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Endocrinology USMLE Step 3 > Section 5: Prolactinoma, Acromegaly and Hormones of Reproduction > Flashcards

Section 5: Prolactinoma, Acromegaly and Hormones of Reproduction Flashcards

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USMLE® Step 1 flashcards
1
Q

Most accurate diagnostic test for prolactinoma

A

MRI of the brain

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2
Q

Best initial therapy for prolactinoma

A

Dopamine agonists: Bromocriptine Cabergoline

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3
Q

Why is DM common among those with acromegaly?

A

Because growth hormone acts as an anti-insulin

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4
Q

Best initial test for acromegaly

A

Insulin-like growth factor (IGF)

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5
Q

Why is GH not the best initial test for acromegaly?

A

Growth hormone (GH) level is not done first, because GH has its maximum secretion in the middle of the night during deep sleep. GH also has a short half-life.

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6
Q

Most acurate test to diagnose acromegaly

A

Suppression of GH by giving glucose excludes acromegaly.

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7
Q

What is the place of MRI in the diagnosis of acromegaly?

A

To locate the lesion

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8
Q

Outline the Rx of acromegaly

A
  • Surgical resection with transphenoidal removal cures 70 percent of cases
  • Octreotide: Somatostatin has some effect in preventing the release of growth hormone
  • Cabergoline or bromocriptine: Dopamine agonists inhibit growth hormone release
  • Pegvisomant: This is a growth hormone receptor antagonist.
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9
Q

Clinical features of Turner’s syndrome

A
  • Short stature
  • Webbed neck
  • Wide-spaced nipples
  • Scant pubic and axillary hair
  • The XO karyotype prevents menstruation

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 3488-3490). . Kindle Edition.

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10
Q

What is the etiopathogenesis of testicular feminization syndrome?

A

The absence of testosterone receptors results in no penis, prostate, or scrotum.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 3492). . Kindle Edition.

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11
Q

Name two causes of primary amenorrhea

A
  • Turner’s syndrome
  • Testicular feminization syndrome
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12
Q

Enumerate the causes of secondary amenorrhea

A
  • Pregnancy
  • Exercise
  • Extreme weight loss
  • Hyperprolactinemia
  • Polycystic ovary syndrome
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13
Q

Best initial tests for pheochromocytoma

A
  • High plasma and urinary catecholamine levels
  • Plasma-free metanephrine and VMA levels
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14
Q

Most accurate test for pheochromocytoma

A

CT or MRI of the adrenal glands

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15
Q

Rx outline for pheochromocytoma

A
  • Phenoxybenzamine (alpha blockade) first to control blood pressure. Without alpha blockade, patients’ blood pressure can significantly drop intraoperatively
  • Propranolol is used after an alpha blocker like phenoxybenzamine
  • Surgical or laparoscopic resection
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16
Q

What is the strongest indication for screening for DM

A

HTN

17
Q

Name the characteristics of MEN syndrome type 1 (Wermer’s syndrome)

A
  • Parathyroid hyperplasia
  • Pancreatic islet cell tumor
  • Pituitary adenoma

Remember with 3 Ps (W looks like 3 rotated 90 degress anticlockwise)

18
Q

Name the characteristics of MEN syndrome type 2A (Sipple’s syndrome)

A
  • Parathyroid hyperplasia
  • Thyroid medullary cancer
  • Pheochromocytoma
19
Q

Name the characteristics of MEN syndrome type 2B

A
  • Thyroid medullary cancer
  • Pheochromocytoma
  • Mucocutaneous neuromas
  • Ganglioneuromatosis of the colon
  • Marfan-like habitus
20
Q

Name the anterior pituitary hormones and the hypothalmic hormones that control their release

A
  • ACTH controlled by CRH
  • GH controlled by GHRH
  • TSH controlled by TRH
  • LH controlled by GnRH
  • FSH controlled by GnRH
  • PRL controlled by Dopamine (inhibits)

ACTH = AdrenoCortiTropic Hormone

CRH = Corticotropin Releasing Hormone

FSH = Folicle Stimulating Hormone

GnRH = Gonadotropin Releasing Hormone

GH = Growth Hormone

GHRH = Growth Hormone Releasing Hormone

LH = Leutinizing Hormone

PRL = Prolactin

21
Q

Diagnosis:

HTN + Low renin + Low potassium

A

Hyperaldosteronism

22
Q

Confirmatory diagnostic test for hyperaldosteronism

A

CT scan of the adrenals

23
Q

Risk factors for osteoporosis

A
  • Menopause
  • Low BMI
  • Family hx of osteoporosis
  • Early ovarian failure
  • Low calcium intake
  • Smoking
  • Nulliparity
  • Alcohol
  • High caffeine intake

(Source: S95)

24
Q

What are implications of prebreakfast, prelunch, predinner and bedtime glucose levels?

A
  • Prebreakfast glucose level: Reflects predinner NPH dose
  • Prelunch glucose level: Reflects prebreakfast regular insulin dose
  • Predinner glucose level: Reflects prebreakfast NPH dose
  • Bedtime glucose level: Reflects predinner regular insulin dose
25
Q

What are the time of onset, peak effect and duration of regular insulin

A
  • Onset: 30-60 minutes
  • Peak effect: 2-4 hours
  • Duration: 5-8 hours
26
Q

What are the time of onset, peak effect and duration of lispro

A
  • Onset: 5-10 minutes
  • Peak effect: 0.5-1.5 hours
  • Duration: 6-8 hours
27
Q

What are the time of onset, peak effect and duration of aspart

A
  • Onset: 10-20 minutes
  • Peak effect: 1-3 hours
  • Duration: 3-5 hours
28
Q

What are the time of onset, peak effect and duration of glulisine?

A
  • Onset: 5-15 minutes
  • Peak effect: 1.0-1.5 hours
  • Duration: 1.0-2.5 hours
29
Q

What are the time of onset, peak effect and duration of NPH (Neutral Protamine Hagedorn)?

A
  • Onset: 2-4 hours
  • Peak effect: 6-10 hours
  • Duration: 18-28 hours
30
Q

What are the time of onset, peak effect and duration of detemir?

A
  • Onset: 2 hours
  • Peak effect: No discernible peak
  • Duration: 20 hours
31
Q

What are the time of onset, peak effect and duration of glargine?

A
  • Onset: 1-4 hours
  • Peak effect: No discernible peak hour
  • Duration: 20-24 hours
32
Q

Possible diagnoses:

  • TSH - low
  • T4 - high
  • RAIU - decrease
A

Subacute thyroiditis (hyperthyroid stage)

Hashimoto thyroiditis (hyperthyroid stage)

Exogenous T3/T4: levothyroxine

Postpartum thyroiditis

33
Q

Possible diagnoses:

  • TSH - low
  • T4 - high
  • RAIU - increase
A
  • Graves’ disease
  • Toxic adenoma
  • Multinodular goiter
34
Q

Possible diagnoses:

  • TSH - low
  • T4 - decrease
A
  • Pituitary hypothyroidism
  • Hypothalamic hypothyroidism
35
Q

What are the predominant estrogens in reproductive years and during menopause?

A

Under the stimulation of the leutinizing hormone (LH), the theca cells of the post-menopausal ovary produce androstenedione and testosterone. Estrone, a product of androstenedione conversion in adipose tissue, is the predominant estrogen in menopause.

Estradiol is the most prevalent estrogen in the reproductive years, and estriol is made by the placenta during pregnancy.

Estrane is a minor estrogen

36
Q

What is hungry bone syndrome?

A

Hypocalcemia following surgical correction of hyperparathyroidism in patients with severe, prolonged disease, as calcium is rapidly taken from the circulation and deposited into the bone.

Endocrinology USMLE Step 3 (6 decks)

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