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Master the Boards > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Nelson syndrome

A

rapid enlargement of pituitary adenoma after removal of both adrenal glands for Cushing’s disease; characterized by bitemporal hemianopsia and hyperpigmentation

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2
Q

Dx. nelson’s syndrome

A

MRI - suprasellar extension of pituitary adenoma

labs - very high plasma ACTH levels (since youve taken away the adrenal’s products, which usually provide negative feedback)

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3
Q

tx. nelsons syndrome

A

surgery and/or pituitary radiation– makes sense since you just can’t have such a rapidly enlarging pituitary adenoma messing with your vision and pigment

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4
Q

lab findings in non-functioning pituitary adenoma

A
  1. hypogonadism - low levels of FSH and LH
  2. serum alpha subunit levels are elevated

note- the only symptoms the patient gets is from sheer mass effect, or from loss of normal pituitary function. if the adenoma compresses the pituitary too much, it won’t be able to make hormones normally

alpha subunit + beta subunit present in gonadotropins: hcg, LH, FSH, TSH

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5
Q

preferred therapy for nonfunctioning pituitary adenoma

A

trans-sphenoidal surgery

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6
Q

tx. prolactin-secreting adenomas

A

DA agonists ex. cabergoline

Note- MEN1 patients get prolactinoma

males with prolactinoma will have lower testosterone levels so they may have less libido

women lose their menstrual periods and have incrased breast milk production

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7
Q

what dyslipidemia is common in HIV pt

A

triglyceridemia assoc. with elevated LDL and TC; decreased HDL

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8
Q

tx. of hypertriglyceridemia in HIV pt on antiretroviral therapy

A

if TG> 500 -> fibrate medication (gemfibrozil)

if TG < 500, can use a statin

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9
Q

amiodarone effects on thyroid

A

INTRINSIC DRUG EFFECT:

  • blocks thyroid hormone from entering cells
  • inhibits 5’ deiodinase, so decreased conversion from T4 to T3 = decreased T3 and increased T4 levels
  • less T3 binding the T3 receptor
  • can cause a destructive thyroiditis

IODINE EFFECT:

  • cant escape wolff-chaikoff effect
  • iodine thyroid autoimmunity
  • upregulates hormone production via jod-basedow effect
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10
Q

diagnoses of DM

A
  1. two FPG > 126 (<110 normal)
  2. one random glucose > 200 with symptoms
  3. abnormal OGTT > 200 2 hours post-load (<140 normal)
  4. HbA1c > 6.5%
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11
Q

pt with type 2 DM that is not adequately controlled with metformin - next step?

A

add sulfonylurea (ex glipizide)

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12
Q

S/E of metformin

A

lactic acidosis

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13
Q

contraindications of metformin

A

renal insufficiency (Cr > 1.4, CCl < 50)

use of contrast agents –> ARF

alcohol abuse

liver disease

CHF

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14
Q

what should you do in pt on metformin about to have a contrast procedure done?

A
  1. stop metformin 1 d prior
  2. if high risk for RF, give NaHCO3 or NS before procedure, adequately hydrate
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15
Q

DPP-IV inhibitors

A

sitagliptin, saxigliptin - increase insulin release and block glucagon

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16
Q

C/I to rosiglitazone/pioglitazone

A

CHF

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17
Q

insulin secretagogues

A

nateglinide, repaglinide - short acting - cause hypoglycemia

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18
Q

GLP analogs

A

exenatide, liraglutide - decrease gastric motility (increase feeling of fullness)

  • increase satiety - promote weight loss
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19
Q

s/e exenatide or liraglutide

A

NV

dyspepsia

sensation of fullness/bloating

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20
Q

best test to determine severity of DKA

A

serum bicarb (also: ph < 7.3 or anion gap high)

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21
Q

effect of glucose on Na levels

A

high glucose artificially drops Na levels

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22
Q

which hyperlipidemia drug is C/I in diabetes

A

niacin - worsens glucose intolerance

“niacin not nice to diabetics”

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23
Q

Tx. diabetic neuropathy

A

gabapentin pregabalin

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24
Q

Tx. diabetic gastroparesis

A

erythromycin (gut motility stimulator and antibiotic) or metoclopramide (reglan- gut motility stimulator)

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25
lab findings in TSH secreting adenoma
elevated TSH and T3/T4 increased serum alpha subunit levels
26
s/e of sulfonylrureas
hypoglycemia SIADH
27
TH resistance syndrome
elevated TSH and T3/T4 symptoms of hypothyroidism
28
increased RAIU
Graves disease goiter tsh secreting adenoma
29
decreased RAIU
subacute/painless thyroiditis iatrogenic/factitious disorder
30
Grave's opthalmopathy
Tx. does not affect the ocular findings if severe, may lead to compression of the optic N. with visual field deficits
31
what intervention may decrease severity of graves ophthalmopathy
smoking - increases severity
32
Tx. Grave's disease
PTU or MTZ acutely, then RAI to ablate the gland
33
target TSH levels in treatment of thyroid cancer? if mets?
TSH between 0.1 and 0.3 uU/mL. Even lower in distant mets
34
s/e of treatment with suppressive doses of levothyroxine
bone loss A.fib
35
silent thyroiditis
autoimmune process with a nontender gland and hypothyroidism; RAIU normal or decreased, + TPO ab
36
Tx. silent thyroiditis
none - spontaneously resolves
37
CF: Subacute thyroiditis
likely due to viral infection; pt presents with fever, tender\* thyroid gland and hyperthyroid followed by hypothyroid symptoms
38
Lab findings in subacute thyroiditis
TSH low, T4 high RAIU decreased
39
Tx. subacute thyroiditis
Aspirin propranolol - to decrease sx Steroids - if symptoms severe and not resolving with NSAIDs
40
only cause of hyperthyroidism with an elevated TSH
pituitary adenoma
41
Tx. thyroid storm
iodine PTU or MTZ dexamethasone propranolol
42
MCC of Hypercalcemia
Primary hyperparathyroidism
43
MCC hypophosphatemia
Continuous glucose infusions
44
Clinical presentation of hypophosphatemia
Muscle weakness, ESP. Diaphragm giving respiratory weakness Decreased cardiac contractility
45
When do you treat hyperparathyroidism surgically? (4)
Symptomatic disease Renal insufficiency Markedly elevated 24 hr urine calcium Very elevated serum calcium \> 12.5
46
Presentation of acute severe hypercalcemia
Confusion Constipation Short QT syndrome Polyuria, polydipsia from nephrogenic DI Renal insuff, ATN, kidney stones
47
Management of acute hypercalcemia
1. Hydration: 3-4 L normal saline 2. Furosemide: only after hydration has been given - if those two don't work, can try calcitonin 3. Bisphosphonate (pamidronate) - chronic management
48
Clinical findings in severe Hypocalcemia
Seizures Neural twitching Arrhythmia prolonged QT
49
Diagnosis of Cushing syndrome
1. 1 mg dexamethasone suppression test - if this fails to suppress: 2. 24 hour urine cortisol test
50
You find a pt to have high cortisol, high ACTH level that suppresses to high dose dexamethasone test. You suspect pituitary adenoma but MRI does not show any lesions. What should you do next?
Inferior petrosal sinus sampling
51
CF of Addison Disease
Fatigue, anorexia, weakness, weight loss, hypotension Thin pt with hyperpigmented skin Concomitant autoimmune disorders
52
Lab findings in Addison's disease
Hyperkalemia with metabolic acidosis Hyponatremia Hypoglycemia Neutropenia Peripheral eosinophillia
53
Most accurate diagnostic test
Cosyntropin (ACTH) stimulation test - give ACTH , should have increase in cortisol, if no increase then you have adrenal insufficiency
54
Tx. Addison's disease
1. Acute crisis (ie hypotensive) - give hydrocortisone or dexamethasone (doesn't interfere with cortisol measurement) and IVF 2. Chronic - prednisone 3. If still hypotensive despite steroid replacement, give fludrocortisone
55
CF in hyperaldosteronism
Hypertension Hypokalemia with metabolic alkalosis Weakness Nephrogenic DI from Hypokalemia (polyuria and polydipsia)
56
Diagnostic findings in hyperaldosteronism
Low renin Hypertension Elevated aldosterone level despite salt loading with normal saline
57
Tx. Hyperaldosteronism
Solitary adenoma - surgery Hyperplasia - spironolactone
58
Best initial tests for pheochromocytoma
High plasma and urinary catecholamine levels Plasma free metanephrine and VMA levels
59
Most accurate test for pheochromocytoma
CT or MRI of the adrenal glands
60
When do you do a MIBG scan for pheochromocytoma
If \>5 cm in size and suspicion of extra renal disease Positive hormone levels but negative imaging
61
Tx. Hypertensive crisis in pheochromocytoma
IV nitroprusside Phentolamine Nocardipine
62
Tx. Hypotensive crisis in pheo
Normal saline bolus Pressors if no response
63
Tx. Hypoglycemia in pheo
IV dextrose infusion
64
Cardiac tachyarrhythmias
IV lidocaine or esmolol
65
Medical prep prior to surgery for pheo
Phenoxybenzamine for 10-14 days Propranolol before surgery (1-2d)
66
Features of all types of CAH
Low aldosterone and cortisol High ACTH levels Tx. Prednisone
67
Most accurate test for prolactinoma
MRI of the brain
68
Best initial therapy for prolactinoma
DA agonists - bromocriptine, cabergoline Note- dopamine inhibits prolactin release
69
Best initial test for acromegaly
IGF1 level
70
Most accurate test for acromegaly
OGTT - normally, GH is suppressed by glucose Suppression of GH by glucose excluded acromegaly
71
Tx. Acromegaly
Surgical removal - transsphenoidal resection Octreotide, cabergoline, bromocriptine - prevent release of GH
72
Pegvisomant
GH receptor antagonist
73
Testicular feminization - features
Female, who does not menstruate Breasts present Exam: vagina ends in blind pouch, no cervix, uterus or ovaries Genetically, XY!
74
CF of Klinefelters
Tall men, small testicles XXY karyotype Insensitivity to FSH and LH on their testicles (high levels but no testosterone is produced)
75
Tx. Klinefelters
Testosterone
76
Kallmans syndrome
Anosmia Hypogonadism - low LH, FSH, GnRH
77
Pituitary apoplexy
Sudden hemorrhage into pituitary gland causing a rapid drop in cortisol level and hypotension that fails to respond to IVF Patient ends up obtunded
78
Tx. Pituitary apoplexy
Stabilized with high dose steroids and IVF. Give fludrocortisone
79
In what situation should you not use Ringers lactate solution
Hyperkalemia - it contains K+ think RinKKKKers laKtate
80
Insulin dosing prior to surgery
Admin of 1/3 usual insulin dose

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