Endocrinology Flashcards
1
Q
sx associated w. gigantism
A
HA
visual defects
wt gain
enlarged forehead/hands/feet/tongue
diaphoresis
2
Q
acromegaly and gigantism are caused by
A
1. mc - pituitary adenoma that secretes GH
2. non pituitary tumors secreting GnRH
3
Q
gigantism is GH secretion in:
acromegaly is GH secretio in:
A
gigantism: childhood (before epiphyseal closure)
acromegaly: adulthood
4
Q
dx for gigantism/acromegaly
A
-GH test 2 hr after glucose load
-increased IGF-1
-MRI/CT
5
Q
tx for gigantism/acromegaly
A
pituitary tumor removal
6
Q
primary adrenal insufficiency is aka
A
addison’s dz
7
Q
25 yo M w. fatigue, wt loss, recurrent n/v, and weakness - PE shows darkened skin - BP 90/70
A
addison’s dz
8
Q
hallmark labs of addison’s
A
hyponatremia
hyperkalemia
9
Q
pathophys of addison’s
A
AI destruction of adrenal cortex -> loss of cortisol
10
Q
6 nonspecific sx of addison’s
A
hyperpigmentation
hypotn
fatigue
myalgias
GI
wt loss
11
Q
dx for addison’s
A
high dose cosyntropin stimulation test - cortisol measured after cosyntropin injxn
12
Q
what is cosyntropin
A
synthetic ACTH
13
Q
normal response to cosyntropin test
A
rise in blood and urine cortisol after injxn
14
Q
addison’s dz findings of consyntropin test
A
little to no increase (<20 mcg) in cortisol levels after cosyntropin injxn
15
Q
tx for addison’s: maintenance vs crisis
A
maintenance: hydrocortisone/prednisone daily
crisis: IV saline, glucose, steroids
16
Q
collection of s/sx due to prolonged exposure to cortisol
A
cushing’s syndrome
17
Q
ACTH secreting pituitary microadenoma
A
cushing’s dz
18
Q
cushing’d dz is aka
A
secondary cushing’s
19
Q
hallmark features of cushing’s dz
A
obesity
buffalo hump
moon facies
supraclavicular fat pads
htn
excessive thirst
polyuria
pigmented striae
20
Q
sx of cushing’s dz
A
backache
HA
oligomenorrhea/amenorrhea
ED
emotional lability
psychosis
21
Q
gs dx for cushing’s dz
A
1. 24 hr urine free cortisol - gs/initial
2. ACTH level to confirm cortisol source
alt: low dose dexamethasone suppression test
22
Q
what do high and low ACTH levels indicate when working up cushing dz
A
high: ACTH dependent cause (pituitary adenoma) -> order a brain MRI
low: ACTH independent cause (adrenal mass) -> order adrenal CT
23
Q
how does the low dose dexamethasone suppression test work
A
- give low dose dexamethasone
- failure of steroid to decrease cortisol -> dx of cushing’s ->
- order high dose dexamethasone suppression test -> 4. no cortisol suppression = cushing’s syndrome
- suppression of cortisol -> exclude cushing’s
24
Q
tx for cushing’s dz
A
transsphenoidal selective resection of pituitary tumor
25
diabetes insipidus is caused by
deficiency/resistance to vasopressin (ADH) -> decreases kidney reabsorption of water -> massive polyuria
26
2 types of diabetes insipidus
**central - mc**
nephrogenic
27
deficiency of ADH from posterior pituitary/hypothalamus -> no ADH production
central diabetes insipidus
28
cause of central diabetes insipidus
**AI destruction of posterior pituitary:**
head trauma
brain tumor
infxn
sarcoidosis
29
lack of reaction to ADH -> partial vs complete insensitivity to ADH
neprogenic diabetes insipidus
30
4 causes of nephrogenic diabetes insipidus
drugs
hypercalcemia
hypokalemia
ATN
31
2 drugs mc associated w. nephrogenic diabetes insipidus
lithium
ampho b
32
dx for diabetes insipidus
-high serum osmolality: unable to stop secretion of water into kidneys
-water deprivation test: continued production of dilute urine despite water deprivation
-desmopressin stimulation test
33
most reliable test for diabetes insipidus
water deprivation
34
desmopressin stimulation test of central vs nephrogenic diabetes insipidus
central: reduction in urine output due to response to ADH
nephrogenic: continued production of dilute urine (no response to ADH)
35
tx for diabetes insipidus: central vs nephrogenic
central: desmopressin/DDAVP
nephrogenic: Na and pro restriction, HCTZ, indomethacin
36
what abs are associated w. T1DM
HLA-DR3/4/O
islet cell
GAD65
IA-2
37
what is the dawn phenomenon
decreased insulin sensitivity/nightly surge of counter-regulatory hormones during nighttime fasting -> elevated BG from 2-8 AM
38
management of dawn phenomenon
bedtime injxn of NPH insulin
avoid late night CHO
39
what is the somogyi effect
surge in nocturnal growth hormone -> nocturnal hypoglycemia followed by rebound hyperglycemia
40
management of somogyi effect
decreased nighttime NPH dose
bedtime snack
41
what is the insulin warning
progressive rise in BG from bedtime to morning
42
sx of DKA
fruity breath
wt loss
rapid respirations
hypotn
43
management of DKA
-admit
-large volume IVF NS
-electrolyte replacement
-insulin
44
dx for DM
**one of the following:**
-random BG > 200 x 2
-fasting BG BG > 126 x 2
-BG > 200 following 3 hr OGTT
-A1C > 6.5
45
gs dx for GDM
3 hr OGTT
46
high fasting C-peptide is associated with which type of DM
type 2
47
low or inappropriately normal fasting C-peptide levels suggest which type of DM
type 1
48
BG goals for DM
fasting: <130
postprandial: <180
49
moa for metformin
decreases:
hepatic glucose production
peripheral glucose utilization
intestinal glucose absorption
50
2 main s.e of metformin
lactic acidosis
GI
51
contraindications for metformin
GFR <30
Cr >1.5
*not recommended for GFR 30-45*
52
name 3 sulfonylureas
glyburide
glipizide
glimepiride
53
moa for sulfonylureas
insulin secretagogue
54
main s.e of sulfonylureas
hypoglycemia
55
name 2 thiazolidinediones
pioglitazone
rosiglitazone
56
moa for thiazolidinediones
increase peripheral insulin sensitivity
57
contraindications for thiazolidinediones
CHF
liver dz
58
2 s.e of thiazolidinediones
fluid retention
wt gain
59
name 2 alpha-glucosidase inhibitors
acarbose
miglitol
60
moa for alpha glucosidase inhibitors
delay intestinal glucose absorption
61
s.e of alpha glucosidase inhibitors to know
GI
62
name 2 meglitinides
repaglinide
nateglinide
63
moa for meglitinides
insulin secretagogue
64
s.e to know of meglitinides
hypoglycemia
65
name the GLP-1 agonists
exenatide
dulaglutide
semaglutide
liraglutide
66
moa for GLP-1 agonists
incretin mimetic -> insulin secretagogue
decrease glucagon -> delay gastric emptying
67
s.e of GLP-1 agonists
GI
68
caution using GLP-1 agonists in pt's w. what condition
gastroparesis
69
2 benefits of GLP-1 agonists
wt loss
reduced CV mortality
70
name 2 DPP-4 inhibitors
sitagliptin
saxagliptin
71
moa for DPP-4 inhibitors
dipetpidylpetase inhibition -> inhibit degradation of GLP-1 -> increase insulin secretion and delay gastric emptying
72
s.e of DPP-4 inhibitors
increased risk of heart failure
73
name one SGLT2 inhibitor
canagliflozin
74
moa for SGLT2 inhibitors
inhibit SGLT2 -> lower renal glucose threshold -> increase urinary glucose excretion
75
5 s.e of SGLT2 inhibitors
vulvovaginal candidiasis
UTI
bone fx
lower limb amputation
AKI
DKA
76
3 benefits of SGLT2 inhibitors
wt loss
reduction in SBP
reduced CV mortality
77
when should you add insulin to a DM med regimen
A1C > 9
78
how often should microalbumin be checked in a diabetic
annually
79
mc complication of DM
neuropathy
80
leading cause of preventible blindness in adults
diabetic retinopathy
81
diagnostic criteria for preDM (3)
A1C 5.7-6.4
fasting BG 100-125
2 hr OGTT 140-199
82
3 screening tests that should be performed annually for DM
ophthalmologist
microalbumin
foot check
83
med you should consider for all pt w. microalbuminuria
ACEI
84
BP goal for DM
<130/80
85
new statin guidelines for DM
recommended for DM pt's 40-75 yo with:
LDL 70-189 but w.o clinical ASCVD
86
hallmark presentation of hypercalcemia
stones
bones
abd groans
psychiatric moans
87
EKG finding of hypercalcemia
shortened QT
88
lab findings of hypercalcemia
elevated: Ca, PTH
decreased: phos
89
2 causes of hypercalcemia to know
malignancy
hyperparathyroidism
90
tx for hypercalcemia
IV NS
furosemide
91
etiology for hypernatremia (5)
diarrhea
burns
diuretics
diabetes insipidus
deficit of thirst
92
sx of hypernatremia
poor skin turgor
dry mm
flat neck veins
hypotn
BUN:Cr > 20:1
93
what causes the increased BUN:Cr ratio w. hypernatremia
decreased volume -> decreased renal perfusion -> higher serum urea -> elevated BUN
94
tx for hypernatremia
D5W 5%
95
consequence of correcting hypernatremia too rapidly
crebral edema
pontine herniation
96
33 yo F w. diffuse pain and fatigue - c/o bone and muscle pain, abd pain, and trouble focusing
hyperparathyroidism
97
elevated PTH causes _ serum Ca
elevated
98
how does increased PTH lead to elevated Ca (3)
bone breakdown -> Ca release
increased renal Ca reabsorption
increased intestinal Ca absorption
99
2 causes of hyperparathyroidism
primary: parathyroid adenoma
secondary: response to hypocalcemia, vitamin D deficiency, CKD
100
mcc of secondary hyperparathyroidism
CKD
101
common presentation of hyperparathyroidism
bone loss -> bone pain
increased renal Ca absorption -> stones
increased GI Ca absorption -> abd groans
102
UA findings of hyperparathyrodism
hyperphosphaturia
hypercalciuria
103
tx for hyperparathyroidism: primary vs secondary
primary: parathyroidectomy
total = 3.5 glands
secondary: vit D/Ca supplementation, IVF. lasix, calcitonin, bisphosphonates
104
etiology of hyperthyrodism (5)
AI (graves)
toxic adenoma
thyroiditis
pregnancy
amiodarone
105
hallmark presentation of hyperthyroidism
heat intolerance
palpitations
diaphoresis
wt loss
tremor
anxiety
tachycardia
106
3 PE findings of graves
diffuse goiter w. a bruit
exophthalmos
pretibial myxedema
107
3 PE findings of thyroid storm
fever
tachycardia
delirium
108
RAIU findings of graves vs toxic multinodular hyperthyroidism
graves: diffusely high uptake
toxic multinodular: discrete areas of high uptake
109
abs associated w. graves
antit-thyrodtropin
110
tx for hyperthyroidism (4)
bb
methimazole
PTU
radioactive iodine
thyroidectomy
111
tx for thyroid storm
bb asap
112
mc complication of thyroidectomy
injury to recurrent laryngeal nerve -> hoarseness
113
tx for hyperthyroidism in pregnancy/lactation
first semester: PTU
after first trimester: methimazole
nursing: methimazole
114
4 types of thyroiditis
hashimoto's
subacute
postpartum
suppurative
115
hallmark presentation of hashimoto's thyroiditis
diffusely enlarged, painless nodular goiter
116
hallmark presentation of subacute thyroiditis
young female post viral infxn
painful enlarged thyroid
dysphagia, mild fever
117
tx for subacute thyroiditis
ASA
118
hallmark presentation of postpartum thyroiditis
1-2 mos after delivery
119
tx for postpartum thyroiditis
bb
120
hallmark presentation of suppurative thyroiditis
fever
pain
erythema
fluctuant mass
leukocytosis
121
tx for supporative thyroiditis
abx
surgical drainage
122
painless thyroiditis should make you think
hashimoto's
123
EKG findings of hypocalcemia
prolonged QT
124
lab findings of hypocalcemia
decreased: Ca, PTH
increased: phos
125
PE findings of hypocalcemia
trosseau's
chvostek's
126
involuntary contraction of the hand/wrist (carpopedal spasm) with compression of the arm (bp cuff)
trousseau's sign -> hypocalcemia
127
twitching of facial muscles with gentle tap to the cheek
chvostek sign -> hypocalcemia
128
tx for hypocalcemia
IV calcium gluconate vs calcium chloride
129
4 PE findings of hyponatremia
peripheral/presacral edema
pulmonary edema
JVD
HTN
130
lab findings of hyponatremia
decreased Hct
decreased serum protein
decreased BUN/Cr
131
2 sx of hyponatremia
muscle cramps
sz
132
3 classifications of hyponatremia
hypervolemic
euvolemic
hypovolemic
133
5 causes of hypervolemic hyponatremia
CHF
nephrotic syndrome/renal failure
cirrhosis
134
3 causes of euvolemic hyponatremia
SIADH
steroids
hypothyroid
135
causes of hypovolemic hyponatremia
renal vs non renal
136
tx for hyponatremia
asymptomatic: fluid restriction
moderate: IV NS, +/- loop diuretics
severe: hypertonic 3% IV NS
137
guidelines for sodium repletion for chronic hyponatremia
correct slowly:
138
consequence of repleting chronic hyponatremia too quickly
osmotic demyelination syndrome
139
mcc of hypoparathyroidism
thyroidectomy
140
3 sx of hypoparathyroidism
tingling
tetany
cataracts
141
2 PE findings of hypoparathyroidism
chvostek's sign
trousseau's sign
142
lab findings of hypoparathyroidism
low: Ca, PTH, urinary Ca
elevated: phos
143
tx for hypoparathyroidism
IV calcium gluconate
tetany: ABC's
144
3 causes of hypothyroidism
hashimoto's
thyroidectomy
congenital
145
5 PE findings of congenital hypothyroidism
round face
large tongue
hernia
delayed milestones
poor feeding
146
2 abs associated w. hashimoto's
antithyroid peroxidase
antithyroglobulin abs
147
bone remodeling d.o that results in the formation of an unorganized mosaic of woven and lamellar bone that is less compact and weaker than normal bone
paget dz of the bone
148
cause of paget's
idiopathic vs genetic
but can be triggered by viral infxns
149
4 mc locations mc affected by paget's dz of the bone
pelvis
skull
spine
legs
150
2 rf for paget's dz of the bone
increasing age
fam hx
151
common presentation of paget dz of the bone
bone deformities
frequent broken bones
bone pain
152
complication of paget dz of the bone
osteosarcoma -> paget sarcoma
153
what is this showing
lytic lesions
thickened bone cortices
**paget dz of the bone**
154
lab findings of paget dz of the bone
elevated alk phos
155
tx for paget dz of the bone
bisphosphonates
+/- calcitonin
surgery
156
moa for bisphosphonates
reduce bone resorption
157
catecholamine secreting adrenal tumor that secretes norepinephrine and epinephrine
pheochromocytoma
158
5 p's of pheochromocytoma
pressure (htn)
pain (ha)
perspiration
palpitations
pallor
159
2 conditions associated w. pheochromocytoma
neurofibromatosis type 1
MEN 2A/B
160
dx for pheochromocytoma
1. 24 hr catecholamine metabolites (metanephrine, vanillylmandelic acid)
2. MRI vs CT abdomen
161
tx for pheochromocytoma
1. complete adrenalectomy
3. acute HTN crisis: phentolamine vs sodium nitroprusside vs nicardipine
162
pre op adrenalectomy management of pheochromocytoma
1. nonselective alpha blockade: phenoxybenzamine vs phentolamine x 7-14 days
2. followed by bb for HTN control
163
consequence of failing to administer alpha blocker before bb in pheochromoctyoma
unopposed beta blockade -> unopposed alpha constriction -> life threatening HTN
164
noncancerous tumors in the pituitary gland that don't spread beyond the skull
pituitary adenomas
165
mc type of pituitary adenoma
functional microadenomas -> secrete pituitary hormones
166
3 types of pituitary adenomas
functional
nonfunctional
compressive
167
size of microadenomas vs macroadenomas
micro: <10 mm
macro: >10 mm
168
mc sx of pituitary adenomas
visual:
diminished temporal vision
bitemporal hemianopsia
169
4 types of functional pituitary adenomas
**lactotroph/prolactinoma - mc**
growth hormone secreting
corticotroph secreting (ACTH secreting)
thyrotroph (TSH secreting)
170
growth hormone adenomas are associated w. what 2 conditions
gigantism
acromegaly
171
corticotroph adenomas are associated w. what conditoin
cushing's
172
thyrotroph adenomas are associated w. what condition
hyperthyroidism
173
gs dx for pituitary adenomas
MRI
174
management of pituitary adenomas
-dopamine agonists (cabergoline/bromocriptine)
-transphenoidal pituitary resection
175
mc rf for thyroid ca
XRT exposure
176
sx of thyroid ca
hoarse voice
solitary cold nodule on RAIU
177
mc type of thyroid ca
papillary carcinoma
178
dx for thyroid ca
1. US
2. bx all lesions > 1 cm
3. serial US for lesions < 1 cm
4. RAIU to eval for malignancy
5. FNA for cold lesions on RAIU
179
characteristics of malignant thyroid lesions on US
microcalcifications
hypoechogenicity
solid cold nodule
irregular margins
chaotic intranodular vasculature
more tall than wide
180
what do hot and cold lesions mean on RAIU
cold: does not take up iodine -> cancerous
hot: take up iodine -> benign
181
management of all cold thyroid nodules
FNA
182
tx for thyroid ca
complete vs partial thyroidectomy for all
anaplastic: add chemo + xrt
