Endocrinology (Alice) Flashcards
3 causes of resting tremor
parkinson’s
wilson’s
severe essential tremor
5 types of postural/action tremor
physiologic
drugs/toxins
essential tremor
writing tremor
parkinson’s
tremor w. peripheral neuropathy
charcot-marie-tooth
6 causes of intention tremor
MS
trauma
vascular dz
wilson’s dz
hepatocerebral degeneration
drugs/toxins
how much fatigue is normal post op
6-12 weeks
t/f: even “nonsedating” antihistamines have a 15% sedation rate
t!
7 endocrine causes of fatigue
hypothyroid
DM
pituitary insufficiency
hypercalcemia
adrenal insufficiency
chronic renal failure
hepatic failure
short PR interval and a delta wave on EKG
wolf parkinson white syndrome
htn
diaphoresis
palpitations
pheochromocytoma
irritability, diaphoresis, weakness, tremulousness, palpitations
insulinoma
muscle cramps, constipation, flattened/inverted T waves, U waves
hypokalemia
muscle weaknessm, hyperreflexia, prolonged QT/PR, wide QRS, vtach, torsades
hypomagnesemia
SOB
palpitations
systolic murmur w. midsystolic ejection click
MVP
heat intolerance/cold intolerance make you think of
heat: hyperthyroidism
cold: hypothyroidism
3 eye signs associated w. hyperthyroidism
stare
lid lag
exophthalmos
what is spared in a thyroidectomy (2)
parathyroid glands
recurrent laryngeal n
indication for complete total thyroidectomy (vs subtotal)
graves w. ophthalmopathy
decreased ACTH production causes _,
which leads to what symptoms (3)
hypocorticolism:
-fatigue
-slow return to health after minor illness
-orthostatic hypotn
excess parathyroid hormone causes excess blood levels of
calcium
what level of hypercalcemia is mc asymptomatic
< 12
sx of hypercalcemia
n/v
LOA
weak
fatigue
constipation
confusion
lethargy
cardiac arrhythmia
coma
pathway of hyperparathyroidism
causes of hyperparathyroidism: primary vs secondary
primary: parathyroid adenoma secreting PTH
secondary: 2/2 to hypocalcemia, vit D deficiency, CKD
mcc of secondary hyperparathyroidism
CKD
complications of hyperparathyroidism
osteoporosis
renal calculi
bone pain
GI
dpn/psychosis
stones, bones, groans, psychiatric moans
hallmark finding of hyperparathyroidism
serum Ca > 10.5
3 ways in which increased PTH secretion raises blood Ca
breaks down bone
increased absorption from GIT
increased absorption from kidneys
results in: increased serum and urinary Ca, osteoporosis, renal calculi
urine findings associated w. hyperparathyroidism
hyperphosphaturia
hypercalciuria
tx for hyperparathyroidism
primary: parathyroidectomy (subtotal vs total)
secondary: vit D, Ca supplementation
severe secondary: IVF, furosemide, calcitonin, bisphosphonates
tx for hyperthyroidism
methimazole
PTU
pregnant, first trimester: PTU
sx of thyroid storm
fever
weakness
muscle wasting
extreme restlessness
emotional swings
confusion/psychosis
n/v
diarrhea
hepatomegaly/mild jaundice
shock
tx for hyperthyroidism in the acute setting
bb
major rf for thyroid ca
childhood irradiation to the head/neck
order of dx for thyroid nodules (4)
- palpable nodule
- confirm by US
- RAIU scan
- FNA
characteristics of malignant thyroid nodules (6)
microcalcifications
hypoechogenicity
solid nodule
irregular margins
chaotic intranodular vasculature
nodule that is more tall than wide
RAIU scans: findings of cancerous vs non-cancerous
cancerous: lesion does not make hormone -> does not take up iodine -> cold nodule
non-cancerous: lesion does make hormone -> does take up iodine -> hot nodule
on RAIU, cancerous nodules are _, and non-cancerous lesions are _
cancerous: cold
non-cancerous: hot
tx for thyroid nodules
benign: f/u in 6 months
malignant/suspicious: thyroidectomy
unsatisfactory specimen: FNA in 1-4 weeks
3 nonthyroidal neck masses
-inflammatory lesions: abscess/lymphadenitis
-congenital lesions: thyroglossal duct, branchial cleft cyst
-malignant lesions: lymphoma, metastases, squamous cell carcinoma
gs test for thyroid nodule
FNA
what tx for thyroid nodules is diagnostic and therapeutic
thyroid suppression:
administer TSH -> suppresses TSH secretion -> up to 1/2 of benign nodules disappear
4 rf for thyroid carcinoma
neck radiation
fam hx of thyroid ca or MENII
young age
female
5 characteristics of a cancerous thyroid nodule
single nodule
cold nodule
increased calcitonin
LAD
hard, immobile nodule
4 sx of thyroid carcinoma
voice change
dysphagia
neck discomfort
rapid enlargement
mcc of thyroid enlargement
multinodular goiter
3 indications for surgery w. multinodular goiter
cosmetic deformity
compressive sx
can not r.o ca
what is plummer’s dz
toxic multinodular goiter
catecholamine secreting adrenal tumor, which secretes NE and epi autonomously
pheochromocytoma
5 sx of a pheo
5 p’s
pressure (htn)
pain (HA)
perspiration
palpitations/tachy
pallor
what conditions are associated w. pheo’s (3)
neurofibromatosis type 1
MEN 2A/2B
von hippel-lindau dz
dx for a pheo
- 24 hr urine screen for catecholamine metabolites (metanephrine/vanillylmandelic acid)
- MRI vs CT abdomen
tx for a pheo
- preop nonselective alpha blockade x 7-14 days: phenoxybenzamine vs phentolamine
- bb
what happens if you treat a pheo w. a bb before an alpha blockade
unopposed alpha constriction -> life threatening htn
where are pheo’s found
adrenal medulla and sympathetic ganglion
mc sx of a pheo
htn
2 lab findings of a pheo (other than catecholamine metabolites)
hyperglycemia
polycythemia
what must you rule out in a pt w. a pheo
MEN II
almost all cases are bilat
mc type of thyroid carcinoma
papillary
thyroid nodules must be > _ cm in order to be palpated
1
mc type of benign thyroid nodule
thyroid adenoma
2 lab findings of a nonfunctional thyroid nodule
normal vs high TSH
normal T4
indication to bx a thyroid nodule
> 1 cm
tx for cancerous thyroid nodules always includes (2)
complete vs partial thyroidectomy
chemo
indication for xrt w. a cancerous thyroid nodule
anaplastic thyroid ca
5 types of thyroid carcinoma: mc -> lc
papillary
follicular
medullary
huerthle cell
anaplastic/undifferentiated
what 2 oncogenes are associated w. thyroid carcinoma
Ras
RET
histologic findings of papillary carcinoma
psammoma bodies
2 types of adrenal masses
functional
nonfunctional
mc type of adrenal mass
nonfunctional adenoma
3 types of functional adrenal tumors
pheochromocytoma
aldosteronoma
cortisol-producing adenoma
3 features of adrenal cortical cancer (acc)
mixed cortisol
aldosterone hypersecretion
heterogenous/large tumors (>4 cm)
lab work up for acc (4)
-plasma or urine fractionated metanephrines (r/o pheo)
-serum K+/aldosterone/renin
-24 hr urinary free cortisol or dex suppression
-DHEA-S
CT findings of acc (7)
> 4 cm
calcifications
irregular shape
central necrosis
high attenuation
enhanced w. contrast
delayed contrast washout
CT findings of adrenal adenoma (3)
low attenuation
rapid contrast washout
smooth borders
indications for adrenalectomy
e.o hormone production
suspicious for acc
what type of adrenalectomy is NOT recommended for ACC
laparoscopic
high rate of recurrence due to positive/close margins
tx for metastatic nonfunctioning adrenal tumors
chemo
xrt
