PANCE Endocrine Flashcards
what disease is not enough cortisol
addisons
what gland produces TRH
hypothalamus
what is the best initial test for thyroid
TSH
Thyroid stimulating Ab/ TSH receptor Ab these are specific for what condition
graves
high TSA but normal T4 is what
subclinical hypothyroidsim
what is the rason for decreased uptake on the radioactive iodine test
Graves or
thyroiditis
what is sunclinical hypothroidsims at risk for
cardiovascular disease
what do you treat subclinical hypothroidsim
TSH > 20
what thyroid issue can cause menorrhagia
hypothyroid
what is cretinsim
congenital hypohyroidism
what is extream hyperthyroidism called
Thyroid storm
what are the 4 treatments for Thyroid storm
- propylthiouracial (PTU)
- beta blockers
- glucocorticoids
- avoid asprin
what is the MC cause of hyper thyroidism
GRAVES
how do you treat graves
- radioactive iodine
- MME/ PTU
- beta blocker
- thyroidextom
what medication do you give for hyper thyroid MME or PTU if they are pregnant
PTU
what two medications cause hypothyroisism
- amiodarone
- lithium
what is a risk for thyroid nodule
- extreme ages
- history of head and neck radiation
what is the malignancy rate of thyroid cancers in Men and women
M: Malignant
W: non malignant
what is the MC symptom of a thyroid nodule
asymptomatic
thyroid nodule “rapid growth, fixed in place, no movement with swallowing”
- malignant
what is the thyroid function with thyroid cancer
- euthyroid
what is the best test for a thyroid nodule
FNA
what is the MC type of thyroid nodule
follicular adenoma
how often do you monitor a thyroid nodule
every 6 - 12 months
what is the MC type of thyroid carcinoma
papillary
what type of thyroid cancer is associated with radiation exposure
papillary
what is the MC thyroid cancer (malignant) in males
anaplastic
what is the MC type of thyroid nodules
follicular adenoma
what vitamin is required for CA to be absorbed
Vit- D
Increased parathyroid hormone does what to Ca in the blood
increases
what is the MC cause of primary parathyroisism
parathyroid adenoma
what is the MC cause of secondary hyper parathyroidism
- Dec Ca
- Inc PTH
CKD
what is the DTR with inc Ca
deceased
Tx for increased parathroid hormone
parathroidectomy
what EKG for hypothyroidism
prolonged QT
for osteoporosis do you look at the T score of the Z score
T: < -2.5
blue tinted sclerae and presenile deafness
OI
failing kidneys do not eliminate phosphate correctly what pathology
renal osteodystrophy
Brown cysts and “salt and pepper” appearance of the skull on X ray
renal osteodystrophy
a decrease in Vit D causes soft bones and what pathology
Rickets
what is the tx for rickets
Vit D
what is more common primary of secondary adrenal disorders
secondary.
This is a failure of the pituitary gland to secerete ACTH
why is aldosterone intact with secondary ACTH
because it is stimulated by the RASS system
what is the MC cause of primary adrenal cortical (addisons)
steroid use
what is the MC cause of primary adrenal cortical insufficiency (addisons) disease
autoimmiue
infection
what is an addisons crisis
this is when someone with adrenal cortical insufficiency does not have enugh cortisol (stress hormone) on board and shit starts to go south
what are the labs of addisons crisis
hyponaterima
hyperkalemia
hypoglycemia
where is the issue with crushing disease
pituitary
what is cushings syndrome
signs and symptoms related to cortisol excess
what are the three tumors that can cause cushings disease
- Puititary (disease)
- Small cell
- adrenal tumor
what is the test for cushings disease
dexamethasole supression test
what medicaion do you use with adrenal tumor
ketoconazole
whta is conn syndrome
too much aldosterone
what is the MC cause of too much aldosterone
idiopathic
what is the MC pituitary tumor
- prolactinoma
prolactinoma symptoms
amenorrhea
golactorea
what hormone inhibits prolactin
dopamin
what is the best test to look at the pituitary
MRI
what does bromocriptine tx
- acromegaly
- prolactinoma
what does octreotide tx
acromegaly
what is the postprandial glucose goal
< 180
what type of insuline is LOG
rapid
what is the MC cause of DKA and HHS
infection
what do you differentiate DKA
HHS
DKA: Ketones
HHS: higher glusoe > 250
what are the three tx’s (all required for DKA HHS)
- Fluids
- insulin
- Potassium
MEN 1 effects an overactivity of what 3 glands
Pituitary
pancreas
parathyroid
hyperparathyroid tx
- hydration
2. bisphosphonates
Hyperparathyroidism cause MCC
Parathyroid neoplasm
Hyperparathyroidism DTR
decreased
● Hypoparathyroidism
Tx
Vit D 8-8.6 mg,
Ca 1-2g/day,
Magnesium supplementation
- Chvostek sign
- Trousseau sign
are associated with what pathology
hypocalcermia
● Hyperthyroidism
1 MCC
Graves
Peroxidase antibodies, thyroglobulin antibodies what pathology
graves
Hyperthyroidism TX 2
propylthiouracil (PTU, DOC preg),
methimazole (MMI);
what is the 1st med given in a thyroid strorm
- propanolol
what medication for a thyroid storm do you give after a PTU
iodine
● Subacute Thyroiditis
labs
TSH (low),
T3/T4 (high),
very tender thyroid gland with or without fever (hallmark)
- Subacute Thyroiditis caused by coxaxkie
○ S/S: tender thyroid gland, fever, pharyngitis, overlying erythema
○ Cause: gram-positive bacteria (staph aureus)
- Suppurative Thyroiditis
Suppurative Thyroiditis tx
○ surgical drainage w/ fluctuation
● Drug Induced Thyroiditis
1
amiodarone
- thyrotropin receptor-blocking antibodies
Hashimoto Thyroiditis
○ Cause: dense fibrous tissue development; sclerosing cholangitis, retroperitoneal fibrosis, orbital pseudotumor
what pathology
● Fibrous Thyroiditis (Riedel)
Fibrous Thyroiditis (Riedel) tx
Tamoxifen
Myxedema Crisis/Coma tx
Thyroxine IV
Myxedema Crisis/Coma This is what
severe hypothyroidism
Cushing syndrome dx
24hr urine collection (free cortisol >125);
overnight dexamethasone suppression
low 8:00 AM plasma cortisol <3,
addisons
Cause: pituitary adenoma (GH excess)
● Acromegaly/gigantism
Acromegaly/gigantism tx
somatostatin analogs (octreotide
IGF-1 (low), GH (low);
● Dwarfism
how do you treat central DI
HCTZ w/ potassium or amiloride
how do you treat nephrogenic DI
Desmopressin acetate
Insulin to carb ratio
1 unit insulin for 10-15g carbs
gemfibrozil function 2
lower TG;
raise HDL
what is the best initial test for thyroid
TSH
2 causes of hypo thyroid
- iodine deficiency
- hashimotos
what is congenital hypo thyroid
cretinsim
thyroid stimulating ab what dx
graves
what is the MC thyroid nodule
follecular adenoma (benign)
what is the MC type of malignant thyroid cancer
papillary
best tx for thyroid nodule malignant
surgery
best inital test for thyroid cancer
FNA
what is the MC cause of secondary hyperparathyroidism
CKD
what two pathologies in endocrine have decreased DTR’s
- hypothyroid
- hyperPARA thyroid
tx for hyperparathyroisism
removal
what are the MC reasons for addisons (primary adrenoc ortico insuffiency)
- infection
- autoimmune
what are the MC reasons for secondary adrenoc ortico insuffiency)
Pituitary issue
exogenous steroids
what are the 3 labs that go with addisons
hyponatremia
hypoglycemia
hyperkalemia
do you need aldosterone in addisons disease
yes
menorrhagia is associated with what type of thyroid disorder
hypothyroidism
How do you treat graves (20
- MME / PTU
2. Iodine
what meds kill the thyroid
- Amiodarone
2. Lithium
how do you treat
- Hashimotos Thyroditis
levo (check every 6 weeks)
what are the 2 risk factors for a thyroid nodule
- extreme ages
- radiation to the neck
what is the MC type of thyroid nodule
follicular adenoma
what is the MC type of thyroid cancer
papillary
what is the worst type of thyroid cancer
anaplastic
what are the 2 MC reasons for hypoparathroidism
- iatrogenic
- autoimmune
what are the DTR’s with hypoparathyroisism
- increased
- how do you treat
- hypoparathyroisism
calcium
“blue- tinted sclerae and presenile deafness”
OI
what is the serum Ca levels in the blood with renal osteodystrophy
low ca
- also has low PTH
- high phosphate
tx for renal osteodystrophy
phosphate binders
radio-graphs
- “looserlines”
- “psudo fracture lines”
osteomalesia / rickets
osteomalesia / rickets Tx
Vit D
what class is sevelamer
- phosphate binder
what is the cause of primary chronic adrenocortical insufficiency
- This is at the adrenals
- autoimmune
- infection
what is the MC cause of secondary adrenocortical insufficiency
- withdrawal of steroids
how do you test for adrenocortical insufficiency
ACTH stimulation
how do you treat addisons CRISIS (3)
FLUIDS
Glucocorticoids
Fludocortisone
what is the lab with Cushings disease
- increased ACTH
what is the one condition that will be suppressed with dexamethasone suppression test
cushings disease
what are the 3 causes of endogenous cushings
- Disease (puititary tumor, Inc ACTH)
- small cell acth tumor
- adrenal tumor
what is the MC cause of cushings syndrome
iatrogenic
catecholamine secreting adrenal tumor
- Pheochromocytoma
what are the symptoms of
Palpitations
Hypertension
Excessive sweating
what medication do you not want to initiate with a Pheochromocytoma
beta blocker
what are teh 2 tx for prolactinoma
- carbergoline
- bromocripitine
prolactinoma symptoms
- ammenorrhea
- golactorrea
what is the ending for sulfonylurea
Ide
what DM do you NOT want to give to CHF MI
Thiazolidinediones
who can not get metformin
hepatic or renal impairment
what medication slows gastric emptying
GLP -1 “tide:
