Endocrinology Flashcards
where does adrenal carcinoma have METS to?
liver and lung
what’s the s/s of adrenal carcinoma?
Most often hormone HYPERSECRETION
Women- hirsutism, temporal balding, increased muscle mass, amenorrhea
Men- gynecomastia, testicular atrophy, impotence, decreased libido
what’s the PE like for adrenal carcinoma?
abdominal mass
what’s the tx of choice for adrenal carcinoma?
Surgical excision of tumor
what’s the post-op tx for adrenal carcinoma?
corticosteroid replacement
what is Addison’s disease?
adrenocortical insufficiency d/t adrenal gland destruction
lack of cortisol AND aldosterone
what’s are the MC causes of Addison’s disease?
Autoimmune: MC cause in industrialized countries - causes adrenal atrophy
Infection: MC worldwide -> Tb***, HIV
is Addison’s secondary or primary adrenal insufficiency?
primary adrenal insufficiency
what’s secondary adrenal insufficiency d/t?
pituitary failure of ACTH secretion (lack of cortisol)
-d/t exogenous steroid use
what’s the sx’s of Addison’s disease?
- Hyperpigmentation (d/t ACTH stimulation of melanocyte-stimulating hormone secretion)
- Orthostatic hypotension, hyponatremia, HYPERKALEMIA***, non-anion gap metabolic acidosis, hypoglycemia (d/t Decr. Aldosterone)
- Decr. sex hormones in women: loss of libido; amenorrhea, loss of axillary and pubic hair
how do you dx adrenal insufficiency?
- High Dose ACTH (cosyntropin) stimulation test:
- SCREENING test for adrenal insufficiency
- if adrenal insufficiency then little or no increase in cortisol levels - 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
what’s the tx for adrenal insufficiency? (Primary and Secondary)
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
what’s Cushing’s disease?
hypercorticolism caused specifically by PITUIARY INCR. ACTH secretion MC d/t benign pituitary adenoma
what’s the s/s of crushing’s syndrome/disease?
central obesity, moon facies, buffalo hump, HTN, hypokalemia, acanthuses nigricans, hirsutism
what’s the MC overall cause of Cushing’s syndrome?
Long-term high dose corticosteroid tx
what’s Cushing’s syndrome vs. Cushing’s disease/
Cushing’s syndrome = s/s of cortisol excess (from exogenous steroid use)
Cushing’s disease = from pituitary tumor increasing ACTH secretion
what’s the MC cause of primary hyperparathyroidism?
parathyroid adenoma
what’s the MC cause of secondary hyperparathyroidism?
CKD
what is secondary hyperparathyroidism?
increased PTH d/t hypocalcemia or Vit. D deficiency (as a result of CKD)
what’s the s/s of hyperparathyroidism?
signs of ***HYPERCALCEMIA -> “stones, bones, abd groans, psychiatric moans
decr. DTRs
what’s the dx of primary hyperparathyroidism?
***triad: hypercalcemia/incr. Ca + incr. intact PTH + decr. phosphate
incr. 24h urine calcium excretion (incr. Ca, incr. vit D)
what’s the tx of hyperparathyroidism?
PARATHYROIDECTOMY
IVF, loop diuretics, bisphosphonates/calcitonin
vit. D/Ca supplement if secondary hyperPTH
what is the criteria to perform a parathyroidectomy for hyperparathyroidism?
> 50 y/o or with any symptoms
what are the levels of PTH, Ca, and vit. D in primary hyperparathyroidism?
All increased
what are the labs of secondary hyperparathyroidism?
PTH high, Ca decr., vit. D decr.
(d/t CKD) -> can’t convert vit D to usable form to absorb Ca
what’s Graves Disease?
hyperthyroidism
what’s the cause of Graves Disease?
autoimmune
circulating TSG receptor antibodies cause incr. thyroid hormone synthesis and thyroid gland growth
what’s the MC cause of hyperthyroidism?
Graves disease
what are the s/s of Grave’s disease?
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
what s/s of Grave’s disease are exclusive to it?
ophthalmopathy*** -> lid lag, exophthalmos/proptosis
pretrial myxedema*** (non pitting, edematous, pink-brown plaques/nodules on shin)
what’s the PE like for Grave’s disease?
tachycardia, hyperreflexia, weight loss, diaphoresis
what’s the labs like for Grave’s disease?
Decreased TSH, increased T3/T4
thyroid-stimulating immunoglobin antibodies (+)
hypercalcemia
how do you dx Grave’s disease?
+ Thyroid-stimulating immunoglobulins (most specific)
Increased T3/T4 and decreased TSH
RAIU -> diffuse uptake
what does the RAIU scan show for Grave’s disease?
diffuse uptake
what’s the tx for Grave’s disease?
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)
which med for tx of hyperthyroidism (ex. Grave’s) is preferred in pregnancy, esp. 1st trimester, Methimazole or PTU?
PTU
what’s the MOA of Methimazole or PTU? adrs?
MOA = inhibit hormone synthesis
Adrs: agranulocytosis, hepatitis
what’s the MC cause of hyperthyroidism in elderly?
Toxic multinodular goiter
what’s the RAIU show for toxic multinodular goiter and toxic adenoma for hyperthyroidism?
TMG -> patchy areas of both incr uptake and decr. uptake
TA -> incr. local uptake (hot nodule)
what’s the MC therapy for tx of toxic multinodular goiter and toxic adenoma for hyperthyroidism?
Radioactive Iodine
what’s the sx’s of TSH secreting pituitary adenoma (cause of hyperthyroidism)?
bitemporal hemianopsia
most pts with thyroid cancer are what?
euthyroid
what are the types of thyroid cancer?
Papillary, follicular, medullary, anaplastic
what’s the MC type of thyroid cancer?
papillary
what’s the MC RF for papillary thyroid cancer? most common in who?
radiation exposure = MC RF
MC in young females
what’s the s/s of papillary? thyroid cancer prognosis?
LEAST AGGRESSIVE
Mets to cervical LN
Prognosis = excellent
what’s a RF for follicular thyroid cancer? most common in who?
iodine deficiency
MC in 40-60 y/o
what’s the s/s of follicular thyroid cancer? prognosis?
aggressive but slow growing
Mets- distant mets common (lung, brain, bone, liver, skin)
Prognosis = excellent
what’s the MC RF for medullary thyroid cancer?
MEN 2
what’s the s/s of medullary thyroid cancer? prognosis?
arises from parafollicular cells that secrete CALCITONIN
LN early, distant mets later
Prognosis = POOR, tumor doesn’t take up iodine
who is anaplastic thyroid cancer MC in?
males >65 y/o
what’s the s/s of anaplastic thyroid cancer?
MOST AGGRESSIVE, rapid growth, with COMPRESSIVE SX
Local & distant METS
MAY INVADE TRACHEA
Prognosis = poor
what’s the tx of papillary and follicular thyroid cancer?
TOTAL THYROIDECTOMY
must supplement with thyroid hormone (levothyroxine)
what’s the tx of medullary thyroid cancer?
Total thyroidectomy w neck LN dissection
Calcitonin levels used to monitor
what’s the tx for anaplastic thyroid cancer?
Most cannot be surgically resected
- radiation
- Chemotherapy
Palliative tracheostomy to maintain airway
what’s a thyroid nodule?
abnormal lump in thyroid gland
what are the RFs of thyroid nodules?
extremes of age (very young or hold >60 y/o)
h/o head/neck irradiation
are most thyroid nodules in women benign or malignant?
benign (follicular adenoma or cysts)
what are the s/s of thyroid nodules?
- Most are asx
- Compressive sx: diff swallowing/breathing, neck, jaw, or ear pain, hoarseness (if compresses recurrent laryngeal nerve)
what’s PE like for thyroid nodules (benign vs malignant)?
Benign:
-varied- smooth, firm, irregular, sharp outlines, painless
Malignant:
-rapid growth, fixed, no movement w swallowing
how do you dx thyroid nodules?
Thyroid Function Tests
-MOST PTS ARE EUTHYROID
FNA w/ bx
-BEST INITIAL TEST TO EVAL NODULE
Radioactive Iodine Uptake Scan (RIAU)
what’s the BEST initial test to evaluate a thyroid nodule?
FNA w/ bx (done with thyroid U/S)
what are the benign thyroid nodules?
Follicular adenoma (colloid) - MC type of thyroid nodule
what is the MC type of thyroid nodule?
follicular adenoma
when is radioactive iodine uptake scan done for thyroid nodule dx?
if the FNA is indeterminate
what does radioactive iodine uptake scan show if thyroid nodule is malignant?
cold nodule (no/low iodine uptake)
what’s the tx for thyroid nodule?
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
what is pheochromocytoma?
CATECHOLAMINE-SECRETING ADRENAL TUMOR (chromaffin cells)
-Secretes norepi & epi autonomously & intermittently
what are triggers of pheochromocytoma to secrete norepinephrine & epi?
surgery = big one
is pheochromocytoma benign or malignant?
majority are benign
what is the s/s of pheochromocytoma?
HTN: most consistent finding (secondary HTN)*
“PHE”:* Palpitations, Headaches (paroxysmal), Excessive sweating
classic triad of: episodic HA, sweating, tachycardia
what’s the most consistent s/s of pheochromocytoma?
HTN (secondary)
how do you dx pheochromocytoma?
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
what’s the classic triad of s/s of pheochromocytoma?
episodic HA, sweating, tachycardia
when do you perform the 24 hr urinary fractionated metanephrines & catecholamines test for dx pheochromocytoma?
low suspicion of disease (no family history)
when do you perform plasma fractionated metanephrines test for dx of pheochromocytoma?
if high suspicion of disease (I.e. family hx - MEN2 and VHL syndrome)
what d/o is pheochromocytoma a/w?
MEN2
what’s the procedure of choice for tx of pheochromocytoma?
laparoscopic complete adrenalectomy
when pheochromocytoma pt is pre-op for surgery of tumor, what meds are used to treat their symptoms while in surgery?
PHENOXYBENZAMINE OR PHENTOLAMINE x7-14 days → followed by beta blockers or CCBs to control HTN
why do you NOT want to initiate beta-blockers in pheochromocytoma pt tx before surgery?
b/c want to prevent UNOPPOSED ALPHA-CONSTRICTION DURING CATECHOLAMINE RELEASE
what type of medication is phenoxybenzamine?
non-selective alpha blocker
what’s the MC cause of hypothyroidism?
Hashimoto’s thyroiditis (autoimmune)
what is adrenal crisis?
sudden worsening of adrenal insufficiency d/t a “stressful” event (surgery, trauma, volume loss)
what’s the MC cause of adrenal crisis?
abrupt withdrawal of glucocorticoids
what’s the s/s of adrenal crisis?
- Shock = primary manifestation; hypotension, hypovolemia
what’s the labs like for adrenal crisis?
hyponatremia, hyperkalemia, hypoglycemia
what’s the tx for adrenal crisis?
NS or D5NS if hypoglycemic
IV Hydrocortisone
Fludrocortisone
