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MKSAP > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Causes of altered HgbA1c levels

A 
IDA
Blood loss/hemolysis
Kidney disease 
Liver diseases 
Pregnancy
Blood transfusion
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2
Q

What should you do with an abnormal diabetes test in a patient who has not been previously diagnosed?

A

Repeat testing

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3
Q

Other antibody in Type I DM that you haven’t been checking

A

Anti-tyrosine phosphatase IA-2

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4
Q

Metabolic syndrome factors

A 
>40 cm waist circumference (35 in women)
Fasting TGL >150
HDL <40 (<50 in women)
HTN 
Fasting glucose >100
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5
Q

Pramlinitide

A

Amylin analogue that delays gastric emptying decreases glucagon secretion, and increases mealtime satiety

Indicated for Type I patients who are having trouble achieving glycemic control

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6
Q

How does metformin work again?

A

Decreases hepatic glucose production and increases insulin-mediated uptake of glucose in muscles

Contraindicated w/ progressive liver, kidney, or cardiac failure

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7
Q

Medications you CANNOT use with sulfonylureas

A

DDP-4 inhibitors (sitagliptin, saxagliptin, linagliptin) as these medicines cause glucose-dependent increases in insulin secretion

-Also, increases risk of pancreatitis and may be associated w/ increased in heart failure exacerbations

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8
Q

Vitamin deficiency that can develop w/ metformin use

A

Vitamin B12 (in up to 5% of patients)

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9
Q

Cancer drugs that are associated w/ hyperglycemia

A

Calcineurin inhibitors (Sirolimus, tacrolimus/prograf, cyclosporine/gengraf)

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10
Q

Cardiac medications that are associated w/ hyperglycemia

A

BBs (decrease insulin release and increase peripheral resistance)
Thiazide (decreased insulin secretion 2/2 hyperkalemia

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11
Q

Psych meds associated w/ hyperglycemia

A

2nd generation antipsychotics

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12
Q

Pathophysiology of DKA/HHS

A

Relative insulin deficiency state w/ subsequent ketone production, lipolysis

HHS typically more lethal due to it happening in younger people with better GFR allowing for higher glucosuria

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13
Q

Thyroid nodule suspicious characteristics

A

Microcalcifications, irregular borders

If extrathyroidal extension, lymph node involvement, or symptoms present, you can biopsy w/ <1cm nodules

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14
Q

Recommendations for nodule w/ atypia of uncertain significance or follicular lesion of uncertain significance

A

Repeat FNAB in 3 months

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15
Q

Pemberton sign

A

Position patient with head down and hands up and look for:

  1. JVD
  2. Facial plethora
  3. Flushing

=» Thoracic outlet syndrome

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16
Q

Most common cause of goiter in geriatric patients in the US

A

Multinodular goiter

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17
Q

Jod-Basedow Phenomenom

A

Administration of iodine to multinodular goiter patient causes iodine-induce hyperthyroidism

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18
Q

Difference in mets in papillary thyroid carcinoma vs follicular carcinoma

A

Papillary-Cervical lymphadneopathy but less commonly w/ distant mets

Follicular- Mets to lung, bone but less commonly w/ follicular lymphadenopathy

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19
Q

High risk features for recurrence in thyroid cancer

A

Extrathyroidal extension
Lymphovascular invasion
Poorly differentiated on histology
Metastatic disease

-Typically administer radioactive iodine after surgery in these patients

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20
Q

Markers monitored after treatment for thyroid cancer

A

Throglobulin or thyroglobulin antibody (if antibody present, use this)

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21
Q

Therapy for high-risk differentiated thyroid cancer

A

LT4 to suppress the TSH to at least less than 2 but is individualized

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22
Q

Anaplastic thyroid cancer

A

Rare but aggressive and presents as a rapidly enlarging neck mass

Median survival is 5 months as it is usually nonresectable at diagnosis; treatment for this one is chemo

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23
Q

Medullary thyroid cancer

A

Arises from parafollicular cells due to germline RET oncogene mutation (MEN syndromes)

Tx: Total thyroidectomy w/ central neck lymph node dissection

24
Q

Scenarios in which T3 measurement is recommended

A
  1. Identifying isolated T3 toxicosis
  2. To assess the severity of hyperthyroidism and the response to therapy
  3. To differentiate hyperthyroidism from destructive thyroiditis
25
Q

What clinical indication is there to check rT3?

A

None

26
Q

What meds can decrease LT4 absorption?

A

Calcium, PPIs, Iron, sucralfate

27
Q

What meds increase LT4 metabolism?

A

Dilantin
Carbamazepine
Rifampin
Sertraline

28
Q

What drugs cause thyroiditis

A

Amiodarone
Lithium
Interferon-a (can also cause antithyroid antibodies to develop)
IL-2
TKIs (sunitinib)
Immune checkpoint inhibitors (nivolumab, pembrolizumab)

29
Q

What drugs inhibit TSH synthesis/release?

A

Steroids
Dobutamine
Octreotide

30
Q

What drugs increase TBG?

A

OCPs
Tamoxifen
Methadone

31
Q

What drugs decrease TBG?

A

Androgens
Steroids
Niacin

32
Q

Struma ovarii

A

Causes thyrotoxicosis in ovarian teratoma

33
Q

Wolff-Chaikoff effect

A

Relative hypothyroidism when ingesting increased amounts of iodine

Seen in amiodarone use in first few months but usually resolves

34
Q

Goal TSH for pregnant patients

A

<2.5; you also start treating treatment-naive patients if found to have anti-TPO and TSH is >2.5

35
Q

TSH levels not consistent w/ euthyroid sick syndrome

A

TSH <0.01 or TSH >20

36
Q

Treatment for thyroid storm

A 
Treat inciting cause AND 
IV BB 
PTU w/ transition to methimazole when stable 
IV dexamethasone 
KI (administer one hour after thioamide)

Plasmapheresis can be considered if no response

If patient survives, thyroidectomy or radioablative therapy indicated

37
Q

Med to administer empirically prior to starting treatment for myxedema coma

A

Glucocorticoids; after that, administer IV bolus of LT4 at 400ug

38
Q

Labs that need measured in chronic hypoparathyroidism

A

Ca, Mg, Cr, and URINE Ca

-Urine Ca should be <300mg/24hrs; if its higher, decrease calcium supplementation as this may cause urinary stones/fall in GFR

39
Q

Empty sella work up

A

Typically, clinics assessment and 8AM cortisol and TSH

Hyperprolactinemia is the most common abnormality tho as pituitary is still present, it is just in a round ring around the site of the sella

40
Q

Cancers that met to the pituitary

A 
Breast
Lung
Lymphoma 
Renal cell
Langerhans can involve it

-Typically causes DI, optic nerve dysfunction, sometimes HA and CN palsies

41
Q

What cancer drugs cause hypophysitis?

A

Check point inhibitors

42
Q

Work up for pituitary tumor

A

Prolactin
IGF-1
MRI w/out with sella turcica imaging

Also check FSH, LH, TSH to see if they are LOW

43
Q

Monitoring pituitary microarenkma

A

Repeat imaging every 1-2 years

44
Q

Lab to check in patient who you are suspicious for alderosteronoma but are on an ACEI/ARB

A

Renin level

If low, then an actual Angiotensin-Renin level is indicated

45
Q

Gene to check for with medullary thyroid carcinoma and the associated cancers

A

RET

Pheochromocytoma, parathyroid hyperplasia, mucosal neuroma, gastrointestinal ganglioneuroma, and Marfanoid body habitus (if MEN2B)

(These are MEN 2A and 2B tumors so remember your chart)

46
Q

Common meds that can affect biochemical testing for pheochromocytoma

A

Tylenol, antipsychotics, SNRIs, MOAIs, TCAs, Buspirone, caffeine, cocaine, decongestants (pseudoephedrine), ethanol

Should ideally discontinue these 2 weeks prior to testing

47
Q

Steroid with highest anti-inflammatory potency

A

Dexamethasone

48
Q

Steroid with shortest half life

A

Hydrocortisone; this is why it requires TID dosing yah dingus

49
Q

Treatment of choice for adrenal crisis

A

Hydrocortisone 100mg q8hrs

50
Q

When adrenal insufficient patients are ill or having surgery, what should should they do with their steroid dosing?

A

Increase 2-3x

51
Q

Testing for adrenal incidentaloma

A

Must be at least 1cm

Subclinical Cushings (Overnight dexamethasone suppression test)
Pheo testing 
Aldosterone testing if patient has HTN or hypokalemia
52
Q

Indications for adrenalectomy

A

Suspicious imaging
Growth >1cm year
Function tumor (pheo, aldosterone, subclinical Cushings)

53
Q

Lab to check in an obese man with a low 8AM testosterone level

A

Free testosterone

These patients have elevated SHBG leading to falsely decreased 8AM testosterone levels

54
Q

Lab to check after confirming low testosterone levels

A

LH

55
Q

Workup of painful male gynecomastia

A

bHCG, estradiol, LH, 8AM testosterone

56
Q

What does rapid onset of hirsutism in woman >30 years old worry you for

A

Androgen producing tumor

57
Q

Eval of female hyperandrogenism

A

SHBG, 12-hydroxyprogesterone (check for CAH)

hCG, prolactin, FSH, TSH, DHEA if rapid to check for tumor

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