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Endocrinology > MTB 1 > Flashcards

MTB 1 Flashcards

1
Q

Presentation of PRL deficiency in men? Women?

A

Men - ASX

Women - No lactation after birth

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2
Q

Presentation of LH and FSH deficiency in men? Women?

A

Both - Decreased libido, decreased axillary, public, body hair
Men - ED, decreased muscle mass ( do not make testosterone or sperm)
Women - Amenorrhea

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3
Q

Presentation of GH deficiency in children? Adults?

A 
Children - short stature, dwarfism
Adults - mostly ASX, subtle findings:
- Central obesity
- Increased LDL and cholesterol 
- Reduced lean muscle mass
- Accelerated Atherosclerosis
- Fine wrinkles
- Hypoglycemia
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4
Q

Presentation of Kallman syndrome

A 
Anosmia
Amenorrhea
Absent 2 sexual characteristics -breasts, pubic hair
Renal Agenesis
Normal female internal repro organs
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5
Q

Role of cortisol on ACTH

A

Cortisol is feedback inhibition on pituitary for ACTH

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6
Q

Effect of insulin on GH

A

Insulin decreases glucose ->
GH rises
Failure to rise = pituitary insufficiency

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7
Q

Kidney dz’s that cause NDI

A

Chronic pyelonephritis
Myeloma
Amyloidosis
Sickle cell

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8
Q

Electrolyte changes that inhibit ADH’s effect on kidney

A

Hypercalcemia

Hypokalemia

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9
Q

Presentation of DI

A

Extremely High-volume urine output
Excessive thirst
Volume depletion
Hypernatremia

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10
Q

Drugs that cause NDI

A

Lithium
Demeclocycline
Colchicine

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11
Q

Dx tests for DI

A

Urine osmolality LOW
Urine Sodium LOW
Serum osmolality HIGH

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12
Q

DDX of CDI and NDI

A

Vasopressin response

  • CDI = urine volume decreases, urine osmolality increases
  • NDI = no chagne
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13
Q

Tx for CDI

A

Vasoporessin

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14
Q

Tx for NDI

A

Correct underlying problem
HCTZ
Amiloride
PG inhibitors = NSAIDS, Indomethacin

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15
Q

MCC Acromegaly

A

Pituitary Adenoma

aka Somatotroph Adenoma

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16
Q

Acromegaly Presentation

A 
Increased hat, ring, shoe size
Carpal tunnel
Body odor
Coarsening facial features
Deep voice, macroglossia
Colonic polyps
Arthralgias
HTN
Cardiomegaly, CHF 
DM 2
ED
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17
Q

MCC Death Acromegaly

A

Cardiomegaly, CHF

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18
Q

DDX for Bilateral Carpal Tunnel

A

Acromegaly

Hypothyroidism

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19
Q

Presentation of Constitutional Growth Delay

A 
Delayed growth spurt
Delayed puberty
Delayed bone age
Normal birth wt and ht 
Growth slows b/t 6 mos and 3 yrs
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20
Q

Lab tests Acromegaly

A

Glucose intolerance

Hyperlipidemia

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21
Q

Best initial test Acromegaly

A

IGF-1

insulinlike = somatomedins

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22
Q

Most accurate test Acromegaly

A

Glucose suppression test

23
Q

When is MRI done in Acromegaly

A

ONLY after lab Id

Localize tumor for surgery

24
Q

Tx for Acromegaly

A
  1. Transphenoidal resection
  2. Octreotide = somatostatin inhibits GH release
    Cabergoline, Bromocriptine = tumors have Da receptors
    Pegvisomant = GH receptor antagonist
  3. Radiotherapy
25
Q

AE of octreotide

A

Cholestasis –> Cholecystitis

26
Q

Why are PRL levels tested in Acromegaly

A

Bc cosecreted with GH

27
Q

Presentation of Prolactinoma

A

Aka Lactotroph Adenoma
Women: Galactorrhea, amenorrhea, infertility
Men: ED, decreased libido

28
Q

Effect of thyroid levels on PRL

A

Hypothyroidism leads to hyperprolactinemia b/c extremely high TRH levels stimulate PRL secretion

29
Q

Relationship of Dopamine and PRL

A

Dopamine inhibits PRL release

30
Q

Drugs that cause hyperprolactinemia

A 
Antipsychotics - Risperidone, Phenothiazine
Methyldopa
Metoclopromide
Opiods
TCAs
SSRIs
Cocaine
Narcotics
31
Q

Which endocrine dz do we do MRI first

A

None.

32
Q

Dx test for high PRL

A
  1. TFTs
  2. Pregnancy test
  3. BUN/Cr - kidney dz elevates PRL
  4. LFTs = cirrhosis elevates PRL
33
Q

What is empty sella syndrome? Presentation? Tx?

A

Meninges comes in and pushes pituitary to side
Incidental CT finding, trauma, radiation
Obese, multiparous women w HA
Tx: resection

34
Q

Tx for hyperprolactinemia

A
  1. Dopamine Agonists - Cabergoline
  2. Transphenoidal surgery
  3. Radiation
35
Q

Carpal Tunnel Syndrome in hypothyroid

Pathophys

A

Deposits of mucopolysaccarhide protein complexes w/in perineum and endoneurium of Median Nerve, tendons, synovial sheath
BL, severe sx’s

36
Q

Hashimoto thyroiditis abs

A

Anti TPO

Antimicrosomal

37
Q

What is pituitary apoplexy

Presentation

A

Hemorrhage of preexisting pituitary adenoma

Presents like meningitis, HA, AMS

38
Q

Presentation of Sheehan syndrome

A

Postpartum gland necrosis
Inability to lactate
Can be years post partum

39
Q

Best initial test thyroid disorders

A

TSH

Then T4

40
Q

Tx of hypothyroid?

What if left untreated?

A

Thyroxine

If untreated = rapid bone loss b/c of increased osteoclastic bone resorption

41
Q

Hypothyroidism during Pregnancy
When?
Why?

A

Usually 1st trimester

Increased requirement

42
Q

Labs in Hypothyroidism during Pregnancy

A

High TBG => High T4, T3

43
Q

Management for Hypothyroidism during Pregnancy

A

Check TSH q 3 mo’s

Increase dose of levothyroxine

44
Q

What is sub-clinical hypothyroidism and tx

A

TSH > 10
Tx: L-thyroxine
Hypercholesterolemia = very high LDL

45
Q

Sick Euthyroid syndrome

A

“Low T3 syndrome”

Abnormal TFTs with sick, acute, severe illness from caloric deprivation and increased cytokines (IL1,6)

46
Q

Labs in Sick Euthyroid syndrome

A

Decreased total and free T3

Normal TSH, T4

47
Q

Lab findings in Graves

A

Low TSH

High RAIU

48
Q

Tx for Graves

A

RAI

49
Q

Tx for acute hyperthyroidism and Thyroid storm

A
  1. Propranolol = inhbits T4-> T3
  2. Thiourea drugs = methimazole, PTU
  3. Iodinated contrast
  4. Steroids
  5. RAI
50
Q

AE of Methimazole and PTU

A

Agranulocytosis

51
Q

When do we discontinue PTU/Methimazole

A

Pt with fever and sore throat

Measure WBC, if < 1,000

52
Q

Best initial tx for Graves opthalmopathy

A

Steroids

53
Q

When is RAI CI

A

Graves w severe exophthalmus

Endocrinology (2 decks)

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