Internal Medicine Essentials Questions: Endocrine and Metabolism Flashcards
In a case of suspected prolactinoma (galactorrhea, decreased libido, vaginal dryness and amenorrhea in a woman), you should first do _____________.
a serum prolactin level; only if that’s elevated should you do a pituitary MRI
Lab signs of adrenal insufficiency include ________________.
hypoglycemia and hyponatremia (hypokalemia can occur but is less typical)
True or false: you can have a very low TSH and still have hypothyroidism.
True!
Central hypothyroidism presents with a low TSH.
Hypothyroidism can cause what blood pressure anomaly?
Diastolic hypertension
All thyroid nodules greater than ________ in diameter should be biopsied.
1 cm
Give the quick rule of thumb for treating hypothyroidism in pregnancy.
Increase levothyroxine dose by 30% in the first trimester.
Note: the first trimester is when transplacental levothyroxine is the most important.
How should subclinical hypothyroidism be managed?
Repeat TSH in 6 months
Patients may report fatigue, but as long as their T4 is normal you should not give levothyroxine.
True or false: adrenal incidentalomas require no testing if there is no history or signs/symptoms of functional tumor or malignancy.
False
Even if the person has no features of functional tumor, you should still do a 24-hour dexamethasone suppression test, a urine metanephrines level, and renin/aldosterone assays.
Patients with ___________ adrenal insufficiency typically do not require mineralocorticoids.
central
The release of aldosterone is controlled by the renin-angiotensin-aldosterone system and thus is less dependent on ACTH.
Which test is best at diagnosing primary hyperaldosteronism?
•CT abdomen
•Renin:aldosterone ratio
• Dexamethasone suppression test
Renin:aldosterone ratio
CT abdomen could detect an adrenal adenoma, but because you can have hyperaldosteronism without an adenoma it is less useful.
Dexamethasone suppression is useful in diagnosing Cushing’s syndrome, so it is only indicated in those with systemic signs of Cushing’s (e.g., striae, hirsutism, weight gain).
During a mild illness (like a viral URI), the dose of hydrocortisone in a person with adrenal insufficiency should be ____________________.
increased threefold
Note: this is even if they don’t have symptoms of adrenal insufficiency.
The best two tests for diagnosing Cushing’s syndrome are ______________.
24-urinary cortisol levels or midnight salivary cortisol levels
Hypertension and what “classic triad” are pathognomonic of pheochromocytoma?
- Diaphoresis
- Palpitations
- Headaches
For critically ill patients with diabetes who are admitted to the hospital, what glycemic range is recommended?
140 - 200
When patients with type 1 and type 2 diabetes get diagnosed, the suite of screening tests you do differs. Why? What tests are recommended for each?
• Type 1: lipid panel
- Patients typically present very soon after development of the disease, there’s not enough time for retinopathy or nephropathy to develop.
•Type 2: lipid panel, urine albumin-creatinine ratio, dilated fundoscopic exam
- T2DM patients can go years without knowing that they have diabetes, so there is time for these disorders to develop.
Note: the tests for T2 are recommended in T1 after five years of disease.