Endocrinology

Question 1

State the common name for adrenal insufficiency. Give the most common cause and state some additional causes.

Answer 1

Addison’s Disease –> MC cause = autoimmune

Other = pituitary adenoma, TB

Question 2

List some events that may be likely to precipitate Addisonian crisis.

Answer 2

infection, trauma, surgery, stress, lymphoma, metastatic cancer, amyloidosis, scleroderma, hemochromatosis, stopping steroid meds w/o tapering

Question 3

List common S/S associated with Addison’s disease.

Answer 3

Fatigue, weight loss, amenorrhea, salt carving, hyperpigmentation, delayed DTR –> hypotension and hypoglycemia in crisis

Question 4

What lab findings are consistent with Addison’s disease.

Answer 4

HyperK, hypoNa, hypoglycemia, hypercalcemia, low BUN, DHEA < 1,000, Antiadrenal abs in 50% of patients

Question 5

Describe the testing process for Addison’s disease.

Answer 5

ACTH Stim Test: measures inc in cortisol in response to exogenous ACTH. Primary adrenal insufficiency (Addison’s) will show no increase in cortisol. In secondary disease, test will produce rise in cortisol.

Question 6

What is the treatment for Addison’s disease?

Answer 6

Steroids and mineralcorticoids (aldosterone), DHEA in some patients.

Question 7

Differentiate between Cushing’s syndrome and Cushing’s disease.

Answer 7

Syn: any cortisol excess
Dis: hypercortisol from ACTH secreting pituitary adenoma

Question 8

Describe S/S associated with Cushing’s disease.

Answer 8

Obesity with fat redistribution –. buffalo hump, moon face, supraclavicular fat pads. abdominal striae, HTN, thirst.

Question 9

Differentiate between serum ACTH, low dose, and high dose dexamethasone suppression testing in the evaluation of Cushing’s syndrome.

Answer 9

Low Dex: Initial screening for Cushing’s syndrome. Cortisol over 1.8 indicates inadequate suppression of HPA axis and is positive for Cushing’s syndrome.
ACTH: Drawn if low test is positive. Low ACTH indicates a primary adrenal cause. If ACTH remains normal or high, the problem is at the pituitary or other ectopic ACTH secreting tumor.
High Dex: Used in secondary disease to distinguish pituitary cause (Cushing’s Disease) from ectopic ACTH secreting tumor. Reduction in serum cortisol of 50% or more indicates Cushing’s disease.

Question 10

What is the treatment of a pituitary tumor?

Answer 10

Transphenoidal resection is most common. Irradiation may also be a choice.

Question 11

Describe and state the most common cause of type 1 diabetes mellitus.

Answer 11

Little to n exogenous insulin secretion from beta cells. Autoimmune destruction of the beta cells is the most common cause.

Question 12

What are the “three P’s” that describe the common S/S associated with DM?

Answer 12

Polyuria, polydypsia, polyphagia.

Question 13

What are the diagnostic requirements for diabetes mellitus?

Answer 13

Random glucose > 200 or fasting glucose > 125 with symptoms or on more than one occasion. A1C > 6.5 also diagnostic.

Question 14

What regular monitoring and prophylaxis is indicated for a diabetic patient?

Answer 14

ASA to dec CAD risk, foot care, ophthalmology exams, exercise, maintain personal hygiene.

Question 15

Differentiate the common presentation of type 1 DM from type 2 DM.

Answer 15

T1D: young, skinny
T2D: older, obese

Question 16

List types of insulin by immediate, short, intermediate, and long acting.

Answer 16

Immediate: Lispro, Aspart
Short: Regular
Intermediate: NPH
Long: Glargine, Detemir

Question 17

Insert slides for T2D oral meds from pharm packets

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Question 34

What is the most common cause of hyperthyroidism and what labs are consistent with the condition?

Answer 34

MC cause = Grave’s disease

Labs: decreased TSH, elevated T3, free T4

Question 35

What does radioactive iodine uptake show in Graves disease?

Answer 35

Increased uptake in thyroid.

Question 36

What S/S are most consistent with hyperthyroid?

Answer 36

weight loss, anxiety, insomnia, fine tremor, fatigue, musle cramps, amenorrhea, tachycardia, palpitations, HTN, brittle hair, heat intolerance

Question 37

What medications are primarily used to treat hyperthyroid?

Answer 37

1st line: methimazole

PTU –> 2n line or 2st line in early pregnancy.

Question 38

What is the most common cause of hypothyroid disease?

Answer 38

Autoimmune disease, such as Hashimoto’s

Question 39

What S/S are most consistent with hypothyroid?

Answer 39

lethargy dry/coarse hair, slow speech, cold intolerance, exophtalmos, facial edema, weight gain, depression, anemia, bradycardia, enlarged thyroid

Question 40

In terms of lab findings, differentiate between primary, secondary, and subclinical hypothyroid.

Answer 40

Primary: high TSH, low T3 and free T4
Secondary: low/normal TSH, low T3 and free T4
Subclinical: elevated TSH, normal T3 and free T4

Question 41

How is hypothyroid treated?

Answer 41

Levothyroxine –> start low and titrate dose to normal serum TSH.

Question 42

In what patients is it particularly important to start low and escalate slowly with the dosing of levothyroxine?

Answer 42

History of CAD –> too much thyroid hormone can exacerbate cardiac disease.