endocrine uworld Flashcards
what vitamin deficiency might see in carcinoid syndrome?
niacin
low urine osmolality < 300 mOsm
low urine specific gravity < 1.006
high serum osmolality > 250 mOsm
THEN
Low serum Na vs High serum Na >145
diluted urine
pointing towards diabetes insipidus
low: primary polydipsia
high: diabetes insipidus
wt loss, DM, diarrhea, painful, pruritic rash
necrolytic migratory erythema: erythematous papule that coalesce to form large, indurated plaques with central clearing
dx w/:
glucagonoma
dx w/: abdominal imaging MRI or CT scan
decreased libido, ED, no morning eretions, DM, joint pain, hepatomegaly
hereditary hemochromatosis
d/t excessive absorption of iron and deposition of excess iron in the tissues
can cause secondary hypogonadism
young girl with rapidly progressive (<1year) hirsutism and virilization (clitoromegaly)
dheas
testosterone
LH levels
androgen secretion tumor
androgens will be high
dheas: high
testosterone: high
LH: low d/t negative feedback from testosterone
Female with hirsuitism, rapid onset (<1year), virilization(temporal balding, clitoromegaly) suggests:
androgen secreting neoplasm
High TESTOSTERON with normal dheas –> ovarian source
high DHEAS suggests adrenal tumor
propylthioruracil and methimazole adverse effect:
agranulocytosis
TSH - low
Free T4 - high
RAIU - low
next step?
measure thyroglobulin
if low: then exogenous hormone (weight loss supplement)
graves disease treatment that worsens ophthalmopathy
radioactive iodine
Patient takes OCP’s and then elevation in T4 but normal TSH
estrogen induced increase in T4-binding globulin
(increased thyroid hormone binding protein)
thyrotoxicosis (lid retraction, fine tremor) with HTN
what’s causing the HTN?
increased myocardial contractility
muscle weakness, muscle atrophy, with anxiety, tachycardia, wt loss
thyrotoxic myopathy
muscle weakness, muscle atrophy, with anxiety, tachycardia, wt loss
thyrotoxic myopathy
treatment management of Graves hyperthyroidism
**INITIAL: b-blocker
1) anti-thyroid drugs :
Propylthiouracil or Methimazole
2)^^if still no results then Radioactive iodine (more definitive treatment)
3) thyroidectomy (if they have a large goiter or coexisting thyroid nodule suspicious for cancer or have severe ophthalmopathy (since RAIU is contraindicated)
untreated hyperthyroidism can cause:
bone loss leading to osteoporosis
(increase osteoclast activity)
hypoglycemia + high insulin + LOW c-peptide
exogenous insulin
hypoglycemia + high insulin + high c-peptide + high pro-insulin >5pmol/L
beta cell tumor (insulinoma)
or
surreptitious use of insulin or sulfonylurea (but you will see sulfonylurea in the plasma)
chronic glucocorticoid therapy effects on:
cortisol:
aldosterone:
ACTH:
cortisol: LOW
aldosterone: normal
ACTH: LOW
chronic glucocorticoid therapy effects on:
cortisol:
aldosterone:
ACTH:
cortisol: LOW
aldosterone: normal
ACTH: LOW
euthyroid sick syndrome: why will you see low T3
decreased peripheral conversion of T4 to T3
cool, dry ski, metabolic slowing, cognitive (difficulty concentrating) psychiatric depression, irritability, + abnormal uterine bleeding
TSH:
prolactin:
FSH:
LH:
hypothyroidism
THS: HIGH
PROLACTIN: HIGH
FSH: low
LH: low
PCOS treatment
weight loss
OCP’s
letrozole for ovulation induction
hemorrhage during child birth can cause ____
ACTH:
Serum sodium:
serum potassium:
Sheehan syndrome
pituitary infarction (central AI) causing adrenal insufficiency
AI causes cortisol deficiency
cortisol acts as an inhibitor of Anti-diuretic hormone –> so you will see SIADH –> hyponatremia
ACTH: LOW
SERUM NA: LOW
K: normal (vs Primary AI destroyed cortex Addisons: hyperkalemia)
29F generalized weakness, fatigue, nausea, abdominal pain, dry and pigmented buccal mucous membranes, eosinophilia
primary adrenal insufficiency: autoimmune response (Addisons)
