Michels CIS Flashcards
tachycardia and hypotension
pigmentation on buccal mucosa and palms of hands
low sodium, high potassium
What is this? How will ACTH, aldosterone, and Renin be?
primary adrenocorticoinsufficiency
ACTH will be high
aldosterone is probably low (due to primary adrenal insufficiency)
renin is high (to stimulate increased volume)
what is the cause of in adrenal insufficiency hyperpigmentation?
increased POMC and cross-reactivity with ACTH with melanocytes
after giving birth, a woman is tired, can’t lose weight, milk production scant, no mentruation, rough skin, deeper voice.
What is the most likely cause of her hypopituitarism?
post-partum necrosis
growth of anterior pituitary during pregnancy (to produce more prolactin) can –> post-partum necrosis, esp. if difficult birth w/ blood transfusion,e tc.
lady with fatigue, weight gain, muscle cramping, feels cold
constipation and headaches, pale dry skin
high TSH, low T3 and T4
likely what?
primary hypothyroidism
what lab value will distinguinsh type 1 from type 2 diabetes?
islet autoantibodies
femoral neck fracture, greater than expected from age and impact.
increasing leg weakness and persistent loer back pain
low 25-OH-D low calcium low phosphorous high PTH high alk phos
what is the likely cause of the hypocalcemia?
vitamin D deficiency
–> not absorbing calcium from gut, lack of mineralization of the bones
PTH levels are increased as a response to the low calcium
alk phos high because of bone breakdown
phosphate levels are low because PTH increases secretion
16 y/o female no menses or pubic hair oro breast development
headaches, ringing in ear, high blood pressure
high sodium
low potassium
low, low renin
diminished 17-ketosteroids, estrogen and increased progeterone, pregnenolone, 11-deoxycorticosterone, and corticosterone
loss of which adrenal enzyme?
17-alpha hydroxylase
loss of this restricts formation of androgens and cortisol
elevated bp is caused by high aldosterone (excess mineralocorticoids)
28 y/o female amenorrhea after motorcycle accident
fatigued, gained weight
FSH, LH, cortisol, TSH low
prolactin high
what is up?
hypopituitarism due to damage to the pituitary stalk. a slightly elevated level of prolactin is usually not from a prolactinoma
a prolactinoma could also lead to these symptoms; FSH and LH would go down due to negative inhibition on GnRH
66 y/o fem had a pituitary tumor removed 30 years ago due to Cushing’s
post-menopausal, not taking estrogens calcium good alk phos high n-telopeptides high 25 (OH)D3 is not too bad PTH normal
bone density is 2.8 SD below mean
n-telopeptides indicate increase in bone resorption
T score more than 2.5 indicates osteoporosis
cause: estrogen deficiency
45- y/o female constant thirst, frequent urination
high bp history
slightly high sodium
low potassium
high aldosterone
low renin
what challenge and assay will have most diagnostic significance?
IV saline and measure plasma aldosterone
30 y/o female, irregular menses, missed periods.
some galactorrhea
FSH and LH are low
prolactin super high
prolactinoma - adenoma of the lactotropes
56 y/o fem, routine bloodwork hypercalcemic low phosphorous super high PTH high alk phos high urinary calcium
primary hyperparathyroidism
30 y/o female, growth on neck, 6 lb weight loss, uncomfortable in warm rooms
thyroid enlarged
low TSH
super high T3 and T4
grave’s disease
we know for sure it’s not exogenous thyroid hormone because we find antibodies and exophthalmos
34 y/o fem 2 months amenorrhea, headaches, fatigue, weight gain
small goiter, dry skin
low T4 and T3, TSH super high
elevated prolactin
hypothyroidism
TSH can stimulate prolactin secretion
79 y/o male with COPD and sepsis, intubated
low bp
lower lobe consolidation
TSH relatively normal, low free thyroxine, low total triiodothyronine
reason for low thyroid function tests?
euthyroid sick syndrome
TSH levels are normal
