Endocrinology Flashcards
What two hormones are secreted by the posterior pituitary?
Oxytocin and antidiuretic hormone (ADH:vasopressin)
What is Sheehan’s syndrome?
Ischemia of the pituitary due to volume depletion
how do glitazones work?
They improve insulin sensitivity.
Large doughy hands make you think of what dx?
Gigantism
Diabetes insipidus is caused by deficiency of what hormone?
Vasopressin
How much more potent is T3 than T4?
3-4x
What is the first line medical tx for a pheochromocytoma?
Alpha blocker.
What is the best imaging for a thyroid nodule?
Ultrasound
A patient presents with ED and c/o of some numbness in his feet. On second thought, he has noticed significant polyuria and polydipsia. What dx should you be thinking of?
Diabetic neuropathy
Pretibial myxedema should make you think of what dx?
Graves’ disease
A 35 yo female presents c heat intolerance, wt loss and palpitations. What is the most likely dx?
Hyperthyroidism
what is the first line medical tx for a pt who presents with palpitations and nervousness secondary to hyperthyroidism?
Beta blockers
What is Hashimoto’s disease?
An autoimmune cause of hypothyroidism
How does levothyroxine work?
It is a synthetic T4
What is the most common thyroid cancer?
Papillary: it makes up about 80% of thyroid CA
In a patient with hyperthyroidism, will TSH most likely be elevated or decreased?
Decreased
How do fibrates work to affect the lipid profile?
They inhibit synthesis of VLDL and elevate lipoprotein lipase
What med might you use prior to thyroidectomy in a patient with hyperthyroidism?
Methimazole or propylthiouracil (PTU)
What is included in Whipple’s triad of hypoglycemia?
hx of previous hypoglycemia
serum glucose of <40
immediate recovery upon admin of glucose
Positive antithyroid peroxidase and antithyroglobulin antibodies should make you think of what dx?
Hashimoto’s
What is the tx for myxedema?
Levothyroxine and slow warming
What is the most common cause of hypoparathyroid?
post thyroidectomy with the complication of parathyroidectomy
What is Chvostek’s sign?
Tap on facial nerve and get a twitch with low Ca
cortical adrenal insufficiency is also known as what dz?
Addison’s disease
What is Trousseau’s sign?
Inflate BP cuff and hold for 3 minutes. Pt c low Ca will get carpal tunnel syndrome.
What is the most common cause of hyperparathyroidism?
Single parathyroid adenoma in 80% of cases.
In cushing’s disease, is ACTH elevated or decreased?
Elevated
What is Graves’ disease?
The most common cause of hyperthyroidism. It is an autoimmune disease.
What specific breathing pattern is associated with diabetic ketoacidosis?
Kussmaul respirations
What is the least aggressive thyroid CA?
Papillary
Name 2 tests you might use to r/o cushion’s syndrome.
24 hr free cortisol urine test
dexamethasone suppression test
List 2 ectopic tumors that may produce ACTH and give a pt cushion’s syndrome.
Small cell lung cancer
pancreatic islet cells
thymomas
Exophthalmos should make you think of what dx?
Hyperthyroidism
What percentage of diabetes in the US is type 2?
80-90%
HLA-DR gene is a marker for what endocrine disorder?
DM type 1
What is the main function of parathyroid hormone?
Increases serum Ca
List 4 diagnostic criteria for diabetes.
Random glucose >200
FBG >126
2h post prandial glucose >200
HgA1c> 6.5%
Moans, groans, stone and bones describe symptoms of what endocrine problem?
Hyperparathyroid
Stocking glove anesthesia should make you think of what dx?
Diabetic neuropathy and B12 deficiency neuropathy
Fruity breath should make you think of what dx?
Diabetic ketoacidosis
As it relates to diabetics, what is the dawn phenomenon?
Reduced insulin response between 5 & 8 am
What is the most common cause of hypopituitarism?
Tumor
How does metformin work?
Decreases the hepatic glucose production
increases peripheral glucose uptake
How does sulfonylureas work?
They stimulate production of insulin
What class of medications does pioglitazone (actos) fall into?
Thiazolidinediones aka glitazones
What is the suffix associated with sulfonylureas?
Ide is the suffix
Glipizide
Tobutamide
Tolazamide
Typically what is the first medication started in diabetes type 2?
Metformin
How often should a diabetic’s HgbA1c be checked and what should it be?
every 3 months (Life of an RBC is 90-120 days) and it should be below 6.5%
What are the five criteria for metabolic syndrome?
HDL<40 men, <50 for women BP>135/85 Tri >150 FBG>100 Waist >40" men, >35" women
What class of medication if the first line for lowering LDL?
Statins
Which lipid medication may cause flushing?
Niacin
What life threatening SE do statins have?
Rhabdomyolysis
Does niacin increase or decrease HDL?
Increase
What medication class does metformin (Glucophage) fall into?
Biguanide
List the 5 insulins in order of peak efficiency.
Lispro 1-2h Regular 2-4h NPH 5-7h Lente 4-8 hr Ultralente 8-14h
Is metformin indicated or contraindicated in renal failure?
contraindicated
What is the most common cause of DM type 1?
Autoimmune destruction of the islet cells in the pancreas
List 4 physical exam findings for Cushing’s syndrome.
Moon facies buffalo hump purple striae central obesity supraclavicular fat pads easy bruising
Propranolol belongs to what class of meds?
Beta blockers
During pregnancy, which is the preferred tx of hyperthyroidism PTU or methimazole?
PTU
Name the four thyroid CA
Papillary
Follicular
Medullary
Anaplastic
What heparin complication is relevant to endocrinology?
Adrenal infarct leading to a Cushing’s syndrome
How does nicotinic acid work to affect the lipid profile?
It inhibits secretion of VLDL.
Hyper pigmentation of the skin along creases should make you think of what dx?
Addison’s disease
Which thyroid cancer is the most aggressive?
anaplastic
How do statins work to affect the lipid profile?
They slow the rate limiting step of cholesterol synthesis.
Will ACTH be elevated or decreased in Addison’s disease?
Elevated if the problem is at the adrenal glands.
What role does C-peptide play in the dx of diabetes?
It is a marker of insulin production. Elevated C peptide points to DM2. Decreased C-peptide points toward DM 1.
