Endocrinology from PANCE Pearls Flashcards
What is Hyperthyroidism and what does it do in your body
High T3/T4 Increases Metabolism Increases glucose absorption from GI Catabolic effect on muscle mass Increased CO and RR Increased Catecholamine levels Increased Oxygen Consumption
What is the most common cause of Hyperthyroidism
Graves
Autoimmune
Antibodies against TSH receptor
What is a common cause of Hyperthyroidism in the elderly
Toxic Nodular Goiter
Leads to thyrotoxicosis (Increased T3/T4)
Sx of Hyperthyroidism
Anxiety, Emotional Lability, Weight loss, Weakness, Tremor, Palpitations, Heat Intolerance, Warm, Moist Skin, Thin Hair, Tachycardia, Fine Resting Tremor, Hyper-reflexia
What is a unique sx seen in Graves
Exophthalmos
Proptosis, Lid Lag, Eyes Bulging
Dx of Hyperthyroidism
Low TSH
High T3/T4
If graves, see TSH Ig Antibodies
Tx of Hyperthyroidism
Anti-Hormonal Therapy: PTU (propylthiouriacil) or Methimazole Radiactive Iodine destroys gland
Which of the tx for Hyperthyroidism can be used during pregnancy
PTU
What drugs can you use to curb sx of Hyperthyroidism
Beta Blockers: Propranolol, decreases HR and BP
Glucocorticoids prevent conversion of T4 to T3
Dx of TSH secreting pituitary adenoma
High TSH
High T3/T4
MRI to look for pituitary mass
Tx of TSH secreting pituitary adenoma
Transphenoidal surgery to remove pituitary tumor
What is Hyperparathyroidism
Overactive Parathyroid glands that lead to increased calcium absorption
What is primary Hyperparathyroidism and what causes it
Excess inappropriate PTH production
Parathyroid Adenoma is the most common cause
What is secondary Hyperparathyroidism and what causes it
Increased PTH due to hypocalcemia or Vitamin D deficiency
Chronic Kidney Failure is the most common cause
Sx of Hyperparathyroidism
Bones, Stones, Groans and Psychic Groans
Bone pain, Kidney stones, Abdominal Pain Constipation, Depression and Confusion
Dx of Hyperparathyroidism
Increased PTH Hypercalcemia Decreased Phosphate Check 24 hour urine calcium excretion Osteopenia on bone scan
Tx of Hyperparathyroidism
Surgery
Parathyroidectomy
Vitamin D/Calcium supplement if secondary
What is Hypoparathyroidism
Due to low PTH or Insensitivity to its action
What are the more common causes of Hypoparathyroidism
Accidental damage/removal of parathyroid during neck/thyroid surgery
Autoimmune destruction of parathyroid gland
Sx of Hypoparathyroidism
Hypocalcemia: Carpopedal Spasms, Trousseau and Chvostek Sign, Perioral Parasthesias, Increased DTR
Chvostek Sign: Tap on facial nerve and it causes twitching
Trousseau Sign: Blood pressure cuff on arm blocks flow to brachial artery, causes flexion in fingers, extension of wrist
Dx of Parathyroidism
Hypocalcemia
Decreased PTH
Increased Phosphate
Tx of Parathyroidism
Calcium Supplement and Vitamin D
Vitamin D helps to absorb calcium in gut (Ergocalciferol or Calcitriol)
What is Primary Hypothyroidism
Increased TSH
Low T3/T4
What is the most common cause of Hypothyroidism in the United States vs. world
United States: Hashimotos (Autoimmune Disorder)
World: Iodine Deficiency
Sx of Hypothyroidism
Decreased Metabolic Rate Cold intolerance Weight gain Dry, thick skin Goiter Fatigue, depression Constipation, Bradycardia, Decreased CO Menorrhagia Hypoglycemia
Dx of Hypothyroidism
If Hashimotos, Thyroid antibodies present
Tx for Hypothyroidism
Levothyroxine
What are risk factors for a thyroid nodule
Extremes of age (very young or very old)
Hx of head or neck irradiation
Sx of thyroid nodule
Asymptomatic
Compressive sx: difficulty swallowing or breathing, neck jaw or ear pain, hoarseness
Dx of Thyroid Nodule
Benign: Smooth, firm, irregular, sharply outlined
Malignant: Rapid growth, fixed, no movement with swallowing
Thyroid Function Test (Euthyroid = normal functioning thyroid gland)
FNA is best initial test
-Benign: Colloid
-Malignant: Follicular
Radioactive Iodine Uptake Scan, cold is suspicious for malignancy
Ultrasound
Tx of Thyroid Nodule
Thyroidectomy
Observation with ultrasound
Suppressive therapy with thyroid hormone in attempt to shrink nodule
What are the 4 forms of Thyroid Cancer
Which one is the most common
Which one is the most aggressive/worst and least aggressive/best
Papillary: Most common and Least Aggressive, Great prognosis
Follicular: More aggressive
Medullary: More aggressive, low cure rate
Anaplastic: Most aggressive, Rapid growth, Poor prognosis
What is Pheochromocytoma
Catecholamine Secreting Adrenal Tumor
Secretes Norepinephrine and Epinephrie Autonomously and Intermittently
Sx of Pheochromocytoma
HTN
Palpitations, Headaches, Excessive Sweating
Chest or abdominal pain, weakness, fatigue, weight loss
Dx of Pheochromoctyoma
Increased 24 hour urinary catecholamines including metabolites (Metanephrine and Vanillylmadelic Acid)
MRI or CT
Tx of Pheochromocytoma
Complete Adrenalectomy
Preoperative nonselective alpha Blockage (Phenoxybenzamine or Phentolamine for 7-14 days followed by beta blockers
Remember: Surgery causes a release of catecholamine release, so you want to block this prior to surgery)
What is Cushings Disease
High Cortisol caused by excess ACTH secretion
What is Cushings Syndrome
Signs and Sx related to Cortisol
Sx of Cushings Disease
Central Trunk Obesity Moon Facies Buffalo Hump Superclavicular Fat Pads Wasting Extremities Striae HTN Weight Gain Osteoporosis, Hypokalemia Acanthosis Nigricans Hirtuism
Dx of Cushings Disease (1st step)
Test to see that you have elevated Cortisol
24 hour urine
Salivary
Low Dose Dexamethasone
What do the results of the Low Dose Dexamethasone tell you
Normal response is Cortisol suppression
No suppression = Cushings Syndrome
Dx of Cushings Disease (2nd step)
Measure ACTH
If elevated ACTH: Dependent
If normal or reduced: Independent
If Independent it means the adrena glands are going crazy (adrenal tumor), so scan the adrenals and take out the tumor
If Dependent, it means Cortisol is being secreted as a response to high ACTH.
Now you need to figure out where its coming from. Could be Pituiatry Tumor or Ectopic Tumor
Dx of Cushings Disease (3rd step - Where is the high ACTH coming from)
High dose Dexamethasone
If Cortisol is suppressed, it means excess ACTH is coming from Pituiatry tumor (adrenal glands are responding normally to suppression)
If cortisol is NOT suppressed, it means ACTH is coming from an ectopic location (mutated cells)
Tx of Cushings Disease
Transphenoidal Surgery
Tx of Cushings due to Ectopic or Adrenal Tumor
Remove Tumor
Tx of Cushings if due to exogenous cause (like excess steroid use)
Withdraw gradually to avoid Addison Crisis
