FINAL Flashcards

1
Q

hyperaldosteronism

A

-adrenal cortex
-primary- single adenoma (conns), bilateral adrenal hyperplasia
-renin independent-> low renin and high aldosterone
-low K
-polyuria, polydipsia
-BP > 150/90 3 diff times or > 140/80 on 3 diff meds or controlled on 4 diff meds
-paresthesias - metabolic alkalosis
-constipation
-palpitations
-high HCO3, low H
-saline infusion test, oral sodium loading test, CT, adrenal venous sampling
-unilateral- surgery
-bilateral- spironolactone
-secondary- high renin and high aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

congenital adrenal hyperplasia (CAH)

A

-glucocorticoid deficiency
-low cortisol high ACTH

-21β-hydroxylasedeficiency: MC
-Hypotension

-XX GENOTYPE
-Female pseudohermaphroditism: clitoromegaly and/or male external genitalia along with a uterus and ovaries
-Precocious puberty- early puberty
-Virilization, irregular menstrual cycles, infertility, hair
-diff dx- PCOS- do US

-XY GENOTYPE
-Normal male external genitalia at birth
-Precocious puberty

-11β-hydroxylase& 17α deficiency:
-Hypertension

-XX GENOTYPE
-Normal female external genitaliaatbirth
-Delayed puberty(primary amenorrhea) or sexual infantilism

-XY GENOTYPE
-Male pseudohermaphroditism:female external genitalia with a blind ending vagina and intra-abdominal testes at birth
-Delayed puberty or sexual infantilism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CAH symptoms

A

-adrenal crisis
-failure to thrive
-hypoglycemia
-hyperpigmentation
-gender dysphoria
-21 beta hydroxylase deficiency -> males present with classic CAH- salt wasting crisis -> shock
-21 beta- low aldosterone and high K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CAH dx

A

-17 hydroxyprogesterone increase in 21 beta
-low cortisol even after cosyntropin (ACTH)
-neonatal screening
-advanced bone age in children
-non classic men presentation -> familial genetics
-CT- abdomen testes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CAH tx

A

-replace low cortisol
-since ACTH is high -> will increase androgens -> control this too
-hydrocortisone- prevent crisis in time of stress
-prednisone - good for androgen excess in children
-increase dose with sickness

-21- fludrocortisone, NaCl
-11- spironolactone, decrease Na
-17- spironolactone, estrogen in females, decrease Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

pheochromocytoma: adrenal medulla

A

-triad- headaches, tachycardia, sweating
-paragangliomas
-MEN2, von hippel-lindau syndrome, neurofibromatosis type 1, familial paragangliomas
-must screen before medullary thyroid cancer surgery
-increase appetite and weight loss
-hyperglycemia
-reynauds
-cardiomegaly, cardiomyopathy
-postural tachy, postural hypotension
-triggered by dye, glucagon inj, needle bx, anesthesia, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pheochromocytoma labs

A

-thyroid- WNL
-leukocytosis
-ESR high
-hyperglycemia- high
-high renin
-metanephrine > 2.2
-catecholamine > 135
-plasma metanephrine- more sensitive
-urinary assay for vanillylmandelic acid (VMA)
-CT, genetic testing, MRI, nuclear, imaging

-things that interfere:
-drugs- acetaminophen, antihistamines, anti-HTN
-food- banana, peppers, caffeine
-ds- severe pain renal failure, exercise hypoglycemia, severe emotion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

pheochromocytoma complications

A

-sudden blindness
-CVA
-sudden death
-ARDS
-severe hypotension after resection
-renal failure
-MI
-seeding of tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

pheochromocytoma tx

A

-laparotomy

-preop- CCB, alpha blocker
-propranolol
-nicardapine- HTN crisis

-post op - blood transfusion, volume replacement

-follow up- recheck urine catecholamines and whole body scan

-inoperable/metastatic tumor- metyrosine

-metastatic pheochromocytoma- combo chemo and irridation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

neurofibromatosis type 1

A

-multiple neurofibromas
-cafe au lait spots
-axillary freckling on skin
-lisch nodules of iris
-usually on adrenals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

adrenal insufficiency

A

-high ACTH, low cortisol
-tx- hydrocortisone
-herediatary factors
-associ with other autoimmune ds (DM, hypothyroid) or mucocutaneous candida infections
-causes: autoimmune, granuloma (TB), congenital adrenal hypo/hyperplasia, B/L hemorrhage, drugs that block corticosteroid synthesis (antineoplastic, HIV meds like dronabinol, ketoconazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

adrenal insufficiency symptoms

A

-salt cravings
-hypotension
-hypoglycemia
-lack of hair
-weakness
-fatigue
-dizzy
-wt loss
-nausea/vomiting
-diarrhea
-intolerance to temp
-abdominal pain
-depression/anxiety
-amenorrhea
-orthostatic hypotension
-hyperpigmentation- high ACTH
-vitiligo

-addisonian crisis-
-fever
-orthostatic hypotension
-salt craving
-sharp sudden pain in abdomen, legs, lower back
-vomiting, diarrhea
-hypoglycemia
-dehydration
-loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

adrenal insufficiency dx

A

-morning cortisol, morning ACTH, ACTH stimulation test
-primary- screen for hypoaldosteronism and hypoandrogenism -> tx depends on this
-secondary- tx not affected by this
-<3 @ 8AM, <8 @ anytime, >20 at 8AM is unlikely
-DHEA <1000
-PRIMARY- high renin*
-SECONDARY- normal renin*
-ACTH > 200 in primary

-primary- no change after ACTH stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

adrenal insufficiency tx

A

-acute:
-fluid replacement
-if still hypotensive -> dexamethasone STAT
-dose doubled during fever, infection, trauma, minor physical stress

-chronic:
-prednisone -
-double dose in summer, sickness
-fludrocortisone

-secondary adrenal insuff- tx- hydrocortisone

-alert bracelet
-emergency pack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

polyglandular deficiency syndrome

A

-autoimmune
-Symptoms d/o the combination of deficiencies
-Three types
-Diagnosis - requires measurement of hormone levels and autoantibodies against affected endocrine glands
-Treatment - replacement of hormones
-Chronic mucocutaneous candidiasis - lifelong antifungal therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

cushings

A

-cushing syndrome- exogenous vs endogenous
-other etiologies- B/L micronodular dysplasia, B/L ACTH independent macronodular hyperplasia, ectopic production of CRH
-if older suspect - ectopic lung
-associated with- DM, alcoholism, MEN type 1, use of steroids
-striae differentiates
-CT or MRI does not R/O cushing disease if not seen -> 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

cushing work up

A

-urinary free cortisol -> 3 24h collections -> rules in cushings
-low dose dexamethasone given at 11PM and cortisol measured at 8AM -> suppresses ectopic and disease; if no suppression -> adrenal
-late night salivary cortisol > 5
-CRH -> disease response
-DEX .8 -> suppresses disease
-BIPSS -> disease gradient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

cushing tx

A

-treat comorbidities of ds -> osteoporosis, psychiatric, DM, HTN, muscle weakness, hypokalemia, infection!
-bone densitometry

-metyrapone- inhibits cortisol
-adrenal enzyme inhibitors- ketoconazole or adrenal steroidogenesis blocker

-cushing disease- trans-sphenoidal resection, radiation

-adrenalectomy- mitotane-antineoplastic (adrenal carcinoma)

19
Q

hyperparathyroidism

A

-hypercalcemia of malignancy - high PTHrP, PTH
-HPT- usually single adenoma
-severe- osteitis fibrosa- tapering of distal collar bones, salt&pepper, brown tumors on long bones, subperiosteal resorption of distal phalange
-abdominal pain
-neuro- proximal myopathy
-renal
-GI- PUD, acute pancreatitis, constipation
-cardio- bradycardia, LV hypertrophy, shortening of QT, HTN

-familial hypocalciuric hypercalcemia- Ca doesnt go down after resection

20
Q

hypercalcemia causes

A

-parathyroid related:
-PTH*
-lithium therapy
-familial hypocalciuric hypercalcemia
-MEN1

-malignancy*:
-breast metastases
-humoral mediation of hypercalcemia (lung, kidney)
-hematologic malignancy (multiple myeloma, lymphoma, leukemia)
-PTHr

-vitamin D:
-intoxication
-sarcoidosis/granulomatous ds
-idiopathic hypercalcemia of infancy

-assoc with high bone turnover
-immobility
-hyperthyroid
-thiazides
-vitamin A intoxication

-assoc with renal failure:
-severe secondary HPT
-aluminum intoxication
-milk alkali syndrome

21
Q

PTH dx and tx

A

-high PTH + Ca = HPT
-If low, check PTHrP, Vitamin A & D, TSH, Cortisol, ACE, 24h urine calcium clearance, review meds
-24 hour urine- <50 -> familial hypocalciuric hypercalcemia
-imaging- wrist, spine, hip DEXA, stones, 99m technetium sestamibi radionuclide scan

-surgery- Ca > 11.5, T-score < -2.5, renal stone
-replace volume
-biphosphonates
-calcitonin - in rapid emergency
-facilitate calciuresis - loops
-estrogen (post menopausal)- raloxifene
-calcimimetic agents
-mild/asymptomatic- no tx

22
Q

secondary hyperparathyroid

A

-renal:
-high PTH
-low Ca
-high phosphate
-osteomalacia, osteitis fibrosa cystica

-vitamin D deficiency
-high PTH
-low calcium
-low phosphate

-prevention- vitamin D, phosphorus binders (sevelamer)

-tx- calcimimetic agents

-surgical- in refractory cases, severe hypercalcemia, severe bone disease, severe pruritis, calciphylaxis, severe myopathy

23
Q

tertiary hyperparathyroid

A

-secondary hyperparathyroidism that is no longer responsive to medications
-Multiple adenomas
-calcium- phosphate product > 70
-severe bone ds and pain
-intractable pruritis
-soft tissue calcification with tumor calcinosis
-calciphylaxis- dark indented scab

-high PTH (renal)
-high calcium
-high phosphorus

24
Q

hypoparathyroid

A

-CaPO4- 60 WNL -> >70 -> crystals in soft tissue -> arteriosclerotic ds
-causes- thyroidectomy, autoimmune, infiltrative ds (wilson, hemochromatosis, granulomas, metastasis), hypomagnesium, DiGeorge syndrome, idiopathic, acute pancreatitis
-renal manifestations of hypoparathyroidism -> due to hypercalciuria
-MC cause of hypocalcemia- hypoalbuminemia

25
Q

hypoparathyroidism S&S

A

-ACUTE
-Tetany
-Carpopedal spasm
-Cramping
-Convulsions
-Circumoral and distal extremity tingling
-Irritability

-CHRONIC
-Lethargy
-Anxiety
-Parkinsonism
-Mental retardation
-Personality changes
-Blurred vision

-dry skin, brittle nails, coarse hair
-HF, arrhythmias
-prolonged QT or ST flat
-cataracts
-laryngospasm
- papilledema
-encephalopathy, dementia
-seizures
-chvosteks sign
-trousseaus sign

26
Q

pseudohypoparathyroidism

A

-albright’s hereditary osteodystrophy
-short stature, round face, mental retardation, calcification of basal ganglia, shortened metacarpal and metatarsal bones, hypothyroidism, other subtle endocrine issues

27
Q

calcium values and testing

A

-total Ca= 8.5-10.3
-in the presence of normal albumin
-ionized Ca = 4.6=5.3

-must collect:
-total Ca
-ionized/free Ca
-urinary Ca
-albumin
-phosphate
-vitamin D
-PTH
-Mg
-renal function
-ECG
-CT- brain calcifications
-slit lamp- cataracts

28
Q

hypocalcemia tx

A

-ACUTE
-ABCs
-calcium gluconate IV
-IV calcium- irritating
-oral calcium
-vitamin D
-Mg

-CHRONIC
-calcitriol and calcium
-ergocalciferol and calcium
-vitamin D or calcium

29
Q

graves disease

A

-genetics and environment
-increase risk postpartum
-Splenomegaly
-Gynecomastia
-dermopathy
-pretibial myxedema
-palmar erythema
-onycholysis
-alopecia
-early signs- sensation of grittiness, eye discomfort, excess tearing
-corneal exposure and damage
-proptosis
-thyroid acropachy
-hyperreflexia
-proximal myopathy
-bone resorption
-hypercalcemia
-elderly- heart problems

30
Q

hyperthyroid tx

A

-thioureylene
-propylthiouracil
-methimazole
-carbimazole
-propranolol

-radioactive 131 iodine
-cant give to pregnant or children
-can worsen orbitopathy - avoid
-stabilize with meds before

-surgery
-pregnant pt refractory to meds
-youth
-rapid tx, compression, thyroid cancer concern

-meds- monitor every 3 months
-radioidone- monitor at 6 weeks, 3 months, 6, annual

31
Q

goiter tx

A

-toxic uninodular and multinodular goiter
-require radioactive 131 iodine -> give meds to stabilize first
-or surgery
-do not go into remission

32
Q

thyroid storm

A

-afib/shock
-fever > 104
-hypotension
-AMS
-withdrawl of meds
-concurrent illness
-aggressive antithyroid therapy

33
Q

causes of hypothyroid

A

-iatrogenic- radioactive 131 iodine, surgery
-lithium
-amiodarone
-iodine excess
-postpartum
-autoimmune

-assoc with many disease- addisons

-sx- cardiomegaly, dyslipidemia

34
Q

hypothyroid tx

A

-levothyroxine- takes 4-6 weeks

-liothryonine (T3)- post thyroidectomy and before iodine scan

-screen annual at first

35
Q

myxedema coma

A

-paralytic ileus
-elderly
-hypothermia
-respiratory depression* - hypoventilation
-psychosis
-cerebellar ataxia
-myxedema heart disease
-cardiomegaly
-pericardial effusion

-tx- respiratory support
-IV levo
-hydrocortisone
-hypertonic saline or IV glucose warmed

36
Q

congenital hypothyroidism

A

-prolonged jaundice
-hoarse cry
-constipation
-somnolence
-feeding problems
-protruding tongue
-dry skin
-wide set eyes
-broad flat nose
-short
-impaired mental
-protruding abdomen with umbilical hernia

37
Q

suppurative/acute thyroiditis

A

-bacterial- staph, strep, enterobacter
-fungal- aspergillus, candida, coccidioides, histoplasma, and pneumocystis
-radiation
-amiodarone
-immunocompromised
-presence of a piriform sinus

-pain +
-abrupt fever
-dysphagia
-red
-flucuation
-lymph

-tx- antibiotics
-incision and drain

38
Q

subacute thyroidits/ de quervain’s

A

-viral
-mycobacterial infection
-interleukin-2
-lithium

-mimic manic episode
-1. hyperthyroid- radioactive iodine LOW, ESR HIGH
-2. hypothyroid- radioactive iodine NORMAL/HIGH
-pain*
-fever
-sore throat
-small goiter

-tx- aspirin, NSAID
-glucocorticoids
-beta blockers, levo

-silent
-postpartum, IL-2, IFN, or amiodarone
-underlying autoimmune
-TPO antibody +
-postpartum- 3x more likely in DM1
-tx- propranolol, levo NO GLUCOCORTICOIDS

39
Q

chronic thyroidits

A

-autoimmune- hashimoto
-antithyroid antibody +
-enlarged
-firm
-finely nodular
-neck tightness
-xerostomia
-keratoconjunctivitis- sicca
-FNA bx
-tx- levo
-if large goiter and normal/high TSH -> T4

-hashimoto’s with hyperthyroid- low T3

-riedel’s
-painless
-compression
-fibrosis
-fixed
-dx- open bx
-tx- surgical relief, tomoxifen

-parasitic
-traumatic

40
Q

differentiated thyroid cancer

A

-iodine uptake +
-follicular cells

-papillary
-assoc with FAP/gardner
-hx of irradiation
-no invasion

-follicular
-hematogenous spread

-mixed

-hurthle
-multifocal
-bilateral
-nonfunctional on radioiodine
-cervical node
-makes thyroglobulin

41
Q

medullary thyroid cancer

A

-parafollicular C-cells
-painful
-cervical nodes
-MEN2
-calcitonin - monitor post op
-0 iodine uptake

41
Q

anaplastic thyroid

A

-non-differentiated
-painful
-enlarging neck
-warm discolored overlying skin
-compressive symptoms
-0 iodine uptake

42
Q

suspicious nodule dx

A

-TSH (normal in Ca), thyrotropin, calcitonin test
-if TSH suppressed -> radioiodine imaging
-US
-FNA- 3x- >1cm, suspicious US, lymphadenopathy invasion, compression, + fam hx, hx of irradiation

-monitor- radioiodine imaging, calcitonin, thyrotropin
-thyroglobulin- BEST MARKER

43
Q

thyroid cancer tx

A

-differentiated - surgically excised
-anaplastic- CT and chest x-ray at time of dx! -> resect if you can -> if not, airway management and pain control

-thyroidectomy indication- extremes of age > 1.5cm, papillary, follicular, hurthle, medullary
-contraindications for thyroidectomy- lymphoma*, unresectable anaplastic, occult papillary thyroid, small follicular lesions without invasion

-modified radical neck dissection- collar bone to jaw

-levo after surgery

-radioiodine ablation- 4-6 weeks after surgery to ablate remnant thyroid tissue and metastasis

-chemo- differentiated that dont respond to traditional therapy -> doxorubicin

-chemo + radiation- anaplastic

-external beam therapy!!!!- anaplastic and primary thyroid lymphoma