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Keystone: Exam 1 > Pituitary, Thyroid, Adrenal > Flashcards

Pituitary, Thyroid, Adrenal Flashcards

1
Q

Most common cause of hyperthyroidism

A

Grave’s Disease

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2
Q

Describe the mechanism of Grave’s Disease

A

Autoimmune → circulating Thyroid Stimulating Immunoglobulins (TSI) → binds to TSH receptor on thyroid → makes lots of thyroid hormone

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3
Q

T/F: Grave’s Disease presents as diffuse asymmetric goiter.

A

False: symmetric

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4
Q

Exophthalmus and infiltrative dermopathy are specific to which disease?

A

Grave’s Disease

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5
Q

Name the diseases (2)
• Focal and/or diffuse hyperplasia of thyroid follicular cells
• Activating somatic mutations of genes for TSH receptor

A

Toxic Adenoma

Toxic Multinodular Goiter

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6
Q

Name the disease:

Inflammation/destruction of thyroid gland

A

Thyroiditis

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7
Q

High fT4, low TSH suggests:

A

Thyroid origin of hyperthyroidism

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8
Q

High fT4, high TSH suggests:

A

Pituitary origin of hyperthyroidism
(Central hyperthyroidism)

High TSH due to oversecretion by tumor

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9
Q

If central hyperthyroidism, next diagnostic step is:

A

Pituitary MRI to find tumor

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10
Q

If thyroiditis, next diagnostic step is:

A

Check ESR

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11
Q

If Grave’s disease, next diagnostic step is:

A

Check TSI antibodies

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12
Q

The best test for diagnosis of type of hyperthyroidism is:

A

Radioactive thyroid imaging

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13
Q

Inflamed thyroid (thyroiditis), damaged membrane show ____ radioiodine uptake.

A

None/ ~0-2%

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14
Q

Over-functioning thyroid show ____ radioiodine uptake.

A

> 25%

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15
Q

Treatment for thyroiditis

A

Beta blocker ONLY

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16
Q

Drug of choice for treating pregnancy and lactation patients with hyperthyroidism

A

Propylthiouracil (PTU)

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17
Q

Name 2 drugs that inhibit synthesis of thyroid hormone

A

Methimazole

Propylthiouracil (PTU)

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18
Q

T/F: Surgery is one of the recommendations for treating hyperthyroidism

A

False. Not recommended since it can be treated non surgically

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19
Q

Treatment regimen for pregnant patient with hyperthyroidism

A

PTU for 1st trimester → then methimazole

Methimazole has teratogenic effect

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20
Q

Primary adrenal insufficiency is caused by:

Deficiency in:

A

Destruction of adrenal cortex

glucocorticoid
minderalocorticoid
adrenal androgen

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21
Q 
All of the following are causes of Primary adrenal insufficiency EXCEPT:
A. Polyglandular failure syndromes
B. Tuberculosis/histoplasmosis
C. Sarcoma 
D. Hemorrhage
A

C. Lung/breast carcinoma

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22
Q

Secondary adrenal insufficiency is caused by:

A

Deficient ACTH release from pituitary
or
Deficient hypothalamic release of CRH

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23
Q

Describe the expected levels in primary adrenal insufficiency:
Cortisol:
Aldosterone:
ACTH:

A

Cortisol: low
Aldosterone: low
ACTH: high

24
Q

Describe the expected levels in secondary adrenal insufficiency:
Cortisol:
Aldosterone:
ACTH:

A

Cortisol: low
Aldosterone: normal
ACTH: low

25
Q

Primary OR secondary adrenal insufficiency:

Hyperkalemia

A

Primary

26
Q

Primary OR secondary adrenal insufficiency:

Fluid depletion

A

Primary

27
Q

Primary OR secondary adrenal insufficiency:

Hyperpigmentation

A

Primary

28
Q

Failure to suppress low dose (1 mg) overnight dexamethasone suppression test suggests:

A

Cushing’s (ACTH-dependent)

29
Q

Increased ACTH suggests (2)

A

Pituitary tumor

Ectopic

30
Q

Decreased ACTH suggests (2)

A

Adrenal tumor

Exogenous

31
Q

> 50% suppression in high dose DST suggests

A

Pituitary Cushing’s

32
Q

No suppression in high dose DST suggests

A

ectopic Cushing’s

33
Q

T/F: Primary hypothyroidism is less common than secondary hypothyroidism.

A

False. 95% are primary.

34
Q 
All of the following are causes of primary hypothyroidism EXCEPT:
A. Autoimmune
B. Destructive
C. Hypothalamic disorder
D. Drug induced
E. Hereditary
A

C. This is secondary hypothyroidism cause. Also pituitary disorder.

35
Q 
All of the following are symptoms of hypothyroidism EXCEPT:
A. Cold intolerance
B. Weight loss
C. Dry skin
D. Edema
A

B. Weight gain

36
Q

Most common form of hypothyroidism

A

Hashimoto’s Thyroidism

37
Q

Thyroid peroxidase antibodies (TPO) are found in what disease?

A

Hashimoto’s

38
Q

Low fT4, high TSH suggests

A

Primary hypothyroidism: thyroid origin

39
Q

Low fT4, low TSH suggests

A

Secondary hypothyroidism

40
Q

Preferred therapy for hypothyroidism

A

Levothyroxine (T4)

41
Q

Goal of therapy for primary hypothyroidism

A

Achieve normal TSH

42
Q

Goal of therapy for secondary hypothyroidism

A

Achieve normal fT4

TSH will always be low

43
Q

T/F: Most thyroid nodules are malignant.

A

False. 95% are benign adnenomas or cysts

Only 5% are malignant

44
Q 
Which of the following is NOT a cause of prolactin elevation?
A. Pregnancy
B. Secondary hypothyroidism
C. Antipsychotics, metoclopramide
D. Renal failure
A

B. Primary hypothyroidism: elevated TRH stimulates lactotrophs –> pituitary enlargement

Also: prolactin secreting pituitary tumor

45
Q

Name the 2 dopamine agonists used to treat elevated prolactin

A

Bromocriptine

Cabegoline

46
Q

T/F: Nausea is a worse in Bromocriptine than Cabegoline

A

True

Minimize effect by increasing dose slowly

47
Q

T/F: The most effective treatment for elevated prolactin is surgery to remove the prolactinoma.

A

False. DA agonist therapy is VERY effective.

• Surgery NOT uniformly effective
o High rate of recurrence
o Risk of damaging healthy pituitary
• Prolactinomas are the only pituitary tumors treated medically

48
Q

GnRH is secreted from ____ and stimulates ____ to secrete ___.

A

hypothalamus
anterior pituitary
LH, FSH

49
Q

Expected lab values in primary hypogonadism
Testosterone:
LH/FSH:

A

Testosterone: low

LH/FSH: high

50
Q

Expected lab values in secondary hypogonadism
Testosterone:
LH/FSH:

A

Testosterone: low

LH/FSH: low or low-normal

51
Q

T/F: 90% of pituitary masses are cystic lesions.

A

False. Pituitary adenoma

52
Q

What test assess for acromegaly?

A

IGF-1 produced in liver
GHRH (hypothalamus) –> GH (pituitary) –> IGF-1 (liver)

GH is too pulsatile and unpredictable to be accurate.

53
Q

What would expect IGF-1 to be in acromegaly?

A

Elevated

Low IGF-1 would indicate no GH to stimulate IGF-1 production –> no acromegaly

54
Q

Compression of pituitary stalk by a tumor would cause ___

A

high prolactin due to interrupting flow of DA from hypothalamus that normally inhibit prolactin secretion.

55
Q

Primary adrenal insufficiency treated with:

A

glucocorticoid AND mineralocorticoid

56
Q

Secondary adrenal insufficiency treated with:

A

glucocorticoid only

57
Q

Stress dosing: Dose of glucocorticoid should be ____ when patient is sick or under increased physical stress.

A

doubled/tripled

Keystone: Exam 1 (12 decks)

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