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Endocrinology > Final > Flashcards

Final Flashcards

1
Q

Name 3 conditions of hyperpituitarism in the anterior pituitary.

A

Increased GH - Pituitary gigantism, acromegaly

Increased ACTH - Cushing Disease

Increased PRL - Hyperprolactinemia

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2
Q

Name a condition of hyperpituitarism in the posterior pituitary.

A

Increased ADH - SiADH

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3
Q

Name a cause of hypopituitarism in the anterior pituitary.

A

Low GH - Pituitary dwarfism

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4
Q

Name a cause of hypopituitarism in the posterior pituitary.

A

Low ADH - Diabetes insipidus

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5
Q

What is the emergent condition related to hypopituitarism?

A

Pituitary Apoplexy (hemorrhage or impaired blood supply of the pituitary gland)

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6
Q

What is the cause of Sheehan Syndrome?

A

Postpartum pituitary gland necrosis. Ischemic necrosis due to blood loss and hypovolemic shock during childbirth.

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7
Q

What is the most common pituitary adenoma?

A

Prolactinoma

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8
Q

What are the lab values associated with Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

A

Low serum osmolality

High urine osmolality

Low BUN due to volume expansion

Plasma Na+ < 135

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9
Q

Compare Diabetes insipidus and Syndrome of Inappropriate Antidiuretic Hormone

A

DI: Low ADH

  • Causes: central, nephrogenic, dipsogenic, geestational
  • ↑ urination
  • ↑ thirst
  • Dehydration
  • Polyuria, polydipsia
  • DX: water deprivation testing, desmopressin stimulation test

SIADH: High ADH

  • Causes: idiopathic, pulmonary disease, cancer, drugs,
  • ↓ Urination
  • ↑ Urine osmolality
  • ↑ ECF fluid > hypo-osmolality, hyponatremia
  • ↑ Intracellular volume > cell swelling (brain) (neurological symptoms: mild > severe/death)
  • Generalized muscle weakness, myoclonus, tremor, asterixis, hyporeflexia, ataxia, dysarthria
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10
Q

Compare the SXS of DI and DM.

A

DI:

  • Non-sweet pee
  • Causes: central, nephrogenic, dipsogenic, geestational
  • ↑ urination
  • ↑ thirst
  • Dehydration
  • Polyuria, polydipsia

DM

  • SWEET PEE
  • Polydipsia
  • Polyuria
  • Polyphagia
  • Weight loss
  • Blurry vision
  • Hyperglycemia in the setting of a combination of insulin resistance and imparied insulin secretion
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11
Q

SXS of hyponatremia (acute and chronic).

A

N/V

Headache

Seizure

Coma

Respiratory arrest

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12
Q

What is the cause of congenital adrenal hyperplasia (CAH)?

A

Rare autosomal recessive disease resulting from mutations in steroidogenic enzymes. Causes low adrenocortical steroids (cortisol always affected). Low cortisol signals ACTH to be released = hyperplasia.

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13
Q

What emergent condition can congenital adrenal hyperplasia lead to?

A

Adrenal crisis

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14
Q

What are the SXS of congenital hyperplasia?

A

F: Ambiguous genitalia

Decreased BP

Short height

Early puberty

Rapid growth

Pubic hair at early age

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15
Q

Name 2 medullary tumors.

A

Pheochromocytoma

Neuroblastoma

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16
Q

What are the SXS of the 2 medullary tumors?

A

Pheochromocytoma - Secrete excess catecholamines, often cause severe HTN. Palpitations, tachycardia, headache, profuse sweating, episodes of dramatic BP elevation, insomnia, facial flushing, anxiety.

Neuroblastoma - Tumors of primitive neural crest cells related to chromaffin cells. Can develop in the neck, chest, abdomen, spine. Abdominal distention, abdominal mass, bone pain, dancing feet/eyes. Most common cancer in babies. 90% in <5YO

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17
Q

What are the causes of primary vs secondary hyperaldosteronism?

A

Primary - Conn Syndrome, Adrenal hyperplasia, Congenital adrenal hyperplasia.

Secondary - Renal artery stenosis, CHF, cirrhosis, nephrotic syndrome

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18
Q

What are the differences in lab values in primary vs secondary hyperaldosteronism?

A

Primary - High aldosterone, regular renin

Secondary - High aldosterone, high renin

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19
Q

What is the condition associated with primary adrenocortical insufficiency?

A

Addison Disease

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20
Q

What are the secondary and tertiary causes of adrenocortical insufficiency?

A

Secondary - Pituitary pathology or exogenous glucocorticoid therapy

Tertiary - Hypothalamic tumors

21
Q

What are the SXS of Cushing Disease?

A

High cortisol, central adiposity, moon facies, purple striae, excess hair,

22
Q

What is the main cause of Cushing Disease?

A

Pituitary adenoma

23
Q

What are the different types of goiters and their symptoms/causes?

A
  • Colloid - early iodine deficiency, smooth enlarged thyroid from colloid accumulation
  • Nodule - iodine deficiency continuation, follicles become cystic and irregularly sized
  • Toxic goiter: Grave’s Dz/hyperthyroidism
24
Q

What is the most common cause of hypothyroidism and its etiology?

A

Hashimoto Thyroiditis; autoimmune

25
Q

What is a common symptom associated with hypothyroidism? (Not the obvious ones)

A

Carpal tunnel syndrome

26
Q

How would lab(s) differ in primary vs central (secondary) hypothyroidism?

A

Primary - ↑TSH, ↓fT4

Secondary - ↓ TSH, ↓fT4

27
Q

What is an emergency condition to look out for with hyperthyroid pts? What are sx of this condition?

A

Thyroid storm; high fever, severe tachycardia, weight loss, heat intolerance

28
Q

What is a common autoimmune cause of hyperthyroidism? What would thyroid hormone levels look like in this condition?

A

Graves disease;

↓ TSH

↑ fT4/T3

↑ TSIs

29
Q

What are the common causes/risks for functional hypothalamic amenorrhea?

A

Female athlete triad: Anorexia, stress, over exercising

30
Q

How is amenorrhea is diagnosed?

A

No period by age 15, in the presence of normal secondary sex characteristics OR 13 with absence of secondary sex characteristics

Secondary: dx of exclusion

↑ androgen/testosterone

31
Q

What is a common cause of premature ovarian failure/insufficiency? What lab(s) would be abnormal with this condition?

A

Turner syndrome

↑ FSH > 25

↓ estradiol <50

32
Q

What lab(s) would be markers of menopause?

A

↑ FSH > 25

↓ inhibin and AMH

33
Q

What are the criteria for making a diagnosis of overt diabetes at the initial pregnancy visit?

A
  • Fasting plasma glucose > 126
  • A1C > 6.5
  • Random plasma glucose > 200 with follow up fasting glucose/A1C
34
Q

What is the definition of pre-eclampsia?

A

Pregnancy-induced HTN + proteinuria and/or edema

35
Q

Sx of preeclampsia?

A
  • Headache that won’t go away/is getting worse
  • Edema
  • RUQ pain
  • Decreased urinary output
  • Urinary frequency of thimbleful of protein urine
  • N/V
  • Malaise
  • Altered mentation
  • Asym if mild
36
Q

Why do thyroid levels need to be monitored for a pregnant pt with hypothyroidism?

A

Pregnancy causes fluctuations in thyroid hormone; need to use trimester specific reference ranges

37
Q

Risk factors for postpartum thyroiditis?

A

Hx of autoimmune, antithyroid antibodies, previous thyroid dysfunction, Fhx

38
Q

What is the most common cause for primary hypogonadism? What is the cause of this disorder?

A

Klinefelter syndrome - extra chromosomes in males

39
Q

What is the primary diagnostic lab in late onset hypogonadism (andropause)?

A

Low serum total testosterone

40
Q

Compare Klinefelter syndrome and Late Onset Hypogonadism (andropause).

A

Klinefelter

  • Small statue + testicles (hypogonadism + infertility)
  • Gynecomastia
  • ↓ Muscle mass
  • ↓ Body/facial hair
  • Broader hips, long arms/legs
  • Learning + reading impairment
  • Low androgen levels

Late onset hypogonadism

  • Sexual fxn: Low libido, ED
  • ↓ Bone mineral density (increased fracture risk)
  • ↓ Muscle mass/strength, ↑ fat mass, central obesity, gynecomastia
  • Low energy
  • Depression
  • Impaired memory
  • ↓ Testicular size
  • ↓ Ejaculated sperm density
  • Low testosterone
41
Q

What is the difference between type 1 DM and type 2 DM?

A

Type 1 - autoimmune → absolute insulin deficiency

Type 2 - hyperglycemia + insulin resistance → impaired insulin secretion

42
Q

What is the emergency complication you have to look out for in all types of DM but is more common in DM1? What are the sx?

A

Diabetic ketoacidosis (DKA)

  • Results from excess ketone body formation from increased fatty acid catabolism
  • Rapid breathing
  • Fruit-like odor breath
  • Disorientation
  • Sudden coma
43
Q

What lab values are diagnostic of DM?

A

Asymptomatic:

Fasting plasma glucose > 126 mg/dL

OR

A1C > 6.5%

OR

Oral glucose tolerance test (OGTT)

2 concordant lab values on a single sample or 1 value repeated on 2 diff samples.

Symptomatic:

Random plasma glucose > 200 mg/dL

4 autoantibodies associated with T1DM:

Islet cell antibodies (ICA) – target cytoplasmic proteins in the β cells

Glutamic Acid Decarboxylase (GAD-65) antibodies

Insulin autoantibodies (IAA)

Islet Antigen 2 antibody (IA-2A) – target protein tyrosine phosphatase

44
Q

What is the difference between LADA and MODY?

A

LADA: hyperglycemia and insulin deficiency w/ varying degrees of insulin resistance w/ the presence of autoimmune antibodies

MODY: genetic defects of B-cell function

45
Q

What is the Chvostek sign and the Trousseau sign?

A

Chvostek: Elicited by tapping the facial nerve about 2 cm anterior to the earlobe, just below the zygoma—response is contraction of facial muscles

Trousseau: Elicited by inflating a BP cuff to ~20 mmHg above systolic pressure for 3 minutes—response is carpal spasm

46
Q

What is the most common cause of hyperparathyroidism and hypoparathyroidism?

A

Hyper - Adenoma

Hypo - Surgery

47
Q

What are the symptom differences between hypocalcemia and hypercalcemia?

A

Hypocalcemia: “CATs go numb” Convulsions, arrhythmias, tetany, numbness/paresthesia

Hypercalcemia: Stones, bones, groans, and moans

48
Q

How do you diagnose osteoporosis?

A

Clinical dx can be made in the presence of a fragility fracture

OR

DEXA T-score ≤ -2.5 standard deviations (SD) at any site based upon bone mineral density (BMD) measurement

Endocrinology (4 decks)

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