Endocrinology Flashcards

1
Q

Addison’s disease is?

A

Primary adrenal insufficiency

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2
Q

How do labs look for Addison’s Disease?

A

Increased ACTH
Decrease cortisol
Hyponatremia
Hyperkalemia

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3
Q

What is the MC cause of Addison’s?

A

autoimmune destruction

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4
Q

What is the MC cause Addison’s worldwide?

A

TB, HIV

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5
Q

What labs are seen in Secondary adrenal insufficiency?

A

Decrease ACTH

Decrease cortisol

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6
Q

Cause of secondary adrenal insufficiency?

A

pituitary macroadenoma or central nervous system tumor

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7
Q

No increase in ACTH after CRH injection is what?

A

Secondary adrenal insufficiency

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8
Q

No increase in cortisol level after ACTH stimulation test is what?

A

Primary adrenal insufficiency (Addison’s Disease)

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9
Q

What does the labs for tertiary adrenal insufficiency look like?

A

decrease cortisol

normal aldosterone

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10
Q

ACTH levels increase after CRH injection

A

Tertiary adrenal insufficiency

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11
Q

What is the MC cause of tertiary adrenal insufficiency?

A

sudden withdrawal of glucocorticoid therapy

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12
Q

What is the mechanism of Addison’s disease?

A

destruction of adrenal cortex resulting in loss of cortisol production

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13
Q

What is the screening test for Addison’s disease?

A

High dose ACTH (cosyntropin) stimulation test

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14
Q

What is the treatment for Addison’s disease?

A

Glucocorticoids + Mineralocorticoid (Hydrocortisone + Fludrocortisone)

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15
Q

What is the treatment of 2ndry adrenal insufficiency?

A

Glucocorticoids (Hydrocortisone 1st line, Prednisone, Dexamethasone)

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16
Q

What is the treatment for Adrenal (Addisonian) Crisis?

A

IV fluids, IV hydrocortisone, glucose,

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17
Q

What symptoms are seen in Addison’s?

A

Hyperpigmentation, Orthostatic hypotension (syncope, dizziness), hyponatremia, hyperkalemia, metabolic acidosis, hypoglycemia, decrease sex hormones in women (loss of libido, amenorrhea, loss of hair)

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18
Q

Mechanism of Cushing Syndrome?

A

s/s due to prolonged exposure to excess cortisol

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19
Q

What are symptoms seen in Cushing?

A

buffalo hump, moon facies, pigmented striae, obesity, hypertension, hypokalema

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20
Q

Diagnosis of Cushing?

A

Dexamethasone supression test

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21
Q

Suppression of cortisol =

A

Cushing’s disease

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22
Q

No suppression=

A

Cushing’s syndrome

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23
Q

Treatment for Cushing disease?

A

Transsphenoidal surgery

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24
Q

What two medications can be used if a adrenal tumor can’t be removed?

A

Ketoconazole or Metyrapone

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25
Q

4 Medications that cause Addison’s?

A

Ketocanzole, Rifampin, Phenytoin, Barbiturates

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26
Q

What causes Type I DM?

A

Autoimmune

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27
Q

Whom do Type I DM occur in?

A

young people before school age or near puberty

28
Q

What is Dawn Phenomenon?

A

normal glucose until rise of serum glucose between 2am-8am. Results from decreased insulin sensitivity and nightly sure of counter regulatory hormones

29
Q

What is Somogyi effect?

A

Nocturnal hypoglycemia followed by rebound hyperglycemia due to surge in growth hormone

30
Q

What is insulin waning?

A

progressive rise in glucose form bed to morning

31
Q

What are the symptoms of Diabetic Ketoacidosis?

A

fruity breath, weight loss, rapid respirations, hypotension

32
Q

What is the treatment for DKA?

A

Large volume IV fluids (normal saline), Insulin IV pump

33
Q

A random glucose of what is dx for DM?

A

200mg/dl w/ classic symptoms

34
Q

A fasting glucose of what is dx for DM?

A

> 126 mg/l on more than one occasion

35
Q

A HGB A1c represents of what is dx for DM?

A

6.5% or higher

36
Q

What is the treatment of Type I DM?

A

Dietary control + insulin

37
Q

What is the A1C goal of Type I DM?

A

< 7

38
Q

What is the BP goal for DM?

A

<140/90

39
Q

All DM pts 40-75 should take a?

A

statin

40
Q

What are the 4 diagnostic criteria for DM?

A

Random glucose > 200
Fasting glucose > 126
2 postprandial glucose > 200
HgA1c >6.5%

41
Q

How does Metformin work?

A

decreases hepatic glucose production and increases peripheral glucose uptake

42
Q

What is the side effect of Metformin?

A

lactic acidosis

43
Q

What is the mechanism of Sulfonylureas?

A

stimulates pancreatic beta-cell insulin release

44
Q

What is the side effect of Sulfonylureas?

A

hypoglycemia and weight gain

45
Q

What is the mechanism of Thiazolidinediones?

A

increases insulin sensitivity in peripheral receptor site adipose and muscle

46
Q

What is the sde of Thiazolidinediones?

A

fluid retention and edema

47
Q

What labs are seen in hyperthyroidism?

A

Decrease TSH
Increase free T4 or T3
Sometimes radioactive iodine uptake

48
Q

What is the initial dx used for hyperthyroidism?

A

TSH

49
Q

What test is used after TSH to confirm hyperthyroidism?

A

Radioactive iodine uptake

50
Q

What is used to treat cardiac symptoms of Graves disease?

A

beta blockers (atenolol)

51
Q

What are the two antithyroid drugs used to treat Graves disease?

A

Methimazole and Proylthiouracil (PTU)

52
Q

What med is used in preggo with Graves?

A

PTU

53
Q

What symptoms are seen in Graves?

A

heat intolerance, weight loss despite increased appetite, exopthalmos, nervousness, sweating, pretibial myxedema, goiter with a bruit

54
Q

What are the labs in hypothyroidism?

A

Increase TSH

Decrease free T4

55
Q

What is the most common cause of hypothyroidism?

A

Hashimoto’s thyroiditis

56
Q

Hashimoto’s is confirmed by what?

A

Antithyroid peroxidase (TPO) antibodies

57
Q

What two other associations are seen with Hashimoto’s?

A

Anemia and high cholesterol

58
Q

Treatment for Hashimoto’s?

A

Thyroid replacement hormone therapy (Oral T4) L-thyroxine

59
Q

What is the preferred txt for Hashimoto’s?

A

Oral T4 L-thyroxine, Levoxyl, Synthroid

60
Q

What are complications of Hashimoto’s?

A

Hashimoto encephalopathy, goiter, heart failure, depression decreased libido, myxedema

61
Q

What symptoms make up the Thyroid storm?

A

Fever, tachycardia, delirium

62
Q

What disease has discrete areas of high uptake?

A

Toxic multinodular

63
Q

What antibodies are seen in Graves?

A

Anti-thyrotropin antibodies

64
Q

Thyroidectomy mostly likely complication is?

A

recurrent laryngeal nerve (hoarseness)

65
Q

What is the recommendation for PTU?

A

given only in the FIRST TRIMESTER! switch to methimazole for the rest of pregnancy

66
Q

What is the sde of PTU?

A

liver damage

67
Q

What are the symptoms of Hashimoto’s?

A

cold intolerance, fatigue, constipation, depression, weight gain, bradycardia