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3rd Year (Step 2) > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Prolactin deficiency – Sx in men & women?

A

Men – none

Women – cannot lactate after pregnancy

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2
Q

LH & FSH deficiency – Sx in men?

A
  • Won’t make Testosterone or sperm
  • Decreased libido
  • Decreased axillary, pubic, & body hair
  • Erectile dysfunction
  • Decreased muscle mass
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3
Q

LH & FSH deficiency – Sx in women?

A
  • Amenorrhea or irregular menses
  • Decreased libido
  • (decreased axillary/body/pubic hair)
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4
Q

Kallman Syndrome – what is it?

A

Dec’d FSH & LH from dec’d GnRH

  • Anosmia
  • Renal agenesis in 50%
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5
Q

Hyponatremia – what are some endocrine causes of this?

A
  • Hypothyroidism
  • Isolated glucocorticoid underproduction

(note: K+ not affected in these b/c aldosterone is normal & this excretes K+)

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6
Q

Which do you replace first before starting the other: Cortisone or Thyroxine?

A

Replace Cortisone before starting Thyroxine

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7
Q

What is Diabetes Insipidus?

A

ADH deficiency (central) or no effect of ADH on kidney (nephrogenic)

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8
Q

Nephrogenic Diabetes Insipidus – causes?

A
  • Chronic pyelonephritis
  • Amyloidosis
  • Myeloma
  • Sickle cell disease
  • Hypercalcemia
  • Hypokalemia
  • Lithium
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9
Q

Diabetes Insipidus – presentation?

A
  • Extremely high-volume urine
  • Excessive thirst resulting in volume depletion & hypernatremia
  • Hypernatremia causes Confusion, disorientation, lethargy, & eventually seizures/coma
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10
Q

Diabetes Insipidus – Urine osmolality?

A

Urine osmolality (& sodium) are both decreased

– Serum osmolality is elevated

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11
Q

How to determine central vs. nephrogenic diabetes insipidus?

A

Response to Vasopressin

  • Central DI: urine volume inc’s & urine osmolality will increase
  • Nephrogenic DI: no effect
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12
Q

Acromegaly – Tx?

A
  1. Surgery
  2. Meds:
    - - Cabergoline (DA inhibits GH release)
    - - Octreotide (Somatostatin inhibits GH release)
    - - Pegvisomant (GH receptor antagonist, inhibits IGF release from liver)
  3. Radiotherapy
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13
Q

Hypothyroidism – causes?

A
  1. Hashimoto’s Thyroiditis (almost always the cause & acute phase is rarely perceived)
  2. Dietary deficiency
  3. Amiodarone
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14
Q

What is the only bodily process that’s not “slowed down” in hypOthyroidism?

A

Menstrual flow – increased

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15
Q

Acute Hyperthyroidism & “Thyroid Stom” – Tx?

A
  1. Propranolol – blocks target organ effect & dec’s conversion of T4 to T3
  2. Thiourea drugs (Methimazole & Propylthiouracil) – block hormone production
  3. Iodinated contrast material (Iopanic acid & Ipodate) – dec’s periph conversion & blocks release of existing hormone
  4. Steroids (hydrocortisone)
  5. Radioactive iodine – ablates gland for permanent cure
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16
Q

Patient has a Thyroid Nodule – how is it handled?

A
  1. Thyroid function tests (TSH & T4)

2. If tests are normal, Biopsy the gland

17
Q

Hypercalcemia – presentation?

A

Polyuria, polydipsia, nausea, vomiting, confusion, stupor, lethargy, & constipation

  • Short QT syndrome & HTN
  • Osteoporosis
  • Nephrolithiasis
  • Diabetes Insipidus
  • Renal insufficiency
18
Q

Hypercalcemia – Tx?

A

Saline hydration & high volume

- Bisphosphonates – Pamidronate & Zoledronic acid

19
Q

Hypercalcemia 2/2 Sarcoidosis – Tx?

A

Prednisone controls hypercalcemia when it is from sarcoidosis or any granulomatous disease

20
Q

Hypercalcemia – most common cause?

A

Primary hyperparathyroidism & Cancer (PTH-rp)

Others: vit D intoxication, Sarcoidosis, Thiazide diuretics, Hyperthyroidism, Metastases to bone & Multiple Myeloma

21
Q

Hyperparathyroidism – causes?

A
  • Solitary adenoma (80-85%)
  • Hyperplasia of all 4 glands (15-20%)
  • Parathyroid malignancy (1%)
22
Q

How to test for bone effects of high PTH?

A

DEXA densitometry

Note: bone x-ray is not a good test for this

23
Q

Hypocalcemia – causes?

A
  1. Primary hypoparathyroidism 2/2 prior neck surgery (i.e. thyroidectomy) = MC cause
  2. Hypomagnesemia (Mg necessary for PTH to be released from gland, low Mg leads to inc’d urinary loss of Ca)
  3. Renal failure – Kidney converts 25-hydroxy-D to more active 1,25-hydroxy-D
  4. Vitamin D deficiency
    Also: Low albumin state, Fat malabsorption, & Genetic disorders
24
Q

Low vs. High Calcium Sx?

A

Low Ca = Twitchy & hyperexcitable

High Ca = Lethargic & slow

25
Q

How to test for Hypercortisolism?

A
  1. 24-hr urine cortisol levels (best - most specific)

2. 1 mg overnight dexamethasone suppression test (should suppress AM cortisol if normal)

26
Q

High cortisol confirmed along w/ high ACTH – next test?

A

Dexamethasone suppression test

ACTH suppresses = Pituitary source
ACTH does not suppress = Ectopic source

(low ACTH before this = adrenal source)

27
Q

Hypercortisolism – effects/sx?

A
  • Hyperglycemia
  • Hyperlipidemia
  • Hyperkalemia
  • Metabolic Alkalosis
  • Leukocytosis (demargination of WBCs. At least half of WBCs in blood are on vessel wall waiting for acute stress to come into circulation & this releases them)
28
Q

Addison disease – causes?

A
  1. Autoimmune destruction of gland (#1 cause in US)
  2. Tuberculosis (#1 cause worldwide)
  3. Adrenoleukodystrophy
  4. Metastatic cancer to adrenal gland
29
Q

Hypoadrenalism symptoms?

A

Both acute & chronic:
Weakness, fatigue, AMS, nausea, vomiting, anorexia, hypotension, hyponatremia, hyperkalemia

Chronic: Hyperpigmentation

Acute adrenal crisis: Profound hypotension, fever, confusion, & coma

30
Q

Hypoadrenalism: lab findings?

A 
Hypoglycemia
Hyperkalemia
Metabolic acidosis
Hyponatremia
High BUN

(Opposite of hypercortisolism)

31
Q

High BP + Hypokalemia = ___?

A

Primary hyperaldosteronism

Would also see low plasma renin. High renin would exclude this as possible diagnosis

32
Q

Primary Hyperaldosteronism: treatment?

A

Unilateral adenoma (80%): laparoscopic resection

Bilateral hyperplasia (20%): Eplerenone or Spironolactone

33
Q

MEN 1

A
  • Primary Hyperparathyroidism (90%)
  • Pancreatic tumors (Gastrinoma, Z-E) (70%)
  • Pituitary tumors (20%)
34
Q

MEN 2A

A
  • MTC (90%)
  • Pheochromocytoma (50%)
  • Parathyroid Hyperplasia (20%)
35
Q

MEN 2B

A
  • MTC
  • Pheochromocytoma
  • Other
    • Mucosal & intestinal neuromas
    • Marfanoid Habitus

3rd Year (Step 2) (44 decks)

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