MTB 1 Flashcards
Presentation of PRL deficiency in men? Women?
Men - ASX
Women - No lactation after birth
Presentation of LH and FSH deficiency in men? Women?
Both - Decreased libido, decreased axillary, public, body hair
Men - ED, decreased muscle mass ( do not make testosterone or sperm)
Women - Amenorrhea
Presentation of GH deficiency in children? Adults?
Children - short stature, dwarfism Adults - mostly ASX, subtle findings: - Central obesity - Increased LDL and cholesterol - Reduced lean muscle mass - Accelerated Atherosclerosis - Fine wrinkles - Hypoglycemia
Presentation of Kallman syndrome
Anosmia Amenorrhea Absent 2 sexual characteristics -breasts, pubic hair Renal Agenesis Normal female internal repro organs
Role of cortisol on ACTH
Cortisol is feedback inhibition on pituitary for ACTH
Effect of insulin on GH
Insulin decreases glucose ->
GH rises
Failure to rise = pituitary insufficiency
Kidney dz’s that cause NDI
Chronic pyelonephritis
Myeloma
Amyloidosis
Sickle cell
Electrolyte changes that inhibit ADH’s effect on kidney
Hypercalcemia
Hypokalemia
Presentation of DI
Extremely High-volume urine output
Excessive thirst
Volume depletion
Hypernatremia
Drugs that cause NDI
Lithium
Demeclocycline
Colchicine
Dx tests for DI
Urine osmolality LOW
Urine Sodium LOW
Serum osmolality HIGH
DDX of CDI and NDI
Vasopressin response
- CDI = urine volume decreases, urine osmolality increases
- NDI = no chagne
Tx for CDI
Vasoporessin
Tx for NDI
Correct underlying problem
HCTZ
Amiloride
PG inhibitors = NSAIDS, Indomethacin
MCC Acromegaly
Pituitary Adenoma
aka Somatotroph Adenoma
Acromegaly Presentation
Increased hat, ring, shoe size Carpal tunnel Body odor Coarsening facial features Deep voice, macroglossia Colonic polyps Arthralgias HTN Cardiomegaly, CHF DM 2 ED
MCC Death Acromegaly
Cardiomegaly, CHF
DDX for Bilateral Carpal Tunnel
Acromegaly
Hypothyroidism
Presentation of Constitutional Growth Delay
Delayed growth spurt Delayed puberty Delayed bone age Normal birth wt and ht Growth slows b/t 6 mos and 3 yrs
Lab tests Acromegaly
Glucose intolerance
Hyperlipidemia
Best initial test Acromegaly
IGF-1
insulinlike = somatomedins
Most accurate test Acromegaly
Glucose suppression test
When is MRI done in Acromegaly
ONLY after lab Id
Localize tumor for surgery
Tx for Acromegaly
- Transphenoidal resection
- Octreotide = somatostatin inhibits GH release
Cabergoline, Bromocriptine = tumors have Da receptors
Pegvisomant = GH receptor antagonist - Radiotherapy
AE of octreotide
Cholestasis –> Cholecystitis
Why are PRL levels tested in Acromegaly
Bc cosecreted with GH
Presentation of Prolactinoma
Aka Lactotroph Adenoma
Women: Galactorrhea, amenorrhea, infertility
Men: ED, decreased libido
Effect of thyroid levels on PRL
Hypothyroidism leads to hyperprolactinemia b/c extremely high TRH levels stimulate PRL secretion
Relationship of Dopamine and PRL
Dopamine inhibits PRL release
Drugs that cause hyperprolactinemia
Antipsychotics - Risperidone, Phenothiazine Methyldopa Metoclopromide Opiods TCAs SSRIs Cocaine Narcotics
Which endocrine dz do we do MRI first
None.
Dx test for high PRL
- TFTs
- Pregnancy test
- BUN/Cr - kidney dz elevates PRL
- LFTs = cirrhosis elevates PRL
What is empty sella syndrome? Presentation? Tx?
Meninges comes in and pushes pituitary to side
Incidental CT finding, trauma, radiation
Obese, multiparous women w HA
Tx: resection
Tx for hyperprolactinemia
- Dopamine Agonists - Cabergoline
- Transphenoidal surgery
- Radiation
Carpal Tunnel Syndrome in hypothyroid
Pathophys
Deposits of mucopolysaccarhide protein complexes w/in perineum and endoneurium of Median Nerve, tendons, synovial sheath
BL, severe sx’s
Hashimoto thyroiditis abs
Anti TPO
Antimicrosomal
What is pituitary apoplexy
Presentation
Hemorrhage of preexisting pituitary adenoma
Presents like meningitis, HA, AMS
Presentation of Sheehan syndrome
Postpartum gland necrosis
Inability to lactate
Can be years post partum
Best initial test thyroid disorders
TSH
Then T4
Tx of hypothyroid?
What if left untreated?
Thyroxine
If untreated = rapid bone loss b/c of increased osteoclastic bone resorption
Hypothyroidism during Pregnancy
When?
Why?
Usually 1st trimester
Increased requirement
Labs in Hypothyroidism during Pregnancy
High TBG => High T4, T3
Management for Hypothyroidism during Pregnancy
Check TSH q 3 mo’s
Increase dose of levothyroxine
What is sub-clinical hypothyroidism and tx
TSH > 10
Tx: L-thyroxine
Hypercholesterolemia = very high LDL
Sick Euthyroid syndrome
“Low T3 syndrome”
Abnormal TFTs with sick, acute, severe illness from caloric deprivation and increased cytokines (IL1,6)
Labs in Sick Euthyroid syndrome
Decreased total and free T3
Normal TSH, T4
Lab findings in Graves
Low TSH
High RAIU
Tx for Graves
RAI
Tx for acute hyperthyroidism and Thyroid storm
- Propranolol = inhbits T4-> T3
- Thiourea drugs = methimazole, PTU
- Iodinated contrast
- Steroids
- RAI
AE of Methimazole and PTU
Agranulocytosis
When do we discontinue PTU/Methimazole
Pt with fever and sore throat
Measure WBC, if < 1,000
Best initial tx for Graves opthalmopathy
Steroids
When is RAI CI
Graves w severe exophthalmus
