Endocrinologr Flashcards
What does the patient have who has a slightly elevated TSH level and normal levels of thyroid hormone? What does it mean?
Subclinical hypothyroidism. This has a low rate of progression to overt hypothyroidism. Recent studies have shown there is an increased risk for cardiovascular morbidity and mortality, however treatment with thyroid replacement does not seem to affect the risk. A decision about whether or not to treat with thyroid replacement should be made on an individual basis. An alternative to treating the patient is to retest TSH annually or sooner if the patient becomes symptomatic.
What laboratory testing should be done as initial screening for late onset male hypogonadism?
A serum total testosterone level. Due to its high cost a free testosterone level is recommended only if the total testosterone level is borderline and abnormalities in sex hormone binding globulin are suspected. Follow up LH and FSH levels help to distinguish primary from secondary hypogonadism.
What are the clinical problems that may arise from subclinical hyperthyroidism?
It may decrease bone density especially and post menopausal women. It is associated with increased risk for atrial fibrillation, heart failure, pulmonary hypertension, angina, and coronary artery disease events. It may be associated with an increased risk for dementia. It may be associated with decreased quality of life, particularly in patients with endogenous subclinical hyperthyroidism. The possible effects include insomnia and a decreased sense of well-being, probably due to such symptoms as palpitations nervousness, tremor and sweating.
When evaluating a patient with a solitary thyroid nodule, red flags indicating possible thyroid cancer include what?p
Male gender, age less than 20 years or greater than 65 years, rapid growth of the nodule; symptoms of local invasion such as dysphagia, neck pain and hoarseness; a history of head or neck radiation; family history of thyroid cancer; a hard fixed nodule greater than 4 cm; and cervical lymphadenopathy.
What common drug may cause hypercalcemia?
Hydrochlorothiazide
Describe the pattern of bone age with relationship to height that is seen in children with cystic fibrosis, hypothyroidism, down syndrome, and fetal alcohol syndrome.
Hypothyroidism is associated with markedly delayed bone age relative to height age and chronological age. In cystic fibrosis bone age and height age are equivalent but both lag behind chronologic age. Children with chromosomal abnormalities such as trisomy 21 or XO have a height age which is delayed relative to bone age. this pattern is also seeing in maternal substance-abuse.
What are the clinical features of polycystic ovary syndrome? What treatments may be helpful?
Weight gain, irregular menses, acne, hirsutism, androgenic alopecia, acanthosis nigricans and insulin resistance.
First-line treatment for anovulation or infertility includes metformin and clomiphene, alone or in combination, as well as rosiglitazone. In one study of non-obese women metformin was shown to be more effective than clomiphene for improving the rate of conception. Oral contraceptives are commonly used to treat menstrual irregularities but there are a few studies supporting their use. They would not be appropriate for ovulation induction. Spironolactone is a first-line agent for treatment of hirsutism, and has shown promise in treating menstrual irregularities. Due to the high prevalence of glucose intolerance in this condition, insulin sensitizing agents are indicated but not insulin or sulfonylurea medications.
What drugs may cause hypocalcemia?
Inhibitors of bone resorption such as bisphosphonates, calcitonin, and denosumab, especially in vitamin D deficiency. Ciacalcet, calcium chelators such as EDTA, citrate and phosphate; foscarnet, phenytoin, fluoride. Diuretics, estrogens, laxatives, and magnesium can sometimes be associated with hypocalcemia.
What is Chvostek’s sign?
it is elicited by tapping on the facial nerve just anterior to the year. This leads to an in voluntary contraction of the facial muscles on the same side of the face. It is seen in hypocalcemia.
What is Trousseau’s sign?
She’s so sign is seen in hypocalcemia. Although it may be absent. It is somewhat more specific than Chvostek’s sign. It is the induction of carpopedal spasm by inflation of a blood pressure cuff above systolic blood pressure for three minutes. It is characterized by abduction of the thumb, flexion of the Metacarpophalangeal joints, extension of the interphalangeal joints, and flexion of the wrist. It may also be induced by voluntary hyperventilation for 1 to 2 minutes after release of the cuff..
What hormones are secreted by the pituitary gland?
The anterior pituitary secretes growth hormone, TSH, ACTH, prolactin, LH and FSH.
The posterior pituitary gland secretes antidiuretic hormone and oxytocin.
List the physical features of Cushing’s syndrome
Easy bruising, moon facies, buffalo hump, abdominal striae, hypertension, and proximal myopathy.
What condition should be suspected in a patient with an unexplained, otherwise asymptomatic creatinine kinase elevation?
Hypothyroidism
What is the best test for primary hyper aldosteronism? What results are positive for it?
A morning plasma aldosterone/renin ratio. If the ratio is 20 or more and the aldosterone level is greater than 15 ng/dL, then primary hyperaldosteronism is likely and referral for confirmatory testing should be considered.
Up to what percent of patients referred to specialists for poorly controlled hypertension have primary hyperaldosteronism?
20%
