IM- Endocrine Flashcards
Tx for prolactinoma with macroprolactinoma (>1cm) (2)
Dopaminergic agonists
Cabergoline & Bromocriptine
In primary adrenal insufficiency, the effect on
Cortisol
ACTH
Aldosterone
Cortisol- LOW
ACTH- HIGH
Aldosterone- LOW
In secondary/pituitary (central) adrenal insufficiency, the effect on
Cortisol
ACTH
Aldosterone
Cortisol- LOW
ACTH- LOW
Aldosterone- Normal
4 presentation of Primary adrenal insufficiency
- Hyperpigmentation
- Hyperkalemia
- Hyponatremia
- Hypotension
1 presentation of secondary & tertiary adrenal insufficiency
- possible hyponatremia (mild symptom)
Secondary adrenal insufficiency is caused by
Pituitary- chronic glucocorticoid therapy
Tertiary adrenal insufficiency is caused by
hypothalamic- chronic glucocorticoid therapy
Cause of primary adrenal insufficiency is
Autoimmune
which MEN types are involved in Parathyroid adenoma?
MEN 1 & 2A
Fatigue, constipation, abd pain, renal stones, bone pain, neuropsychiatric symoptoms
Primary hyperparathyrodism
Labs to take for hyperparathyroidism (3)
- Hypercalcemia
- Elevated or inappropriately normal PTH
- Elevated 24hr urinary calcium excretion
FNA biopsy with large cells with ground glass cytoplasm, and pale nuclei containing inclusion bodies and central grooving consistent with ? Tx?
Papillary thyroid cancer
Surgical resection
Exogenous thyroid hormone is characterized by
Low serum thyroglobulin level
The key pathogenic factor in the development of Type 2 DM and associated abnormalities (hypertension and dyslipidemia )
Central-type obesity (insulin resistance)
a fall in total and free T3 levels with normal T4 & TSH levels
Euthyroid sick syndrome (Low T3 syndrome)
The 4 main substrates of gluconeogenesis are
alanine (gets converted to pyruvate)
glutamine
lactate
glycerol-3-phosphate
5 causes of osteomalacia
malabsorption intestinal bypass surgery celiac sprue chronic liver disease chronic kidney disease
Diagnose of osteomalacia AK & PTH level? Serum Calcium and Phosphorus level? Urinary calcium level? 25 OH-D level?
AK & PTH level- High
Serum Calcium and Phosphorus level- Low
Urinary calcium level- Low
25 OH-D level- Low
What are the x-ray findings in osteomalacia?
- thinning of cortex with reduced bone density
- bilateral and symmetric pseudofractures (looser zones)
Tx for unilateral adrenal adenoma (2)
- Surgery
- Aldosterone antagonists (Spironolactone, eplerenone)
Tx for bilateral adrenal hyperplasia
- Aldosterone antagonists (Spironolactone, eplerenone)
3 agents used for Diabetic gastroparesis
- Metoclopramide
- Erythromycin
- Cisapride
Proximal muscle weakness in the setting of clinical features of hyperthyroidism
Chronic hyperthyroid myopathy
Type of cancer that has increased incidence 60 times greater in patients with preexisting Chronic lymphocytic (Hashimoto’s) thyroiditis.
Thyroid lymphoma
_____ used to predict the risk of future food ulcers in a diabetic neuropathic foot
Monofilament testing
Level of prolactin that is diagnostic for prolactinoma is
> 200ng/mL
What are included in MEN2B (3)
- Pheochromocytoma
- Medullary thyroid cancer (Calcitonin)
- Mucosal neuromas/Marfanoid habitus
What are included in MEN2A (3)
- Medullary thyroid cancer (calcitonin)
- Pheochromocytoma
- Mucosal neuromas/marfanoid habitus
What gene mutation is involved in MEN2
RET-proto-oncogene on chromosome 10
The most beneficial therapy to reduce the progression of diabetic nephropathy is
Strict blood pressure control (goal <130/80)
Postpartum adrenal insufficiency can be due to
primary (adrenal ) or secondary (pituitary)
40-45% of blood calcium is bound to
albumin and other proteins
With Primary polydipsia, Sodium level is
Low
Hyponatriemia
With central DI, Sodium level is
High
Hypernatremia
With nephrogenic DI, Sodium level is
normal
Primary hyperaldosteronism
Renin-
Aldosterone-
Renin- LOW
Aldosterone- HIGH
Secondary hyperaldosteronism
Renin- HIGH
Aldosterone- HIGH
Primary hyperaldosteronism causes (2)
- Aldosterone-Producing tumor
- Bilateral adrenal hyperplasia
Secondary hyperaldosteronism causes (4)
- Renovascular hypertension
- Malignant hypertension
- Renin-secreting tumor
- Diuretic use
autonomous production of thyroid hormones from the hyperplastic thyroid follicular cells
Hyperthyroidism from toxic adenoma
3 ways to diagnoses Cushing syndrome
- 24hr urinary cortisol excretion
- Late-night salivary cortisol assay
- Low-dose dexamethasone suppression test
the 3 osteoclast activities from excess thyroid hormone are
- increased bone resorption
- decrease bone density
- increased fracture risk
Someone with elevated calcitonin and a lump in the neck, two diseases to consider
MEN2
- Medullary thyroid cancer
- Pheochromocytoma (Check metanephrine)
flushing, watery diarrhea (tea colored), hypochlorhydria, mass on a pancreatic tail
VIPoma
Carcinoid is in the small intestine
3 treatments for Graves disease
- Antithyroid drugs (methimazole & PTU)
- Radioiodine ablation
- Surgery
SE for Antihtyroid drugs
agranulocytosis
SE for Methimazole (2)
1st trimester teratogen, cholestasis
SE for Propylthoiuracil (PTU)2
Hepatic failure, ANCA-associated vasulitis
SE for Radioiodine ablation (3)
- Permanent hypothyrodism
- Worsening of ophthalmopathy
- Possible radiation side effects
Diarrhea with foul-smelling and floating, abd cramp, wt loss, fatigue, diffuse bone pain, hgb 9.8, MCV 72.
Dx?
Ca, Ph, PTH levels?
Chronic GI disease (steotorrhea, celiac disease…)- VIt D deficiency
Ca- LOW
Ph- LOW
PTH- HIGH
