Study Guide Info Flashcards
is gynecomastia normal in pubertal boys?
Yes, in 70%
Drugs that can cause gynecomastia
alcohol
spironolactone
cimetidine
ketoconazole
Cause of gynecomastia
estradiol excess either from decrease in androgen production or increase in estrogen production
What is the genotype XXY called?
Klinefelter’s syndrome
what will labs be like with Klinefelter’s syndrome (FSH, LH< testosterone)
Elevated FSH and LH
low testosterone
What will be seen w/ Klinefelter’s patients at puberty
varying degrees of hypogonadism
gynecomastia
small, firm testes <2 cm, azoospermia
tall and lnaky
are Klinefelter’s patients fertile or infertile
often infertile or reduced fertility
What is the absence of 1st menses by age 16?
primary amenorrhea
labs to get w/ primary amenorrhea
hCG FSH LH prolactin TSH
most common cause of primary amenorrhea?
ovarian failure (Hypergonadotropic hypogonadism) followed by mullerian agenesis
What is mullerian agenesis
congenital absense of femal genital tract
results in primary amenorrhea
Structural causes of primary amenorrhea
vaginal obstruction cryptomenorrhea imperforate hymen mullerian agenesis absence of uterus
Gonadal causes of primary amenorrhea
17-alpha hydroxylase deficiency
dysgensis
resistant ovary
pregnancy
2 adrenal causes of primary amenorrhea
congenital adrenal hyperplasia
PCOS
development in women of androgen-dependent terminal body hair in a male pattern (excessive androgenic effect)
Hirsutism
most common disorder w/ hirsutism
PCOS (need abdominal US)
Medical tx for hirsutism
OCP cimetidine metformin (if PCOS) spironoolactone or ketoconazole GNRH agonist
tumors that can cause hirsutism
ovarian tumors (arrhenoblastoma and hilar cell) adrenal tumors (cushing- adrenocortical carcinoma)
Drugs that can cause hirsutism
anabolic steroids (methyltestosterone, oxandrolone)
danazole
some OCPs
most common cause of galactorrhea
prolactinoma
how do women w/ a prolactinoma present?
amenorrhea and infertility
hypothalamic/ pituitary diseases that cause hyperprolactinemia
granulomatous dz (infiltration)
compression of pituitary stalk
acromegaly
primary hypothyroidism
what causes normal prolactin galactorrhea?
local breast stimulation/ irritation
OCP
recent pregnancy
stress
cessation of menses for >3 months in woman with previously normal cycle
secondary amenorrhea
most common cause of secondary amenorrhea
prengnacy
ovarian causes of secondary amenorrhea
chronic anvoluation
PCOS
premature menopause
ovarian tumor
what is scarring of the endometrium that can lead to secondary amenorrhea?
asherman’s syndrome
adrenal causes of secondary amenorrhea
cushing’s
androgen secreting tumor
adrenocortical insufficiency
congenital adrenal hyperplasia
Hypothalamic-pituitary dysfunction causes of secondary amenorrhea
exercise (athlete triad)
stress
eating disorders
hyperprolactinemia
consumption of what food suppressed progesterone effects and can lead to secondary amenorrhea?
papaya
how can hemochromatosis lead to secondary amenorrhea?
deposition of iron in the ovary
drugs that cause gyencomastia
spironolactone
cimetidine
flutamide
physiologic causes of gynecomastia
puberty
recovery from chronic illness/ starvatin
old age
A male with pseudohermphroditism due to absense of androgen receptors. Have cryptorchid testes. Elevation in serum testosterone
Testicular feminization
this deficiency causes males be unable to convert testosterone to a dihydrotestosterone resulting in a bifid scrotum, hypospadias. At puberty scrotum, phallus and muscle mass will enlarge though.
5 alpha-reductase deficiency
What differs the signs and symptoms of type 1 DM from type 2?
No ketosis or ketonuria in Type 2
what is a common initial complaint in men w/ T2DM?
erectile dysfunction
recurrent candidal vaginitis can be an early tip off to what?
DM
which type of diabetes has a stronger genetic component?
Type 2
main risk factor for T2DM?
central obesity then sedentary lifestyle
is gestational diabetes usually symptomatic?
No, usually asymptomatic
risks for gestational DM
marked obesity personal hx delivery of a previous large baby glycosuria PCOS
starting dose for insulin for DMT1
0.4-1.0 micrograms/kg per day
typical initial Rx for DMT2
metformin or sulfonylurea
cornerstone of management of T2DM?
diet and exercise
when is insulin the first therapy of choice w/ T2DM?
fasting glucose >240
2 makers associated w/ T1DM?
HLA-DR3
HLA-DR4
what causes destruction of the beta cells w/ T1DM?
autoantibodies (cytotoxic T cells)
what is the period where there is recovery of some of the beta cell function so exogenous insulin level needs drop w/ T1DM?
honeymoon period
T1DM is sometimes believed to follow what?
infectious or toxic insult (mumps, coxsackie)
onset w/ rapid acting insulins (Humalog, Novolog)
5-15 minutes
peak of rapid acting insulin
1-1.5 hours
duration of rapid acting insulins
3-4 hours
onset of regular (Humulin or Novolin R) insulins
30-60 minutes
peak of regular insulins
2 hours
duration of regular insulins
6-8 hours
onset of NPH (humulin or novolin N) insulins
2-4 hours
peak of NPH insulins
6-7 hours
Duration of NPH insulins
10-20 hours
Onset of insulins glargine (lantus)
1.5 hours
peak w/ insulin glargine (lantus) and insulins determir (levermir)
flat
duration of insulin glargine (lantus)
24 hours
duration of insulin determir (lantus)
17 hours
patients taking excess doses or oral hypoglycemic agents have high levels of what?
insulin
C-peptide
what does C-peptide tell you?
tell the difference between insulin produced by the body and insulin injected into the body.
It is produced if insulin is made by the pancreas
what do low values of c-peptide indicate?
pancreas is producing little or no insulin
what is reactive (postprandial) hypoglycemia?
symptoms occur w/i 4 hours of eating a meal
what causes low blood sugar w/o any symptoms
loss of glucagon and epinephrine responses over time
autonomic dysfunction
delayed counterregulatory responses of GH and cortisol
Criteria for DKA
Hyperglycemia (plasma glucose level of >250 mg/dL)
Ketosis: moderate to severe ketonemia and moderate ketonuria
Acidosis: pH < or equal to 7.3 or bicarb < or equal to 15 mEq/L
physiologic types of cushing’s syndrome
stress
last trimester of pregnancy
persons who do strenuous exercise
pathologic causes of cushing syndrome
exogenous steroids
severe psychiatric states (depression or alcoholism)
ACTH dependent causes of Cushings syndrome
pituitary sources
ectopic ACTH
rare ectopic sources of CRH-tumors
ACTH independent causes of cushings syndrome
adrenal adenomas/ carcinomas
micronodular adrenal dz
autonomous macronodular adrenal dz
what is used to discern b/w cushing’s disease and syndrome
high dose dexamethasone suppression
Autoimmune destruction of adrenal glands - most common cause of primary adrenal insufficiency
Addison’s Dz
causes of addison’s
TB autimmune adrenalitis sarcoidosis histoplasmosis amyloidosis hemochromatosis adrenal hemorrhage
thyrotoxicosis in Graves disease is due what?
the overproduction of an antibody that binds the TSH receptor.
Occurs in older patients with long-standing multinodular goiter, especially in patients from iodine-deficient regions who are exposed to increased dietary iodine or receive iodine-containing radiocontrast dyes.
toxic multinodular goiter
T3 and T4 levels are normal with a suppressed TSH.
subclinical hyperthyroidism
classified as acute, subacute, and chronic. Initial presentation is due to acute release of T4 and T3.
thyroiditis
from the destruction of normal thyroidal architecture by lymphocytic infiltration results in hypothyroidism and goiter.
Hashimoto or lymphocytic thyroiditis
results from ingestion of excessive amounts of thyroxine often in an attempt to lose weight.
Thryotoxicosis Factitia
T4 and T3 levels are normal or low with mildly elevated TSH
Subclinical hypothyroidism
weight gain with cushings
obesity is centripetal, with a wasting of the arms and legs
buffalo hump
moon face
common sx of cushings in younger adults
thinning of the skin on the top of the hands
lab findings in cushing’s
elevated plasma alkaline phosphtase levels , glucose intolerance,
most common form of thyroid cancer
papillary carcinoma
presentation of thyroid cancer
painless neck swelling and single, palpable non-tender firm mass
often feels stony and hard
what type thyroid cancer presents w/ flushing, diarrhea, fatigue and cushing’s syndrome
medullary carcinoma
most common cause of hyperthyroidism
Grave’s disease
what is MEN IIA (sipple)?
medullary carcinoma of the thyroid
hyperparathyroidism
pheochromoctyoma
What is MEN IIB?
medullary carcinoma of the thyroid mucosal neuromas intestinal ganglioneuromas marfanoid habitus pheochromoctyoma
presents w/ HTN, hypervolemia, hypokalemia, hypernatremia, muscle wekaness, fatigue, HA
hyperaldosteronism
more common presentations in females w/ pituitary prolactinoma
anovulation
oligomenorrhea or amenorrhea
infertility
galactorrhea
male presentation w/ pituitary prolactinoma
erectile dysfunction infertiliy decrease muscle mass galactorrhea gynecomastia
what do patients w/ Addison’s Dz need before undergoing surgery
150-300 mg hydrocortisone
Adverse rxns following a thyroidectomy
hypoparathyroidism
recurrent laryngeal nerve severed (hoarseness)
typical approach for a pituitary resection
transsphenoidal surgery
what can reduce risk of nodule growth and decrease size, but is controversial
levothyroxine
how to manage a benign thyroid nodule
observe nodule for 1 year after inital bx
recheck seize by US (q 6-12 months)
perform another bx if enlarging
Manifestatiosn of peripherals vascular dz
ischemic skin ulcers
claudication
limb loss
first line for distal sensory neuropathy
TCAs (have anticholinergic ADRs)
S/S of autonomic insufficiency with DM neuropathy
postural HPOTN
impotence
urinary retention
Drug that can tx gastroparesis
metoclopramide
Tx for diarrhea w/ DM?
broad spectrum (neomycin or tetracycline)
