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
Manif of peripheral nerves autonomic diabetic neuropathy(3)
foot ulcer
poor wound healing
charcot arthropathy
Manif of genitourinary autonmic diabeticneuropathy(3)
reccurent infection
overflow incontinence
erectile dysfonction
why you can’t give blocker initially in Pheochromocytoma
BP will rise dramatically
First anti hypertensor to give in case of pheo
alpha blocker
why beta blocker is dangerous in first intention(2)
you block the bete receptor vascular
unopposed stimulation of alpha receptor by catecholamines
what’s the only beta that can be used in Pheo
Labetalol
Why labetalol can be used in Pheo
it blocks both alpha and beta blocker
primary adrenal insufficiency cause in developping country Dx(3)
TB
fungus infection
cytomegalovirus
calcification on CT for primary adrenal insufficiency Dx?
TB
Primary adrenal insufficiency in developed country
autoimmune
most common of death in patient with acromegaly?
CHF
how much fluid patient with hyperosmolar hyperglycemic state needs
8-10 liters
first cause of acromegaly
somatotroph adenoma
in the rehydration of patient of hyperglycemia why add glucose whe glycemia 250 mg/dl
to prevent cerebral edema
first agent used in diabetes type 2
biguanide (metformin)
second line if metformin fails in case of diabetes type 2
sulfonyluree(glyburide)
when you can use insulin in diabetes type 2
when metformin fails can be used as a second agent if A1C> 8,5
only oral hypoglycemiant associated with weight loss
GLP-1 agonist receptor
Example of GLP-1 agonist receptor
exenatide
oral hypoglycemiant with neutral action on weight
Metformin
DPP_iv inhibitor
example of DPPIV inhibitor
sitagliptin
oral hypoglycemiant associated with weight gain
insulin
pioglytazone
glyburide
family of pyoglitazone
thiazolidonedione(TZD)
oral hypoglycemiant can be used in renal insufficiency
dpp-iv inhibitor
Pyoglitazone
oral hypoglycemiant associated with bladder cancer
pyoglitazone
med with the greater efficacy to decrease A1C
insulin
effect of acidosis on respiration in case of DKA
kusmall
quid of kusmaull
deep and rapid respiration
how to differentiate primary hyperthyroidism and FHH in a context of hypercalcemia
Urinary calcium creatinin clearance ratio(UCCCR)
How ‘s UCCCR in FHH
<0,01
HoCR in primary hyperparathyroidism
> 0,02
Physiopatho of FHH(2)
defect in calcium sensing receptor in kidney
excess reabsorption of calcium
specificity of HCTZ induce hypercalcemia
it’s less than 11
rx which can worsen exophtalmy in grave’s
RAI
the only medication given in first trimester of pregnancy in graves
PTU
drugs used in hyperthyroidism causing agranulocytosis(2)
PTU
MM
permanent rx of hyperthyroidism(2)
surgery
RAI
drugs used in hyperthyroidism causing vasculitis
PTU
procedures used in hyperthyroidism causing hypothyroidism(2)
surgery
RAI
when to use statin in diabetics patient
any diabetics aged 40-45 ans regardless lipid profile
quid of high intensity statin(2)
atorvastatin 80 mg
rosuvastatin 20-40 mg
quid of moderate intensity statin
simvastatin 20-40 mg
indication blocker in pheochromocytoma
tremor
physio patho of hta in thyrotoxicosis
hyperdynamic circulation
How’s HTA in thyrotoxycosis
Systolic
HTA and low renin activity with high plasma aldosterone
conn tumor
Quid of conn tumor
tumor or corticosurrenale
Clue for conn syndrome(4)
HTA
Hypokaliemie
Low renin activity
high plasma aldosterone
cause of secondary hyperaldosteronism
everything which can decrease flux sanguin renal
high renin secretion
cause of secondary hyperaldosteronism(7)
Diuretic use cirrhosis CHF renin producing tumor reno VX HTA Malignant HTA aorta coarctation
best test to confirm primary hyperaldosteronism
adrenal ct scan
screening test for primary hyperaldosteronism
ratio plasma aldosterorone concentration sur plasma renin activity
value for PAC/PRA in primary hyperaldosteronism
> 20
aldosterone > 15 ng/dl
Hta plus hypokaliemie and low PAC and PRA(5)
congenital adrenal hyperplasia glucocorticoid resistance exogenous mineralocorticoid cushing's syndrome altered aldosterone metabolism
Mechanism of Hypocalcemia in renal failure(2)
hyperphospahtemia
cause hyperphosphatemia in renal failure
retention of phosphate
how hyperphosphatemia causes hypocalcemia
by binding to calcium in blood
by interfering with 1.25 oH vit D in kidney
why secondary hyperparathyroidism in renal failure
hyperphosphatemia stimulates parathyroid to produce more PTH
clue for hyperosmolar hyperglycemic state(2)
non anion gap acidosis
Bicarb> 18
why you dont have ketosis in diabete type 2
sufficient insulin to prevent ketosis
why coma in hyperosmolar state
because of hyperosmolarity
how’s bicarb in DKA
< 18
Marker for paget(2)
ALP
N-telopeptide
signification of Ntelopeptide
bone resorption
signification of ALP
bone formation
Mechanism of Paget disease
abnormal bone remodeling
initial work up for primary adrenal insufficiency(3)
doser
cortisol
ACTH
cosyntropin stimulation test
What’s the normal reaction of the body during cosyntropin stimulation test to rule out addison disease
increase of cortisol> 20 mcg when giving 250 mcg of cosyntropin
clue for secondary or tertiary adrenal insufficiency(2)
Low ACTH
low cortisol
screening test for diabetic nephropathy
ramdom urine microalbumine sur creatinine ratio
normal protein excretion in 24 hr
<30 mg
quid of microalbuminuria
30-300 mg of protein excretion par 24 h
effect of T3 T4 on bone
increase osteoclastic activity
risk in hyperthyroidism regarding bone(2)
bone loss———->hypercalcemia
most common risk factor for diabetic foot ulcer
neuropathy
method of screening diabetic peripheral neuropathy
pressure sensation by 10 g monofilament
interperetation of 10 g monofilament test
loss of monofilament sensation is associated with the risk of foot ulceration
risk factor for foot ulceration(6)
diabetic neuropathy smoking PAD Bony abnormalities in foot diabetes > 10 ans sexe male
when beginning diabetic screening
45 years old
Test to screen for diabetes(4)
A1C
fasting glucose
OGTT
random glucose
Abnormal A1C=diabetes
> 6,5
Abnormal OGTT
> 200 mg/dl
abnormal random glucose
> 200 mg /dl
best test to sreen diabetes
A1C
FBG tellig diabetes =is Dx
> 126 mg/dl
quid of impaired fasting glucose
100-125 mg/dl
Normal FBG
70-99mg/dl
Normal A1C
Less 5.7%
A1C telling you are at high risk of diabetes
5,7-6,4%
Rx of diabetic peripheral neuropathy(3)
TCA
or Gabapentin
or NSAIDS
Danger of TCA in the rx of diabetic peripheral neuropathy(2)
can worsen hypotension in diabetes
urinary symptom
what causes Hypotension in diabetics
autonomic dysfunction
marker of androgen producing tumor in woman
DHEAS
symptom of hyperandrogenism in woman
Masculinisation
lieu of production of DHEAS
adrenal gland
Lung malignancy causing hyper calcemia
SCC
causes of hypercalcemia in malignancy(4)
oeteolytic malignancy
PTH related peptide
increase production of 1,25 OHvit D
increase interleukin 6
difference of hypercalcemia causing by ca and primary hyperparathyroidism
calcemia >13 mg in Cancer
best long term rx of grave’s
radio active iodine
contrindication of RAI(2)
pregnancy
severe ophtalmopathy
Most common cause of Vit D deficiency?
gastrointestinal malabsorption
electrolytic abnormality of vit D decficiency(3)
low calcemie
low phosphatemie
High PTH
cause of hypocalcemia(5)
respiratory alkalosis vit d deficiency hypoparathyroidism renal failure low albumin
cause of hypoparathyroidism(4)
post surgery
congenital of absence of parathyroid gland
autoimmune destruction
defective calcium sensing receptor on parathyroid receptor
congenital cause of hypoparathyroidism
di george syndrome
what syndrome cause autoimmune destruction of parathyroid gland
APECED syndrome
quid of APECED syndrome(6)
autoimmune polyglandular endocrinopathy candidiasis ectodermal dysplasia
target of neuropathy(3)
nerve
GI
hypotension
patient diabetic with early satiety
gastroparesis
rx of gastroparesis(2)
metochlopramide or
erythromycine
why they don’t use cisapride anymore in gastroparesis
cardiac aryhtmia
consequence of gastroparesis in diabetic patient(3)
delayed gastric emptying
decrease Gut absorption
risk of hypoglycemia
how’s potassium ion DKA
high
why hyperkaliemie in DKA is called paradoxal
because total body K is depleted
why blood potassium level is high in DKA
extra cellular shift
cause of paradoxical hyperkaliemie in DKA(2)
extra cellular shift with ion H+
insulin dependent impaired entry of ion k+inside of cells
best way to lower the risk of of nephropathy caused by diabetes
tight blood pressure control
causes of erectil dysfunction in diabetes(3)
neuropathy
impaired penile circulation
gonadotrophic hypogonadism
quid of FS/LH in secondary hypogonadism
normal or
low
first step in secondary hypogonadism
ask for serum prolactine level
indication of MRI of head in the context of secondary hypogonadism(4)
high prolactine
testosterone< 150 ng/ml
visual fiel defect
other pituitary hormonal defect
indication of surgery in asymptomatic hyperparathyroidism(4)
young age1mg above the upper normal limit
anapath characteristics of medullary thyroid cancer
Invasion of capsule and blood vessel
characteristic of medullary thyroid cancer
produces calcitonin
what’s the most common type of thyroid cancer
papillary
clue for papillary thyroid cancer
psammoma body
thyroid cancer whoth the best prognosis
papillary carcinoma
complication of invading blood vessel by medullary thyroid cancer
rapidly metastasizes
initial aproach to patient with hypoglycemia
doser insulin
cause of hypoglycemia with high insulinemia(2)
insulinoma
surreptitious hypoglycemia
cause of surreptitious hypoglycemia(2)
voluntary intake of insuline or
sulfonylurea
clue for b cell tumor(2)
c peptide
proinsuline more than 5 pg
Screening of MEN 2A 2b
Dna testing
ret proto-oncogen positif
If Ret protooncogen positif CAT
thyroidectomie
Causes of osteomalacia(3)
digestive malabsorption
liver disease
kidney disease
digestive cause of malabsorption giving osteomalacia(2)
celiac sprue
crhron
complication of osteomalacia?
pseudo fracture
erectile dysfunction treatment(2)
sildenafil and
doxazocin
how to give sildenafil and doxazocin
we have to give them 4 hours interval each
sildenafil and nitrate risk?
Hypotension
risk if sildenafil is given with erytromycin or cimetidine(2)
increase half life of sildenafil
priapism
patient on PTU or Methimazole develops sore throat next step?
wbc count
patient on PTU or methimazole develops wbc < 1000 what to do?
stop meds
patient on PTU or MM develops fever with blood cell >1500 ?
continue the drug
side effect of PTU or MM
agranulocytosis
first thing to do in thyroid nodule
sono to search sign of malignancy
in case of thyroid noduleif sono doen’t show sign of malignancy what to
TSH
Thyroid nodule with low TSH
iode 123 scyntigraphy
quid of cold nodule
hypofunctionning nodule with iode 123
Management of cold nodule
FNA
quid of hot nodule
hyperfunctioning nodule on iode 123
Management of hot nodule
rx hyperthyroidism
if sono shows sign of malignancy next step
FNA
thyroid nodule with no sign of malignancy on sono but normal or high TSH
FNA
patient on prednisone develops hyponatremia Why
central adrenal insufficiency
why hyponatremia during prednisone
because of low cortisol
action of cortisol on ADH(2)
cortisol inhibits release of ADH by post hypophise
low cortisol ,more ADH
why cortisol is low whe taking prednisone(2)
prednisone blocks hypothalamo pituitary axis
low ACTH—>low cortisol
work up of acromegaly
Measure insulin grothw like factor -1
In acromegaly in IGLF-1 positive next step
oral glucose suppression test
interpretation of oral glucose suppression test in acromegaly
GH suppression
if you have an inadequate GH suppression during oral glucose suppression test next step?
brain MRI
adequate glucose suppression
no acromegaly
what cause of hyperthyroidism can cause hypothyroidism after RAI
grave’s
what can cause false decrease of calcium
low albumin
how to measure the right calcium level in case of low albumin
coreected calcium=measeured calcium+0,8(4-measured albumin)
what to do in front of all hypocalcemia
look albumin level
clue for MEN 2B(4)
Medullary thyroid ca
Pheo
marfanoid habitus
neuroma
hyperplasia parathyroid MEN?
2A
Parathyroid adenoma MEN?
1
what’s the most common pituitary tumor?
lactotroph adenoma
cause of high cortisol
cushing syndrome
cushing disease
cause of florid cushing disease
hypophyse tumor
screening test for cushing?(2)
24 hour urine free cortisol
low dose dexamethasone suppression test
florid cushing syndrome
adenoma surrenal
cause of ectopic ACT production(4)
SCC
pancreatic ca
bronchial carcinoma
neuroendocrine tumors
link between cushing disease and ectopic ACTH production
high ACTH
indication of high dose dexamethasone suppression test?
to differentiate ectopic ACTH syndrome from cushing disease
high dose dexamethasone suppression test in favor of ectopic production of ACTH(2)
Failure to suppress 24 Hr urine free cortisol
failure to decrease serum cortisollevel from 50%of its baseline
abnormal 24 h urine free cortisol
> 90 mcg/24 h
Normal ACTH
9-52 pg/ml
Marker of hashimoto
TPO antibodies
risk for hashimoto
thyroid lymphoma
first test to in hyperthyroidism suspected
TSH
T4
most common cause of thyroid nodule
colloid nodule
low TSH and high T4
hyperthyroidism
in case of hyperthyroidismnext step
RAIU
RAUI with diffuse uptake in a context of hyperthyroidism
grave’s
RAIU with nodular pattern in a context of hyperthyroidism(2)
Nodular goiter
Multinodular goiter
high t4 with normal or high TSH
secondary hyperthyroidism
next step in secondary hyperthyroidism
Brain MRI
T4 normal and low TSH in a context of hyperthyroidism?
doser T3
High T3 low TSH normal T4
Hyperthyroidism
Low TSh with normal T3 T4(3)
pregnancy
subclinical hyperthyroidism
non thyroid illness
indication of dosage of thyroglobulin
low raiu
Low RAIU and high thyroglobulin in a context af hyperthyroidism(3)
thyroiditis
iodide exposure
extra glandular production
Low RAIU,high T4,low thyroglobulin
exogenous hormone
best way to monitor response of rx in case diabetes DKA(2)
serum anion gap
arterial PH
what can explain biochemically low raiu in a context of hyperthyroidism(2)
Low TG
high TG
Marker for graves
TSI
quid of isolated low T3 syndrome
sick euthyroid syndrome
what causes sick euthyroid syndrome(2)
increase level of
IL-1
IL-6
cardiogenick shock patient or any hosptilaisede patient with serious illness with isloated low t3
sick euthyroid syndrome
how’s the RAIU in Multinodular toxic goiter
patchy pattern
Raiu in toxic adenoma
one lobe pattern
what’s the first test to do in low calcium(3)
doser MG++
ask for blood transfusion
check drug
drugs causing low calcium(3)
phenytoin
biphosphonate
ca++ chelator
cause of low calcium with high PTH(4)
vit d deficiency
renal failure
inflammatory cause(sepsis,pancreatitis)
tumor lysis syndrome
causes of low calcium and low PTH(4)
surgery
radiation of neck
APCED
infiltrative disease
infiltrative disease causing low calcium and low PTH(3)(primary hypothyroidism)
wilson
hemochromatosis
ca metastatic
what’sthe next step in patient presenting low calcium and elevated PTH
doser 25 OH vit D
causes of polyurie(3)
diabetes melitus
diabete insipide
primary polydipsia
first thing to in a context of polyuria with low osmolarity of urine
water deprivation test
if urine osmolarity increases during water deprivation test
primary polydypsie
if there ‘s no changes in water deprivation test in a context of low urine osmolarity next step
desmopressin
when given desmopressin if osmolarity of urine increases of 50% a 100%
central diabetes insipidus
when given desmopressin if osmolarity of urineshows small change
nephrogenic diabetes
urine osmolarity
50-1400 mosm/kg
serum osmolarity
275-295 mosm/kg
rx of central diabetes insipidus
desmopressin intranasal(vasopressin)
drug of choice of SIADH
demeclocyclin
illaic bone fracture and impotence why?(2)
neurogenic cause
parasympathic fibers are cut
hypothyroidism symptom in a context of Normal thyroid bilan
receptor problem in peripheral tissues
Rx of Paget
biphosphonates
quid of non funvtionning adenoma
pituitary adenoma producing alpha unit of LH and FSH
biochemistry of FSH LH(3)
dimeric
alpha et B unit
Beta units are more active
why non functionning pituitary adenoma causes hypogonadism?
because only alpha unit is produced for LH/FSH
why prolactine is elevated in non functionning pituitary adenoma
mass destroys the dopaminergic neurone inhibiting normally secretion of prolactine
what should be the level of prolactinemia to think of prolactinome
more than 200
how’s t3 t4 in non functionning adenoma in hypophyse
low
central hypogonadism ,low t3 t4 ,increase prolactin level mildly?
non functionning pituitary adenoma
cause of bone pain in osteomalacia
impaired osteoid matrix mineralization
role of vit D(2)
absorption of calcium
and phosphate
foot ulcer grade 1 and management(2)
superficial ulcer
debridement and wound dressing
foot ulcer grade 2 and management(3)
deep ulcer
Mx and ligament are seen
debridement and wound dressing
foot ulcer grade 3 and management(5)
bone involvement osteomyelitis/abcess hospitalisation antibio debridement
foot ulcer grade 4
local gangrene
foot ulcer grade 5
whole foot gangrene
management of grade 4 et 5 foot ulcer
amputation
first test to do in primary hyperaldosteronism
plasma renin activity and aldosterone concentration
high plasma aldosterone concentration ,next step in a context of primary hyperaldosteronism
adrenal suppresion test
si adrenal suppression test is positive next step in a context of primary hyperaldosteronism
CT adrenal
positive CT in a context of primary hyperaldosteronism in 40 rx?
surgery
if CT is negative next step in a context of primary hyper aldosteronism
venous sampling
quid of venous sampling(3)
to differentiate adrenal adenoma from bilateral adrenal hyperplasia in a context of negative CT
patient > 40 ans
venous sampling can also reveal adenoma CT
cause of proximal MX weakness(7)
Polymyositis dermatomyositis hypo or hyperthyroidism cushing Myasthenie gravis Lambert eaton syndrome steroids
Patient taking prednisone develops mx weakness
steroid myopathyy
patient 45 yo with no protinuria normal blood pressure diabetes on metformin ,what meds should be added in medication choix Rosuvastatin,lisinopril
rosuvastatin
