, coma, stupor, nuchal rigidity, HA, nausea, vomiting…dx?
Apoplexy = pit tumor outgrew blood supply or is bleeding.
Pt w/ libido probs, hypothyroid shit, and now presents w/hypotension. all occuring over a long period of time.. dx?
prob hypopituitarism due to tumor, infiltration or AI shit.
dx: insulin = no changes in GH or CORT
Normal: insulin = increase GH, Cort, Glucagon
Guy falls at work and gets an MRI, MRI is normal except the sella is empty. dx? tx?
Empty sella syndrome! = pit is there its just up in the brain!
DONT TREAT! they are fine =D
Normal healthy person comes in for regular check up and complains of polydipsis & polyuria. what test do you run first?
U/A! = check for glucose in urine
Normal person w/polyuria + polydip w/normal U/A. dx?
Diabetes Insipidus = central v nephrogenic v psycogenic
psycogenic v nephrogenic v central DI dx? tx?
Water deprovation tests:
- Psycogenic = water depo shows rise in Uosm = stop drinking so much water
- Central = water depo + exogenous ADH = rise in Uosm = desmopressin
- Nephrogenic = water depo + exog ADH = no change in Uosm = diuretics
Person w/NVH, confusion, decreased nrg, M weakness, spams, w/hyponatremia & hypotonic serum. dx? tx?
SIADH due to Brain, lung, hypothy shit. will have super concentrated urine.
tx: Demeclocycline
Pt w/pretibial myxedema, opthalomopathy(proptosis, exophthalmos) dx? labs? tx?
Graves
Dx/Labs: dec TSH, elv T4 + diffuse RAIU
tx: sx! = propanolol, PTU or Methimazole
if not managed w/meds = Radio I ablation + surg.
pt w/ transient hyperthyroidism but now cold thyroid on RAIU + fever dx?
Thyroiditis
How to differentiate Factitious hyperthhyroidism vs Struma ovarii?
TBG = decreased with both! so do Sestamibi scan to look at ovaries.
pt w/ hyperthyroidism, fever, delirium, hypotension dx? tx?
thyroid storm!
- IVF, cooling blankets +
- Steroids = decreases T4-T3 conv
- Propanolol
- PTU or Methimazole
MCC of hypothyroidism? how do you treat all?
IATROGENIC! give T4!
Pt w/bradycarida, dementia, decreased DTR, constipation + weight gain & lymphocytic infiltrate in thryoid biopsy…
Hashimotos
Pt w/bradycarida, dementia, decreased DTR, constipation + weight gain history but now has HYPOTHEMIA, HYPOTENSION + COMA. dx? tx?
MYXEDEMA COMA
tx: IVF, Warming blankets, HD T4 and if really bad give T3.
When do you start Hypothyroidism tx?
when symptoms start or when TSH > 10
Orphan-annie nuclei, psammoma bodies, MC thyroid cancer. tx?
Papillary, resect
thyroid cancer that looks normal & spreads hematogenously. tx?
resect + I2 ablation
thyroid cancer + hypocalcemia. dx? association?
Medullary = tumor of c-cell making calcitonin. part of MEN2a&B
MEN1
Pituitary, pancreas, parathyroid
MEN2A
Pheo, parathyroid, medullary thyroid
MEN2B
Pheo, medually thryoid, mucosal neuromas
central obesity, extremity wasting, diabetes + hypertension. dx? other sx?
buffalo hump, moon faces. this is cushing syndrome!
+LD vs HD DST to differntiate from cushing dz
Hypotension, NV, Fatigue, Hyperkalemia. dx? other sx? tx?
ADDISONS! = Primary Adrenal Insuff. decreased cortisol due to adrenal gland destruction = increase in ACTH will also give hyperpigmentation. Have Hyperkalemia due to loss of aldo. tx w/prednisone + fludrocortison
Why do you have hyperkalmia w/addisons?
ADDISONS! = Primary Adrenal Insuff. decreased cortisol due to adrenal gland destruction = increase in ACTH will also give hyperpigmentation. Have Hyperkalemia due to loss of aldo.
tx of addisons?
tx w/prednisone + fludrocortison
*adrenal destruction = must replace all that is loss
Hypotension, NV, fatigue…dx?tx?
2nd adrenal insufficency. tx w/prednisone.
how do you differentiate 1 vs 2 adrenal insuff?
Cosyntropin test. If no increase in Cort after 60 min = 2nd due to lack of ACTH. if no change in cort = 1(addisons) due to adrenal destruction
pt w/HTN that is refractory to 3+ medications and now has hypokalemia. dx? ddx? how to tell them apart?
1(Conns=adrenal tumor) vs 2 hyperaldo(fibromusc dys)
1: increase aldo + decrease renin
2: increase aldo + increased renin
When do you take out a incidental adrenal mass?
when its greater than 4cm or you have sx from it
