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KC Endocrine > Tests And Stuff > Flashcards

Tests And Stuff Flashcards

1
Q

Primary hyperparathyroidism Labs:

A

Serum Cal: high
iCal: high
iPTH: high
Serum phosphate: low

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2
Q

S/s of congenital adrenal hyperplasia

A

Virulization; salt wasting; ambiguous genitalia

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3
Q

Congenital adrenal hyperplasia is caused by what deficiency

A

21-hydroxylase enzyme (makes cortisol)

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4
Q

DI on physical exam:

A

Hydronephrosis and larger bladder

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5
Q

Hypoparathyroidism s/s

A 
Laryngospasm/bronchospasm
GI
Neuro
Psych
\+chovesteks and trousseau’s sign
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6
Q

Iatrogenic adrenal insufficiency potential causes:

A

Etodimate
Ketoconazole
Adrenalectomy
RU-486

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7
Q

Common s/s post-parathyroidectomy surgery in hyperparathyroidism

A

“Hungry bones” and now pts getting waxing and waning hypocalcemia

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8
Q

adrenal insufficiency is comomonly caused by withdrawal from chronic use w/ these medications

A

Prednisone and dexamethasone (decadron)

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9
Q

Hypoparathyroidism on Labs:

A

Serum Cal: low
iCal: low
iPTH: low
Serum phosphate: high

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10
Q

Pheochromocytoma etiology

A

90% adrenal medulla tumors of chromaffin cells

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11
Q

Adrenal insufficiency workups

A 
renal failure
Low glucose
Hyperkalemia
Hyponatremia
Metabolic acidosis
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12
Q

Adrenal etiologies with cushings and treatment

A

1- adrenal adenoma (MC); tx u/l laparoscopic adrenal resection
2 adrenal carcinoma; tx- open laparotomy with exploration

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13
Q

Hypopituitarism workup:

A

Labs: panhypopituitarism; MRI of pituitary

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14
Q

Hypoparathyroidism etiology

A

Iatrogenic
Autoimmune destruction
Hypomagnesiemia (reversible)

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15
Q

Central DI tx

A

DDAVP- synthetic ADH

Diet

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16
Q

Tx for symptomatic primary hyperparathyroidism

A

Parathyroidectomy

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17
Q

Hypoaldosteronism labs

A

Hyperkalemia
Hypovolemia
Non-metabolic acidosis
However pt. Asymptomatic presentation

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18
Q

Cushings test to localize the source of acth

A

ACTH serum level: elevated—>pituitary or ectopic source
(R/o adrenal autonomous secretion)
CRH serum level: elevated—>pituitary source
(R/o ectopic source)

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19
Q

Adrenal insufficiency CT reveals calcified adrenals:

A

TB

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20
Q

Meds for tx in hyperaldosteronism

A

CCB and alpha blockade

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21
Q

Nephrogenic DI tx

A

Diet
Thiazide
Amiloride

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22
Q

Prolactinoma work-up

A

1- Labs: prolactin, pregnancy test, TSH

2- MRI w/ contrast

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23
Q

Hyporeninemic hypoaldosteronism tx

A

Thiazide and diet w/ low K

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24
Q

Secondary hyperparathyroidism treatment:

A

1- reduce phosphate foods
2- phosphate binders: need to be taken w/ meals
Calcium acetate (Phoslo)- CA
Selevamer (Renvela; Renagel): non-ca
Fosrenol (Lanthanum) non-CA, chewable and crushable (peg-tube pts)
3- Vitamin D agent:
Calcitriol (rocaltrol)- IV/oral (SC w/ HD appointments)
-Active form of vitamin D
Doxercalciferol (hectoral)- IV/oral
- metabolized to active form
Paricalcitol (zemplar)- IV/oral
- synthetic vitamin D analog; binds at receptor in kidney
4- Calcimimetic agent: Cinacalcet (Sensipar)
5- Surgical (as last resort): parathyoidectomy

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25
Q

Hypercalcemia treatment:

A

Mild (<12)
1- hydrate
2- avoid drugs that worsen (lithium and thiazide)
3- avoidance of factors that worsen (bed rest/immobility)
Severe (>12)
1- bisphosphonate IV (zometa) and IV fluids!!

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26
Q

Labs in adrenal insufficiency

A 
Low glucose
Hyperkalemia
Renal failure
Low sodium
Metabolic acidosis
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27
Q

Cushing’s syndrome test:

A 
1- dexamethasone test
2- salivary cortisol test
3- random urinary free cortisol test
4- ACTH 
5- CRH
6- MRI w/ contrast
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28
Q

Hypoparathyroidism tx

A 
1- IV calcium gluconate—> normal levels
Also high oral calcium intake and vitamin D supplements
2- thiazide diuretics
3- recombinant PTH (natpara)
—> BBW for osteosarcoma
29
Q

Hypocalcemia s/s

A

Parasthesias (oral and hands/feet)
Prolonged QT
Sz
Tetany/muscle spasms

30
Q

Hyperaldosteronism workup:

A
  • Aldosterone to renin ratio w/ patient standing 2+ hours

- MRI w/ contrast

31
Q

Hypoaldosteronism MC associated with these diseases

A

Diabetic nephropathy and chronic tubulointerstitial kidney dz

32
Q

Pituitary Metasteses cancers and survival length

A

Metastasize to the posterior pituitary—> diabetes insipidus
~ 6 months
- breast, lung, & GI

33
Q

MC cause of hyperglycemia in outpatients and MC etiology

A

Primary hyperparathyroidism

Single autonomous parathyroid adenoma

34
Q

Diabetes Insipidus workup:

A

1- 24h urine collection
2- labs:
- ADH
- urine specific gravity (>1.005 is +)
- plasma & urine osmolality (<200 is +)
- serum electrolytes & glucose
3- water deprivation testing to see central vs. nephrogenic

35
Q

Mc cause of Addison’s dz

A

Auto abs to adrenal

36
Q

Prolactinoma Tx:

A

Aymptomatic: yearly MRI and observation
Symptomatic: Bromocriptine & surgical transphenoidal pituitary adenectomy

37
Q

Tx of hypocalcemia

A

Mild: (1.0-1.2)
PO calcium
Calcium gluconate
Calcium chloride (only in central line or w/ emergency)
Severe- IV calcium (<1.0)
W/ symptoms—> 100-300 mg calcium IV over 5-10 minutes w/ continuous infusion at 0.5 mg/kg/hr
W/o symptoms—> 0.5 mg/kg/hr IV infusion (not to exceed 3-4 g over 4 hrs)
Monitor calcium levels Q4-6hours

38
Q

Cushing’s Dx tests

A

1- Dexamethasone suppression test- in patient test
- 1 mg at 11p and measure serum cortisol @ 8a—> elevated or normal is likely cushings
2- salivary cortisol levels- easy test; at home
-saliva specimen at 11p—> high cortisol likely Cushing’s
3- random urinary free cortisol level
Cortisol>(3*creatinine) likely Cushing’s

39
Q

Secondary adrenal dz workup

A

Screening test: serum cortisol levels (<25mg/dL is +)
Diagnostic: cosynotropin stimulation test (obtain baseline levels of aldosterone and cortisol; give 0.25 mg ACTH and measure aldosterone and cortisol levels—>low/unchanged is +)

40
Q

MC cause of Diabetes insipidus w/ central etiology:

A

Idiopathic

- also malignant, surgery, or trauma

41
Q

MC cause of Diabetes Insipidus w/ Nephrogenic etiology:

A

Meds: LITHIUM

- also, renal dz, pregnant, osmotic diuresis

42
Q

MC cause of adrenal insufficiency

A

Addison’s dz

43
Q

Primary treatment of cushings:

A

transphenoidal surgery (high success rate)

44
Q

Secondary adrenal dz presenting differences:

A

No salt cravings
All endocrine hormones affected
No hypigmentation

45
Q

Medical tx w/ ectopic cushings

A

Ketoconazole

46
Q

Hypocalcemia w/u

A

Labs: PTH, mag, creatinine , phosphate, vitamin D metabolites

47
Q

Secondary hyperparathyroidism Labs picture:

A

Serum Cal: low
iCal: low
iPTH: high
Serum phosphate: high

48
Q

Ectopic etiologies in cushings:

A

Carcinoid tumors: lung/GI (MC)

Neuroendocrine: pancreas; pheo; medullary thyroid cancer

49
Q

Etiology of hypercalcemia of malignancy

A

Tumor release of a hormone-related peptide (PTrH) w/ low PTH; BLT and a Kosher Pickle

50
Q

Dx for pituitary macroadenoma:

A

1- intitial screening test: random serum IGF-1
(+)—> elevated IGF-1
2- GH supression test:
- oral glucose load is given and GH level drawn at 120 min
- IGF-1 level>1ng/mL= (+) GH excess
3- thin cuts MRI w/ contrast

51
Q

Tertiary hyperparathyroidism tx

A

MC w/ total or subtotal parathyroidectomy

52
Q

Hypoituitarism tx:

A 
1- ACTH= hydrocortisone 
2- TSH replacement 
3- FSH/LH= 
- fertility—>
Men &amp; women: gonadotropins
- no fertility—>
M: testosterone
W: HRT (est and progest)
53
Q

Hypercalcemia S/S

A

Skeletal muscle weakness

Easy fatig

54
Q

Hypoaldosteronism from Primary adrenal deficiency tx

A

Fludrocortisone (Florinef)

55
Q

Tx of choice for macroadenoma

A 
1- transphenoidal microsurgery 
2- pharm:
- octreotide/lanteotide (somatostatin analog)
- bromocriptine
- pegvisomant (GH receptor antagonist)
56
Q

W/u of hypercalcemia

A

1- confirm hypercalcemia (w/albumin test)
2- Check PTH
—> high: primary hyperparathyroidism
—> low, then require iPTHrP to check malignancy or vitamin D metabolites for granulomatous or vitaminosis

57
Q

Adrenal insufficiency CT reveals enlarged adrenals:

A

Metastatic dz

58
Q

MC cause of hypercalcemia in hospitalized patients

A

Hypercalcemia of malignancy

59
Q

Cushings first line Imaging test

A

MRI w/ contrast

60
Q

Hypercalcemia of malignancy tx

A

IV bisphosphonate

FLUIDS

61
Q

Hyperaldosteronism labs:

A

Hypokalemia
Hypervolemia
Hypernatremia
Metabolic alkalosis

62
Q

hyperaldosteronism tx

A

Adenoma?—> U/L adrenal resection

Hyperplasia?—> aldactone (spironolactone): aldosterone antagonist

63
Q

Tests for adrenal insufficiency

A

1- serum cortisol levels (<25 mcg=+)

2- cosyneotropin stimulation test (low or not changing=+)

64
Q

Hyperaldosteronism etiologies:

A

Mc women 30-50
1- B/L adrenal hyperplasia (MC)
2- aldosterone producing adenoma
3- sometimes adrenal ca

65
Q

Pheochromocytoma Dx test

A

24 hour creatinine urine test

66
Q

Two pharm treatments for hypothyroidism:

A

1- levothryoxine (synthroid)

2- liothyronine (cytomel)

67
Q

Inducers of thyroid pharm tx:

A

Phenytoin
Tegatrol
Rifampin
Phenobarbital

68
Q

Inhibitors of levothyroxine

A

Delivery
Menopause
Oral estrogens
GnRH agonists

KC Endocrine (12 decks)

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