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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
Q

lab findings in TSH secreting adenoma

A

elevated TSH and T3/T4

increased serum alpha subunit levels

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26
Q

s/e of sulfonylrureas

A

hypoglycemia

SIADH

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27
Q

TH resistance syndrome

A

elevated TSH and T3/T4 symptoms of hypothyroidism

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28
Q

increased RAIU

A

Graves disease

goiter

tsh secreting adenoma

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29
Q

decreased RAIU

A

subacute/painless thyroiditis

iatrogenic/factitious disorder

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30
Q

Grave’s opthalmopathy

A

Tx. does not affect the ocular findings if severe, may lead to compression of the optic N. with visual field deficits

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31
Q

what intervention may decrease severity of graves ophthalmopathy

A

smoking - increases severity

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32
Q

Tx. Grave’s disease

A

PTU or MTZ acutely,

then RAI to ablate the gland

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33
Q

target TSH levels in treatment of thyroid cancer? if mets?

A

TSH between 0.1 and 0.3 uU/mL.

Even lower in distant mets

34
Q

s/e of treatment with suppressive doses of levothyroxine

A

bone loss

A.fib

35
Q

silent thyroiditis

A

autoimmune process with a nontender gland and hypothyroidism;

RAIU normal or decreased, + TPO ab

36
Q

Tx. silent thyroiditis

A

none - spontaneously resolves

37
Q

CF: Subacute thyroiditis

A

likely due to viral infection; pt presents with fever, tender* thyroid gland and hyperthyroid followed by hypothyroid symptoms

38
Q

Lab findings in subacute thyroiditis

A

TSH low, T4 high

RAIU decreased

39
Q

Tx. subacute thyroiditis

A

Aspirin propranolol - to decrease sx Steroids - if symptoms severe and not resolving with NSAIDs

40
Q

only cause of hyperthyroidism with an elevated TSH

A

pituitary adenoma

41
Q

Tx. thyroid storm

A

iodine PTU or MTZ dexamethasone propranolol

42
Q

MCC of Hypercalcemia

A

Primary hyperparathyroidism

43
Q

MCC hypophosphatemia

A

Continuous glucose infusions

44
Q

Clinical presentation of hypophosphatemia

A

Muscle weakness, ESP. Diaphragm giving respiratory weakness Decreased cardiac contractility

45
Q

When do you treat hyperparathyroidism surgically? (4)

A

Symptomatic disease Renal insufficiency Markedly elevated 24 hr urine calcium Very elevated serum calcium > 12.5

46
Q

Presentation of acute severe hypercalcemia

A

Confusion Constipation Short QT syndrome Polyuria, polydipsia from nephrogenic DI Renal insuff, ATN, kidney stones

47
Q

Management of acute hypercalcemia

A
  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
Q

Clinical findings in severe Hypocalcemia

A

Seizures Neural twitching Arrhythmia prolonged QT

49
Q

Diagnosis of Cushing syndrome

A
  1. 1 mg dexamethasone suppression test - if this fails to suppress: 2. 24 hour urine cortisol test
50
Q

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?

A

Inferior petrosal sinus sampling

51
Q

CF of Addison Disease

A

Fatigue, anorexia, weakness, weight loss, hypotension Thin pt with hyperpigmented skin Concomitant autoimmune disorders

52
Q

Lab findings in Addison’s disease

A

Hyperkalemia with metabolic acidosis Hyponatremia Hypoglycemia Neutropenia Peripheral eosinophillia

53
Q

Most accurate diagnostic test

A

Cosyntropin (ACTH) stimulation test - give ACTH , should have increase in cortisol, if no increase then you have adrenal insufficiency

54
Q

Tx. Addison’s disease

A
  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
Q

CF in hyperaldosteronism

A

Hypertension Hypokalemia with metabolic alkalosis Weakness Nephrogenic DI from Hypokalemia (polyuria and polydipsia)

56
Q

Diagnostic findings in hyperaldosteronism

A

Low renin Hypertension Elevated aldosterone level despite salt loading with normal saline

57
Q

Tx. Hyperaldosteronism

A

Solitary adenoma - surgery

Hyperplasia - spironolactone

58
Q

Best initial tests for pheochromocytoma

A

High plasma and urinary catecholamine levels

Plasma free metanephrine and VMA levels

59
Q

Most accurate test for pheochromocytoma

A

CT or MRI of the adrenal glands

60
Q

When do you do a MIBG scan for pheochromocytoma

A

If >5 cm in size and suspicion of extra renal disease

Positive hormone levels but negative imaging

61
Q

Tx. Hypertensive crisis in pheochromocytoma

A

IV nitroprusside

Phentolamine

Nocardipine

62
Q

Tx. Hypotensive crisis in pheo

A

Normal saline bolus

Pressors if no response

63
Q

Tx. Hypoglycemia in pheo

A

IV dextrose infusion

64
Q

Cardiac tachyarrhythmias

A

IV lidocaine or esmolol

65
Q

Medical prep prior to surgery for pheo

A

Phenoxybenzamine for 10-14 days

Propranolol before surgery (1-2d)

66
Q

Features of all types of CAH

A

Low aldosterone and cortisol

High ACTH levels

Tx. Prednisone

67
Q

Most accurate test for prolactinoma

A

MRI of the brain

68
Q

Best initial therapy for prolactinoma

A

DA agonists - bromocriptine, cabergoline

Note- dopamine inhibits prolactin release

69
Q

Best initial test for acromegaly

A

IGF1 level

70
Q

Most accurate test for acromegaly

A

OGTT - normally, GH is suppressed by glucose

Suppression of GH by glucose excluded acromegaly

71
Q

Tx. Acromegaly

A

Surgical removal - transsphenoidal resection

Octreotide, cabergoline, bromocriptine - prevent release of GH

72
Q

Pegvisomant

A

GH receptor antagonist

73
Q

Testicular feminization - features

A

Female, who does not menstruate

Breasts present

Exam: vagina ends in blind pouch, no cervix, uterus or ovaries Genetically, XY!

74
Q

CF of Klinefelters

A

Tall men, small testicles

XXY karyotype

Insensitivity to FSH and LH on their testicles (high levels but no testosterone is produced)

75
Q

Tx. Klinefelters

A

Testosterone

76
Q

Kallmans syndrome

A

Anosmia

Hypogonadism - low LH, FSH, GnRH

77
Q

Pituitary apoplexy

A

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
Q

Tx. Pituitary apoplexy

A

Stabilized with high dose steroids and IVF.

Give fludrocortisone

79
Q

In what situation should you not use Ringers lactate solution

A

Hyperkalemia - it contains K+

think RinKKKKers laKtate

80
Q

Insulin dosing prior to surgery

A

Admin of 1/3 usual insulin dose

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