Endocrinology Flashcards
A women presenting with amenorrhea and galactorrhea most likely suffers from …
prolactinoma (microadenoma)
A man presenting with hypogonadism, erectile dysfunction and bi-temporal hemianopia most likely suffers from …
prolactinoma (macroadema)
What are the best initial tests in a pt suspected to have prolactinoma?
- TSH (hypothyroid b/c elevated TRH enhance prolactin)
- pregnancy test
- prolactin levels
(look for possible med/ drug hx - dopamine antagonist/ neuroleptics, H2 blockers)
What are treatment options for prolactinoma?
- dopamine agonist (carbergoline, bromocriptine)
- surgery
- radiation
What is the major side effect associated with somatostatin analogues (octretide)?
cholestasis leading to cholecystitis
What is the most common presentation of acromegaly in childhood?
Gigantism
A pt presents with enlarged hands/feet/ mandible/ tongue, cardiomyopathy, bilateral carpal tunnel syndrome, deeper voice, hepatosplenomegaly, and menstrual problems (in females) most likely suffers from ….
Acromegaly (adult onset: 30’s-40’s)
elevated GH secretion from macroadenoma
What is the best initial test for acromegaly?
IGF-1 level
if elevated, then confirm
What is confirmatory test for acromegaly?
growth hormone level after 100g of glucose (if GH remains high, positive test)
What two disease are associated with bilateral carpal tunnel disease?
- acromegaly
2. hypothyroidism
What are the treatment options for acromegaly in order of preference? (5)
- transphenoidal surgery
- octreotide
- dopamine agonist (bromocriptine, cabergoline)
- Pegvisomant (GH analogue that inhibits endogenous GH)
- radiation
What is the most common cause of death in a pt with acromegaly? What are other complications of acromegaly?
Cardiovascular disease (hypertrophic cardiomyopathy, accelerated atherosclerosis)
diabetes, visual defects from compression of chiasm, cord compression
A pt presents with hypoglycemia, amenorrhea/ decreased libido, signs of hypothyroidism most likely suffers from …
hypopituitarism (loss of GH and FSH/LH first, then lose TSH and ACTH)
What tests should be done to diagnose hypopituitarism?
- GH level after hypoglycemia (insulin) or arginine infusion (no increase in GH)
- FSH, LH, estrogen/testosterone levels
- TSH, fT4, fT3
- insulin tolerance test (cortisol level low)
A pt with a history of an adenoma that was not treated who presents with confusion, headache, meningeal signs and altered mental status most likely suffers from ….
pituitary apoplexy
CT shows bleeding in head; medical & neurosurgical emergency
A woman presents with inability to lactate after giving birth most likely suffers from …
Sheehan postpartum necrosis
symptoms can occur immediately or weeks–> months after pregnancy
An asymptomatic patient is incidentally found to have no pituitary gland on CT or MRI and may have headaches and/or hypertension most likely suffers from ..
Empty Sella Syndrome
loss of diaphragmatic surface so meninges enter into sella turcica compressing pituitary to side
A pt presents with polyuria, polydipsia, hypernatremia, increased serum osmolality, dilute urine, decreased urinary osmolality, and normal glucose level most likely suffers from ….
Diabetes insipidus (ADH dysfunction)
What are causes of nephrogenic diabetes insipidus?
- lithium
- demeclocycline
- hypercalcemia
What is diagnostic test for diabetes insipidus?
water deprivation test
decreased urine osmolality and dilute urine remains
How do you distinguish between nephrogenic and central diabetes insipidus?
vasopressin administration while water deprived
central (decreased ADH production): increased urine osmolality, concentrate urine
nephrogenic (renal resistance to ADH): urine remains dilute, decreased urine osmolality
What is treatment for central diabetes insipidus?
desmopressin (DDAVP)
What is treatment for nephrogenic diabetes insipidus?
- thiazide diuretics
2. amiloride
A pt with hyponatremia, concentrated urine (urine osmolality > 300), high urine sodium (>20), and no signs of edema or hypertension most likely suffers from …
syndrome of inappropriate secretion of ADH
SIADH
