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Surgery Rotation EORE > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

where does adrenal carcinoma have METS to?

A

liver and lung

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2
Q

what’s the s/s of adrenal carcinoma?

A

Most often hormone HYPERSECRETION

Women- hirsutism, temporal balding, increased muscle mass, amenorrhea

Men- gynecomastia, testicular atrophy, impotence, decreased libido

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3
Q

what’s the PE like for adrenal carcinoma?

A

abdominal mass

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4
Q

what’s the tx of choice for adrenal carcinoma?

A

Surgical excision of tumor

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5
Q

what’s the post-op tx for adrenal carcinoma?

A

corticosteroid replacement

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6
Q

what is Addison’s disease?

A

adrenocortical insufficiency d/t adrenal gland destruction

lack of cortisol AND aldosterone

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7
Q

what’s are the MC causes of Addison’s disease?

A

Autoimmune: MC cause in industrialized countries - causes adrenal atrophy

Infection: MC worldwide -> Tb***, HIV

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8
Q

is Addison’s secondary or primary adrenal insufficiency?

A

primary adrenal insufficiency

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9
Q

what’s secondary adrenal insufficiency d/t?

A

pituitary failure of ACTH secretion (lack of cortisol)

-d/t exogenous steroid use

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10
Q

what’s the sx’s of Addison’s disease?

A
  1. Hyperpigmentation (d/t ACTH stimulation of melanocyte-stimulating hormone secretion)
  2. Orthostatic hypotension, hyponatremia, HYPERKALEMIA***, non-anion gap metabolic acidosis, hypoglycemia (d/t Decr. Aldosterone)
  3. Decr. sex hormones in women: loss of libido; amenorrhea, loss of axillary and pubic hair
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11
Q

how do you dx adrenal insufficiency?

A
  1. High Dose ACTH (cosyntropin) stimulation test:
    - SCREENING test for adrenal insufficiency
    - if adrenal insufficiency then little or no increase in cortisol levels
  2. CRH Stimulation Test:
    - DIFFERENTIATES b/w the causes of adrenal insufficiency
    - Primary/Addisons -> incr. ACTH levels but low cortisol
    - Secondary (pituitary problem) -> low ACTH and low cotrisol
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12
Q

what’s the tx for adrenal insufficiency? (Primary and Secondary)

A

Hormone replacement:

If Addisons/Primary -> Glucocorticoids (Hydrocortisone) + Mineralocorticoids (Fludrocortisone)

If Secondary -> ONLY glucocorticoids b/c body makes aldosterone so don’t need mineralocorticoid
-so ONLY Hydrocortisone

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13
Q

what’s Cushing’s disease?

A

hypercorticolism caused specifically by PITUIARY INCR. ACTH secretion MC d/t benign pituitary adenoma

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14
Q

what’s the s/s of crushing’s syndrome/disease?

A

central obesity, moon facies, buffalo hump, HTN, hypokalemia, acanthuses nigricans, hirsutism

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15
Q

what’s the MC overall cause of Cushing’s syndrome?

A

Long-term high dose corticosteroid tx

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16
Q

what’s Cushing’s syndrome vs. Cushing’s disease/

A

Cushing’s syndrome = s/s of cortisol excess (from exogenous steroid use)

Cushing’s disease = from pituitary tumor increasing ACTH secretion

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17
Q

what’s the MC cause of primary hyperparathyroidism?

A

parathyroid adenoma

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18
Q

what’s the MC cause of secondary hyperparathyroidism?

A

CKD

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19
Q

what is secondary hyperparathyroidism?

A

increased PTH d/t hypocalcemia or Vit. D deficiency (as a result of CKD)

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20
Q

what’s the s/s of hyperparathyroidism?

A

signs of ***HYPERCALCEMIA -> “stones, bones, abd groans, psychiatric moans

decr. DTRs

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21
Q

what’s the dx of primary hyperparathyroidism?

A

***triad: hypercalcemia/incr. Ca + incr. intact PTH + decr. phosphate

incr. 24h urine calcium excretion (incr. Ca, incr. vit D)

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22
Q

what’s the tx of hyperparathyroidism?

A

PARATHYROIDECTOMY

IVF, loop diuretics, bisphosphonates/calcitonin

vit. D/Ca supplement if secondary hyperPTH

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23
Q

what is the criteria to perform a parathyroidectomy for hyperparathyroidism?

A

> 50 y/o or with any symptoms

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24
Q

what are the levels of PTH, Ca, and vit. D in primary hyperparathyroidism?

A

All increased

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25
Q

what are the labs of secondary hyperparathyroidism?

A

PTH high, Ca decr., vit. D decr.

(d/t CKD) -> can’t convert vit D to usable form to absorb Ca

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26
Q

what’s Graves Disease?

A

hyperthyroidism

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27
Q

what’s the cause of Graves Disease?

A

autoimmune

circulating TSG receptor antibodies cause incr. thyroid hormone synthesis and thyroid gland growth

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28
Q

what’s the MC cause of hyperthyroidism?

A

Graves disease

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29
Q

what are the s/s of Grave’s disease?

A

diffuse, enlarged thyroid

thyroid bruits***

ophthalmopathy*** -> lid lag, exophthalmos/proptosis
-exclusive to Grave’s

pretrial myxedema*** (non pitting, edematous, pink-brown plaques/nodules on shin)
-exclusive to Grave’s

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30
Q

what s/s of Grave’s disease are exclusive to it?

A

ophthalmopathy*** -> lid lag, exophthalmos/proptosis

pretrial myxedema*** (non pitting, edematous, pink-brown plaques/nodules on shin)

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31
Q

what’s the PE like for Grave’s disease?

A

tachycardia, hyperreflexia, weight loss, diaphoresis

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32
Q

what’s the labs like for Grave’s disease?

A

Decreased TSH, increased T3/T4

thyroid-stimulating immunoglobin antibodies (+)

hypercalcemia

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33
Q

how do you dx Grave’s disease?

A

+ Thyroid-stimulating immunoglobulins (most specific)

Increased T3/T4 and decreased TSH

RAIU -> diffuse uptake

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34
Q

what does the RAIU scan show for Grave’s disease?

A

diffuse uptake

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35
Q

what’s the tx for Grave’s disease?

A

Radioactive Iodine = MC tx used (destroys thyroid gland -> need hormone replacement)

Methimazole or PTU (PTU preferred in pregnancy and 1st trimester)

BBs (like propranolol) for sx relief

Thyroidectomy (if compressive sx, no response to meds)

36
Q

which med for tx of hyperthyroidism (ex. Grave’s) is preferred in pregnancy, esp. 1st trimester, Methimazole or PTU?

A

PTU

37
Q

what’s the MOA of Methimazole or PTU? adrs?

A

MOA = inhibit hormone synthesis

Adrs: agranulocytosis, hepatitis

38
Q

what’s the MC cause of hyperthyroidism in elderly?

A

Toxic multinodular goiter

39
Q

what’s the RAIU show for toxic multinodular goiter and toxic adenoma for hyperthyroidism?

A

TMG -> patchy areas of both incr uptake and decr. uptake

TA -> incr. local uptake (hot nodule)

40
Q

what’s the MC therapy for tx of toxic multinodular goiter and toxic adenoma for hyperthyroidism?

A

Radioactive Iodine

41
Q

what’s the sx’s of TSH secreting pituitary adenoma (cause of hyperthyroidism)?

A

bitemporal hemianopsia

42
Q

most pts with thyroid cancer are what?

A

euthyroid

43
Q

what are the types of thyroid cancer?

A

Papillary, follicular, medullary, anaplastic

44
Q

what’s the MC type of thyroid cancer?

A

papillary

45
Q

what’s the MC RF for papillary thyroid cancer? most common in who?

A

radiation exposure = MC RF

MC in young females

46
Q

what’s the s/s of papillary? thyroid cancer prognosis?

A

LEAST AGGRESSIVE

Mets to cervical LN

Prognosis = excellent

47
Q

what’s a RF for follicular thyroid cancer? most common in who?

A

iodine deficiency

MC in 40-60 y/o

48
Q

what’s the s/s of follicular thyroid cancer? prognosis?

A

aggressive but slow growing

Mets- distant mets common (lung, brain, bone, liver, skin)

Prognosis = excellent

49
Q

what’s the MC RF for medullary thyroid cancer?

A

MEN 2

50
Q

what’s the s/s of medullary thyroid cancer? prognosis?

A

arises from parafollicular cells that secrete CALCITONIN

LN early, distant mets later

Prognosis = POOR, tumor doesn’t take up iodine

51
Q

who is anaplastic thyroid cancer MC in?

A

males >65 y/o

52
Q

what’s the s/s of anaplastic thyroid cancer?

A

MOST AGGRESSIVE, rapid growth, with COMPRESSIVE SX

Local & distant METS

MAY INVADE TRACHEA

Prognosis = poor

53
Q

what’s the tx of papillary and follicular thyroid cancer?

A

TOTAL THYROIDECTOMY

must supplement with thyroid hormone (levothyroxine)

54
Q

what’s the tx of medullary thyroid cancer?

A

Total thyroidectomy w neck LN dissection

Calcitonin levels used to monitor

55
Q

what’s the tx for anaplastic thyroid cancer?

A

Most cannot be surgically resected

  • radiation
  • Chemotherapy

Palliative tracheostomy to maintain airway

56
Q

what’s a thyroid nodule?

A

abnormal lump in thyroid gland

57
Q

what are the RFs of thyroid nodules?

A

extremes of age (very young or hold >60 y/o)

h/o head/neck irradiation

58
Q

are most thyroid nodules in women benign or malignant?

A

benign (follicular adenoma or cysts)

59
Q

what are the s/s of thyroid nodules?

A
  1. Most are asx
  2. Compressive sx: diff swallowing/breathing, neck, jaw, or ear pain, hoarseness (if compresses recurrent laryngeal nerve)
60
Q

what’s PE like for thyroid nodules (benign vs malignant)?

A

Benign:
-varied- smooth, firm, irregular, sharp outlines, painless

Malignant:
-rapid growth, fixed, no movement w swallowing

61
Q

how do you dx thyroid nodules?

A

Thyroid Function Tests
-MOST PTS ARE EUTHYROID

FNA w/ bx
-BEST INITIAL TEST TO EVAL NODULE

Radioactive Iodine Uptake Scan (RIAU)

62
Q

what’s the BEST initial test to evaluate a thyroid nodule?

A

FNA w/ bx (done with thyroid U/S)

63
Q

what are the benign thyroid nodules?

A

Follicular adenoma (colloid) - MC type of thyroid nodule

64
Q

what is the MC type of thyroid nodule?

A

follicular adenoma

65
Q

when is radioactive iodine uptake scan done for thyroid nodule dx?

A

if the FNA is indeterminate

66
Q

what does radioactive iodine uptake scan show if thyroid nodule is malignant?

A

cold nodule (no/low iodine uptake)

67
Q

what’s the tx for thyroid nodule?

A

Surgery if thyroid cancer is suspected or if an indeterminate FNA w/ a cold thyroid scan

Observation of suspicious nodules (usu. q6-12 months) with U/S

68
Q

what is pheochromocytoma?

A

CATECHOLAMINE-SECRETING ADRENAL TUMOR (chromaffin cells)

-Secretes norepi & epi autonomously & intermittently

69
Q

what are triggers of pheochromocytoma to secrete norepinephrine & epi?

A

surgery = big one

70
Q

is pheochromocytoma benign or malignant?

A

majority are benign

71
Q

what is the s/s of pheochromocytoma?

A

HTN: most consistent finding (secondary HTN)*

“PHE”:* Palpitations, Headaches (paroxysmal), Excessive sweating

classic triad of: episodic HA, sweating, tachycardia

72
Q

what’s the most consistent s/s of pheochromocytoma?

A

HTN (secondary)

73
Q

how do you dx pheochromocytoma?

A

Incr. 24h urinary catecholamines including metabolites (incr. Metanephrine & incr. Vanillylmandelic acid)*

OR

plasma-fractionated metanephrines test

-MRI/CT of abdomen & pelvis when above is positive

74
Q

what’s the classic triad of s/s of pheochromocytoma?

A

episodic HA, sweating, tachycardia

75
Q

when do you perform the 24 hr urinary fractionated metanephrines & catecholamines test for dx pheochromocytoma?

A

low suspicion of disease (no family history)

76
Q

when do you perform plasma fractionated metanephrines test for dx of pheochromocytoma?

A

if high suspicion of disease (I.e. family hx - MEN2 and VHL syndrome)

77
Q

what d/o is pheochromocytoma a/w?

A

MEN2

78
Q

what’s the procedure of choice for tx of pheochromocytoma?

A

laparoscopic complete adrenalectomy

79
Q

when pheochromocytoma pt is pre-op for surgery of tumor, what meds are used to treat their symptoms while in surgery?

A

PHENOXYBENZAMINE OR PHENTOLAMINE x7-14 days → followed by beta blockers or CCBs to control HTN

80
Q

why do you NOT want to initiate beta-blockers in pheochromocytoma pt tx before surgery?

A

b/c want to prevent UNOPPOSED ALPHA-CONSTRICTION DURING CATECHOLAMINE RELEASE

81
Q

what type of medication is phenoxybenzamine?

A

non-selective alpha blocker

82
Q

what’s the MC cause of hypothyroidism?

A

Hashimoto’s thyroiditis (autoimmune)

83
Q

what is adrenal crisis?

A

sudden worsening of adrenal insufficiency d/t a “stressful” event (surgery, trauma, volume loss)

84
Q

what’s the MC cause of adrenal crisis?

A

abrupt withdrawal of glucocorticoids

85
Q

what’s the s/s of adrenal crisis?

A
  1. Shock = primary manifestation; hypotension, hypovolemia
86
Q

what’s the labs like for adrenal crisis?

A

hyponatremia, hyperkalemia, hypoglycemia

87
Q

what’s the tx for adrenal crisis?

A

NS or D5NS if hypoglycemic

IV Hydrocortisone

Fludrocortisone

Surgery Rotation EORE (10 decks)

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