Endocrinologie Flashcards
Clue for surreptitious vomiting(2)
Dental erosions
scars dorsal of hands
Normotension and metabolic alkalosis and hypokalemia(4)
Surreptitious vomiting
diuretic abuse
barter syndrome
Gitelman syndrome
Urine chloride in surreptitious vomiting
Low
urine chloride in Barter gitelman syndrome
High
How to differentiate barter from surreptitous vomiting
urine chloride concentration
How’s urine chloride in diuretic abuse
High
Treatment of prolactinoma(2) regardless the size
bromocriptine or
cabergoline
quid of microadenoma
Size less than 10 mm
first thing to in front of hypercalcemia
doser PTH
Cause of hypercalcemia with high PTH
primary hyperparathyroidism
What to do in front of hypercalcemia with low PTH(3)
doser 1,25 OH vit D
25 OH vit D
PTHrelated peptide
Cause of hypercalcemia with high 1 ,25 OH Vit D(2)
Lymphoma
Sarcoidosis
Cause of hypercalcemia with high 25 OH vit D
vit D toxicity
Hypercalcemia with normal vit D and low PTH(7)
drug induced Malignancy Immobilization Multiple Myeloma Hyperthyroidism Vit A toxicity Milk alkali syndrome
Hypercalcemia with PTHrelated peptide
cancer
drug causing hypercalcemia(2)
HCTZ
Lithium
rx of hypercalcemia caused by immobilization(2)
hydration
biphosphonate
Rx of SIADH what to consider
the level of hyponatremia
SIADH with mild hyponatremia(2)
Fluid restriction
< 800 ml jour
Most common type of neuropathy in diabetics
symmetric distal polyneuropathy
what cause hypercalcemia in immobilization
osteoclastic bone resorption
increase osteoclaste activity
The onset of hypercalcemia depends on what factors?(2)
the magnitude of bone turnover
kidney capacity of excreting calcium
control of heart rate in hyperthyroidism
propranolol
first test to ask in Hyperthyroidism
TSH
If TSH is low what ‘s the second test to ask
T4
If low TSH and high T4 next step
radioiodine uptake
scan
importance of radioiodine uptake and scan
to Differentiate graves from other forms of hyperthyroidism
Physiopatho of Paget
Bone remodeling
Clue for Paget
Hearing loss
High ALP
Tumor in Paget(2)
Osteosarcoma
giant cell tumor
In what cases Paget will cause hypercalcemia(2)
Pathologic fracture
immobilzation
More sensitive image test for Paget
Bone scan
Plain xray of Paget(2)
Lytic lesion Mixed Lesion (sclerotic and Lytic)
Rx of Paget
Biphosphonate
Cancer producing PTH related peptide
SCC of lung Renal and bladder cancer ovarian and endometrial breast esophageal cancer Head and neck SCC
How cancer cause hypercalcemia
PTH related peptide production
ectopic PTH
bone Metastasis
Production of 1,25 OH vit D
Cancer producing high 1,25 OH vit D
Lymphoma
Action of 1,25 OH vit D
excessive gut absorption of calcium
how metastasis cause bone resoprtion
tumor secrete Cytokines causing increase activity of osteoclaste
what cytokines are involved in bone resorption in case of metastasis(4)
IL-3
IL-6
TNF Alpha
Macrophage inflammatory factor 1
Hyperandrogenism work up in woman(2)
Testosterone
DHEAS
what is the principal source of production of DHEAS
surrenale
hyperandrogenism ,high testo and normal DHEAS
ovary problem
Hyperandrogenism ,high DHEAS and normal testo
surrenal problem
Lieu of formation of DHEA(2)
ovary
surrenal
When to ask for RAIU in case of primary hyperthyroidism
when there is no sign of graves disease
If RAIU is high ,what pattern will be suggestive for grave’s
diffuse pattern
If RAIU is high with nodular uptake dx?(2)
Multinodular goiter
toxic adenoma
What to if RAIU is low
doser thyroglobuline(TG)
Dx of low RAIU and low TG
intake of exogenous hormone
Dx of low RAIU and high TG(3)
Thyroiditis
iodide exposure
extra glandular production
When to measure T3
when TSH is low and T4 normal
Normal T3 T4 with low TSH(3)
pregnancy
subclinical hyperthyridism
non thyroid illness
High TSH and high T3
Pituitary adenoma secreting TSH
quid of maladie d’addisson
primary adrenal insufficiency
first cause of adrenal insufficiency in Addisson in developped country
autoimmune
clue for adrenal insufficiency(5)
Hypotension hyperkalemia hyponatremia acidosis metabolic hypereosinophilia
why hyperkaliemia maladie d’addison
no aldosterone produced
Why hyponatremia
No aldosterone produced
Why patient with autoimmune adrenal insufficiency can also has hypothyroidism
because you can have autoimmune destruction of this gland (hashimoto)
What other gland can be involved in autoimmune adenal insufficiency(3)
thyroid
parathyroid
ovaries
Hallmark of insipidus diabetes
Hyponatremia
What is the clue of the management of diabetes insipidus
volemia
treatment of insipidus diabetes in hypovemic syptomatic patient
nacl 0,9%
Rx of diabtes insipidus in euvolemic patient
free water
Rx of diabetes insipidus in hypovolemic asymptomatic patient
DW 5%
Rx of insipidus diabetes after becoming euvolemia in a previous symptomatic hypovolemic patient
DW 5%
How to correct the hypernatremia in Diabetes insipidus
0,5 meq/dl/hr
dont exceed 12 meq/dl/24h
why hypernatremia should be corrected slowly in insipidus diabetes
to prevent cerebral edema
what’s the basic level of glucose to have DKA
250 mg/dl
what’s the basic level to have hyperosmolar hyperglycemic state
> 600 mg/dl
why you will never have ketosis in type 2 diabetes
because there is sufficient insulin in the body to prevent ketosis
thyrotoxycosis with low RAIU uptake(4)
Thyroiditis
levothyroxine overdose
iodine induce thyrotoxicosis
stroma ovarii
The 2 types of thyroiditis capable of induce thyrotoxycosis
subacute lymphocytic thyroiditis
subacute granulomatous thyroiditis(de quervain)
in case of hyponatremia what’s the 3 first dx to have in mind?
- Hypothyroidism
- adrenal insufficiency
- SIADH
Dx test for SIADH
osmolarity plasma
osmolarity urine
Osmolarity urine in SIADH
> 100-150
Osmolarity plasma in SIAD
<280
one cause of SIADH
NSAIDS use
Why NSAIDS causes SIADH
because it potentiates action of ADH
Differnce between Dequervain and lymphocytic thyroiditis
Pain in Dequervain
first step in front of a patient with hypercalcemia and HTA and elevated PTH
plasma metanephrines
quid of MEN type 1(3)
Parathyroid adenoma
pituitary adenoma
Pancreatic tumor
MEN 2A(3)
Parathyroid Hyperplasia
Pheo
Medularry thyroid cancer
MEN 2B(4)
Pheo
medullary thyroid cancer
Mucosal and intestinal neuroma
Marfanoid habitus
Screening test for MEN 2
Ret proto-oncogen
Erectile dysfunction causes(2)
psychologic
organic
first thing to assess in case of erectile dysfunction
Nocturnal or morning penile tumescence
What are the 2 mechanism for liver to create sugar
glycogenolysis
gluconeogenesis
what’s the main substrat for gluconeogenesis?(2)
Amino acid
Alanin
Quel est le produit intermediaire entre alanin et glucose
pyruvate
how long can last the glycogen storage in case of fasting
12hrs
How hypothyroidism causes hypercholesterolemia(2)
decrease number of LDL surface receptor
decrease activity of LDL receptor
how hypothyroidism cause hypertriglycedemia
Decrease of lipoproteine lipase activity
What are the five criteria to consider for Metabolic syndrome
Waist circumference HDL triglyceride BP fasting glucose
how many criteria needed to Dx metabolic syndrome?
at least 3
waist circumference in men for MS
> 40
waist circumference in women for MS
> 35
HDL in men for MS
<40
HDL in women for MS
<50
triglycerides in MS
> 150
fasting glucose
> 100 -110
what’s the most pathogenic factor in MS(2)
insulin resistance or
Central type obesity
what are the 3 forms of existence of calcium in the body
ionised
bound to albumin
bound to anions
What’s the active form of calcium
ionised form only
Why respiratory alkalosis causes hypocalcemia
because of increase extracellular PH level
what happen to calcium when extracellualr PH is high
calcium becomes highly bound to albumin
cause of respiratory alkalosis
hyperventilation
cause of hyperventilation without any disease
high altitude
clue for hyporcalcemia(3)
cramps
paresthesia
carpopedal spasm
Patient on diet develops constipation ,thirst and polutria and polydypsia
hypercalcemia cause by excess of vit D intake
why vit supplement can cause hypercalcemia
because fat soluble(vit D eg.) vit are stored in body for long periods of time
what are the 3 hormones most commonly involved in hypopituitarism
ACTH
TSH
Gonadotrophin releasing hormone
causes of hypopituitarism(7)
Infection infarction infiltrative immunologic iatrogenic empty sella syndrome apoplexy
Infarction of pituitary gland
sheehan syndrome
the first disease to infiltrate the pituitary gland
hemochromatosis
iatrogenic cause(2)
surgery
radiation
hypothalmic problem causing hypopituitarism(6)
infection infiltrative iatrogenic tumeur injury metastasis
first tumor causing hypothalamic hypopituitarism
cranipharyngioma
Infection causing hypothalamic hypopituitarism
TB
first cause of secondary adrenal insufficiency
pituitary adenoma
difference between primary and secondary adrenal insufficiency(3)
IN SECONDARY ADRENAL INSUFFICIENCY
no hyperkaliemie
no salt wasting
no hyperpigmentation
trauma causing hypothalamic hypopituitarism
skull base
in secondary adrenal insufficiency how’s aldosterone
normal
clue for DKA(4)
blood glucose >250
PH <15-20
Anion gap acidosis
4 things to in DKA
Nacl 0,9%
Insulin
antibio
rx hyperkalemia
Hypercalcemie with high or normal PTH Dx?(3)
Primary hyperparathyroidism
familial hypocalciuric hypercalcemia
tertiary hyperparathyroidism
How to differentiate primary hyperparathyroidism and FHH
urinary excretion of calcium
quid urinary excretion of ca++ in FHH
< 100/24 h
quid urinary excretion of calcium in primary hyperparathyroidism?
> 250/24 h
first test to in front of hypercalcemia
PTH dosage
hallmark of SIADH
hypernatremia
rx of SIADH rules
depend on severity of symptom
symptom for mild SIADH
forgetfulness
rx for asymptomatic patient or mild symptoms
fluid restricton < 800 ml/day
Syptoms for moderate SIADH(2)
Confusion
lethargy
Rx for moderate SIADH
Hypertonic saline jusqu’a augmenter Nacl 120 meq/l
symptoms for severe SIADH(2)
convulsions
coma
Rx of severe SIADH
Bolus of Hypertonic saline jusqu’a resoultion des symptomes
Conivaptan
quid of conivaptan
vasopressin receptor antagonist
physiopatho of exophtalmos in Grave’s desease(2)
periorbital lymphocytic infiltration
retro orbital tissue expansion
why renin is high in fibromxar dysplasia
decrease renal perfusion
work up for fibro muscular dysplasia(2)
ct angiography of abdomen or
duplex U/S
in addition of renal arteries what other arteries can be involved in fibromuscular dysplasia
Cerebral arteries
mechanism of stroke in fibro muscular dysplasia
cerebral arteries involvement
what’s the most common testicular cancer
Leydig cell tumor
clue for leydig cell tumor(3)
gynecomastia
High testo
high estrogen
role of leydig cells(2)
testo
oestrogen formation
role of aldosterone(3)
regule pompe Na+K+
sortie de K+ couple avec H+
entree de Na+ couple avec HCO3_
best way to slow progression of diabetic nephropathy
ACE inhibitor
clue for primary hyperaldosteronism(4)
HTA
NA high
K+ low
metabolic alkalosis
work up of primary hyperaldosteronism?(3)
low plasma renin
high plasma aldosterone
rapport plasma aldosterone /plasma renin >20
Confirmatory dx of primary hyperaldosteronism?
oral saline load suppression test
interpretation of oral saline load test
adrenal supression=primary hyper aldosteronism
Why CT and adrenal venous sampling are important
to help differentiate adrenal adenoma from bilateral adrenal hyperplasia
two causes of primary aldosteronism
Bilalateral adrenal hyperpalsia
adrenal adenoma
rx for adrenal adenoma
surgery (prefered)
aldosterone antagonist
Rx of bilateral adrenal hyperplasia
aldosterone antagonist
what’s the most drug used in primary hyperaldosteronism
epleronone
spironolactone
quid of urinary dribbling
incontinence
cause of incontinence in diabetic patient
neurogenic bladder
organ targeted by autonomic diabetic neuropathy(4)
cardio vascular
peripheral nerves
gastro intestinal
genito urinary
Manif of cardio vascular autonomic diabetic neuropathy(2)
tachycardia
postural hypotension
Manif of gastrointestinal autonomic diabetic neuropathy(3)
esophageal dysmotility and dyspepsia
gastroparesis
intestinal involvement
