Endocrinology

Question 1

What is Addison’s disease

Answer 1

adrenal insufficiency- usually low cortisol but also can have low aldosterone

Question 2

Hemochromatosis- why do you get diabetes?

Answer 2

Because iron deposits on pancreas! cannot release enough insulin so hyperglycemia
also can deposit in testicles- cause testicular atrophy
also deposit on liver- cause liver enlargement and elevated liver enzymes

Question 3

Pt on lithium therapy has increasing polydipsia and polyuria- Dx?

Answer 3

Nephrogenic DI caused by lithium

Question 4

Effects of vitamin D

Answer 4

kidney- reabsorb calcium
intestine- reabsorb calcium
kidney also: reabsorb phosphate and magnesium

Question 5

Match Sx with treatments for hyperthyroidism:
Sx:
- worsening of ophthalmopathy
- permanent hypothyroidism
- agranulocytosis 
- liver toxicity
- first trimester toxicity

Treatments causing Sx:

a) antithyroid drugs (PTU and Methimazole)
b) radioiodine ablation
c) surgery (thyroidectomy)

Answer 5

Treatments causing Sx:

a) antithyroid drugs (PTU and Methimazole)
- agranulocytosis (both)
- liver toxicity (PTU)
- 1st trimester toxicity (Methimazole)
- permanent hypothyroidism

b) radioiodine ablation
- worsening ophthalmopathy

c) surgery (thyroidectomy)
- permanent hypothyroidism

Question 6

Difference between primary adrenal insufficiency and secondary adrenal insufficiency hormones affected?

Answer 6

Primary- cortisol, aldosterone and ACTH affected
Secondary- only cortisol affected (since its effect of hypothalamus/ pituitary problem on adrenal gland- aldosterone not affected because it relies on RAAS, not HPA) and ACTH is okay so no hyperpigmentation

Question 7

Primary adrenal insufficiency vs secondary adrenal insufficiency causes?

Answer 7

Primary

• autoimmune adrenalitis (Addison’s?)
• infection (TB, CMV)
• malignancy (lung cancer, lymphoma)

Secondary

• CHRONIC GLUCOCORTICOID ADMINISTRATION
• Infiltrative - lymphocytic hypophysitis
• Sheehan syndrome (big blood loss after delivery)

Question 8

What causes a thyroid storm?

Answer 8

• Surgery (thyroid or non thyroid)
• CONTRAST DYES (iodine containing)
• Acute illness

Question 9

Liver cirrhosis patient with gynecomastia, spider angiomas, testicular atrophy and loss of sexual hair- what is the cause?

Answer 9

Hyperestrinism- decreased clearance of estrogen from circulation and increased androgen peripheral conversion

Question 10

Liver cirrhosis causes high or low total thyroid hormones?

Answer 10

LOW- this is perceived to be low because liver produces less TBG, so blood tests perceive it as low, but thyroid is actually making normal free hormone amounts, therefore TSH is in normal range

Question 11

Fluctuating very high BP with anxiety past couple months- Dx mechanism and Tx?

Answer 11

Dx- urine metanephrines- Pheochromocytoma
Tx: venous drainage from adrenal medulla LIGATION if big enough, or laparoscopic adrenalectomy for small
PERIOPERATIVE ALPHA AND BETA BLOCKERS

Question 12

Unilateral adrenal adenoma vs bilateral adrenal hyperplasia Tx

Answer 12

Unilateral adenoma- surgery

Bilateral hyperplasia- ALDOSTERONE ANTAGONISTS are sufficient :)

Question 13

Side effect of spironolactone in men?

Answer 13

Gynecomastia

Question 14

Patient with chronic CKD- mechanism of hyperparathyroidism?

Answer 14

• phosphate retention
• phosphate causes decreased 1,25DHvit D (calcitriol)= decreased intestinal calcium absorption (bulk of absorption!)
  ==> both lead to incr phosphate and decreased calcium (phosphate also binds free calcium in blood so lowers it more) - stimulate incr PTH release

Question 15

Prolactin inhibits which hormone?

Answer 15

GnRH- decreased testosterone in men and decreased estrogen in women

Question 16

Medication to treat prolactinoma?

Answer 16

Dopamine agonists

• Bromocriptine
• Cabergoline

Question 17

Progressive therapeutic intensification for diabetes mellitus type 2? (3 steps)

Answer 17

1. metformin
2. metformin + other oral AD/ GLP1/ basal insulin
3. BASAL+ BOLUS insulin regimen

Basal-bolus insulin involves insulin glargine (long acting) in the morning as basal level, and injection bolus boost of insulin lispro/aspart (short acting) during a meal

Question 18

Why can chronic diarrhea and steatorrhea cause secondary hyperparathyroidism?

Answer 18

Steatorrhea- fat malabsorption,- prevents normal fat emulsification, so chylomicrons can’t aborb vitamin D from intestine
- Low vit D= low calcium and low phosphorus in blood

Question 19

Difference in urine osmolality between Central DI and Nephrogenic DI

Answer 19

• UO is less than 50 percent of serum osmolality for Central DI (impaired thirst mechanism)
• UO is 50 percent or more of serum osmolality for Nephrogenic DI- i.e only a 10 percent decrease in urine osmolality compared to serum osmolality

Question 20

Causes of nephrogenic diabetes insipidus? name 2 mc

Answer 20

• Chronic lithium use

- HYPERCALCEMIA (cause resistance to ADH in kidney)

Question 21

Thiazide diuretics side effects

Answer 21

• HypERcalcemia, uricemia

- HypO - natremia, magnesemia, chloremia, kalemia

Question 22

What happens if you give undiagnosed hypothyroid person with high lipid profile (typical) statins?

Answer 22

Statins will WORSEN hypothyroid myopathy (muscle pain)
So do not give someone statins without doing a thyroid test (if they have other Sx like muscle aches and fatigue that raise suspicion)
Treatment of Levothyroxine is enough

Question 23

Pt comes in with severe abdominal pain, fever, HD instability.
lab values:
hyponatremia, hypochloremia, hypERkalemia, hyPOglycemia
Dx and Tx?

Answer 23

Adrenal crisis

TX: IV hydrocortisone!!

Question 24

Abnormal labs in primary adrenal insufficiency

Answer 24

• hyponatremia
• hyperkalemia
• EOSINOPHILIA
• Low morning cortisol (or normal) with high ACTH

Question 25

Additional effects of cortisol you often don’t remember:

Answer 25

• Cortisol decreases eosinophils in blood (decr immune)
• induces hyPERglycemia
• INHIBITS ADH! (which is why in deficiency you get hypOnatremia)