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)
PAI - Addisons
what tests?
8 am cortisol
or
cosyntropin (synthetic ACTH analogue) ACTH stimulation
PAI - Addisons
what tests?
8 am cortisol
or
cosyntropin (synthetic ACTH analogue) ACTH stimulation
initial tests for Cushing syndrome:
24 hr urinary cortisol excretion
late night salivary cortisol assay
low-dose dexamethasone suppression test
38F with hirsuitim, weight gain, bone demineralization, HTN, muscle weakness:
d/t :
Cushing syndrome d/t excess cortisol from either
1)exogenous glucorticoid use
2)endogenous cortisol secretions:
A) ACTH-Producing pituitary tumor (Cushing dx)
B) ectopic ACTH production (small cell lung cancer)
C) Primary adrenal disease (adenoma)
either way: causes breakdown of muscles, painless with normal ck values
muscle atrophy
diabetes medication that:
induces weight loss, decrease of atherosclerotic cardiovascular disease, heart failure, and slow progression of albuminuria in diabetic nephropathy
SGLT-2 inhibitors
and GLP-1 receptor agonists
diabetes med: reduces cardiovascular mortality, induce weight loss, and has low risk for hypoglycemia
glucagon-like peptide 1 receptor agonist GLP-1
management for DKA
HHS management
replenish K ***** since giving insulin can cause hypokalemia
drugs for neuropathy
pregabalin
diabetic neuropathy:
proprioception loss (negative symptoms)
vs
pain/paresthesia (positive symptoms
large
small
diabetic gastroparesis
dx:
tx:
HTN, hypokalemia, metabolic alkalosis, elevated plasma aldosteron:renin ratio>20
dx:
tx: (2)
primary hyperaldosteronism Conn syndrome
dx: plasma aldosterone/renin ratio
CT scan
absence of aldosterone suppression with oral saline laid
tx: bilateral adrenal hyperplasia MRA spironolactone epilreone(doesnt have the gyno decreased libido effects)
unilateral adenoma: surgical resection
primary hyperaldosteroneism chart
adrenocortical causes of HTN
pulmonary embolism with hyperventilation and respiratory alkalosis –> hypocalcemia sxms:
why low calcium
vs
if in state of acidosis what would drive Ca towards
alkalosis: hydrogen ions dissociate from albumin, allowing na increase in binding to calcium (causing hypocalcemia since ionized calcium is the active form)
vs
acidosis: increASED LEVELS OF IONIZED calcium
Acromegaly:
what test?
if positive what next test?
if inadequate GH suppression, what next?
treatment options?
1) Insulin-like Growth Factor-1 (IGF-1 from liver) level
2) Oral glucose suppression test –> normally: should suppress GH
3) MRI of brain for pituitary adenoma
tx options:
transphenoidal surgical resection
or
somatostatin analogue: octreotide
or
GH receptor antagonist: Pegvisomant
water deprivation test
pt with DM2, better glycemic control will reduce the risk of ____ complications within 5 years?
MICRO-vascular complications like nephropathy or retinopathy
macro-vascular complications like MI, stroke, all-mortality has no change
muscle weakness, fatigue, HTN, mild hypernatremia, low potassium, 3cm mass in left adrenal gland
what is it?
bicarb level?
Primary Hyperaldosteronism
increase in aldosterone causing wasting of potassium –> HYPO-kalemia
Aldosterone stimulates nephron to secrete H+ resulting in increased reabsorption of bicarb (elevated bicarb metabolic alkalosis)
increase in Na reabsorption leading to HTN but d/t aldosterone escape: [you will see increased Renal Blood flow, increased GFR, increased atrial natriuretic peptide] WHICH all lead to some increase in Na excretion (which is why you see mild hypernatremia)
60M with dry cough, fatigue, anorexia, 20lb weight loss over 3 mo, smoking, now with hypercalemia due to:
elevated Parathyroid hormone-related protein
PTH-RP
pt has hypercalcemia, next best test/step?
measure parathyroid level:
determines if it is PTH-independent (suppressed PTH) d/t malignancy, vit-D toxicity etc.
or PTH dependent (elevated PTH) D/T primary hyperparathyroidism
pituitary microadenoma (>1cm) OR symptomatic (prolactinoma with galactorhea amenorrhea etc.)
treatment?
tumor size of >3cm or refractory to medication, treatment?
dopamine agonist cabergoline or bromocriptine – normalize prolactin levels and reduce tumor size
large 3cm+ transphenoidal resection
post-viral painful tender goiter
tx?
subacute thyroiditis
tx: symptomatic with b-blockers and nsaids
bone pain, fatigue, hypo-phosphatemia, with malabsorptiv disorder (celiac)
what are the impt lab values
osteomalacia
elevated alk-phos, PTH
LOW Ca, Phos, AND urinary Ca
Low 25(OH)D
impaired osteoid matrix mineralization
Vitamin D deficiency cause: drugs:
anti-convulsants: phenytoin, CARBAMAZEPINE,
isoniazid, rifampin
