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*DOOS 2 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

what does GH hypersecretion lead to in childhood?

A

gigantism

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2
Q

what does GH hypersecretion lead to in adults

A

acromegaly

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3
Q

what most often causes hypersecretory GH

A

pituitary adenoma

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4
Q

ACTH levels are ________ in adrenal insufficiency because of the primary adrenal disorder.

A

normal to high

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5
Q

ACTH is ___________ in adrenal insufficiency secondary to hypothalamic-pituitary hypofunction

A

low to absent

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6
Q

what metabolism does GH affect?

A

carbohydrate metabolism

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7
Q

How do deficiencies of GH manifest in children?

A

growth delays and fasting hypoglycemia

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8
Q

in adults how do growth hormone deficiencies manifest?

A

abdominal girth
reduce strength
decreased lean body mass

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9
Q

cut off point between micro and macro adenomas

A

<1 cm is microadenoma

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10
Q

An amino acid secreted episodically by pituitary lactotrophs

A

Prolactin

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11
Q

what do estrogens increase?

A

PRL secretion

gluccocorticoids

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12
Q

Is PRL needed to maintain lactation after nursing has begun?

A

No

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13
Q

PRL levels greater than what are highly suggestive of PRL-secreting adenomas

A

> 200 ng/ml

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14
Q

what hormone is checked for growth hormone problems?

A

IGF-1

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15
Q

in men with a prolactinoma what will be suppressed?

A

testosterone

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16
Q

A glycoprotein hormone synthesized & secreted by pituitary thyrotroph cells .

A

Thyroid stimulating hormone (TSH)

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17
Q

Normal TSH level?

A

1.5-5.0

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18
Q

what do anterior pituitary deficiency result in?

A

leads to growth retardation, deficient or absent lactation, hypogonadism, hypothyroidism & adrenal insufficiency.

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19
Q

what are common causes of anterior pituitary deficiency

A

tumor, infarction, necrosis, infection, autoimmune inflammatory processes, certain Rx & genetic anomalies.

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20
Q

2 posterior pituitary hormones

A

oxytocin

ADH

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21
Q

Diagnostics of chronic for anterior pituitary deficiency

A

IGF-1; plasma testosterone, TSH, Free T4, and plasma cortisol response to synthetic ACTH

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22
Q

mot common functioning tumor

A

prolactinoma

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23
Q

Caused by pituitary adenoma causing excess GH or excess GHRH

Link to the MEN-I gene (Multiple Endocrine Neoplasia)

A

acromegaly

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24
Q

⇑ growth of jaw, hands, feet & internal organs

occurs if disease hits before closure of epiphyses

A

Gigantism

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25
Q

other random features of acromegaly

A

moist palms
CTS
deep, coarse voice
sleep apnea

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26
Q

most reliable lab study for possible acromegaly

A

IGF-1

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27
Q

most common presentation of prolactinoma

A

amenorrhea

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28
Q

Tx for acromegaly

A

endoscopic trans-sphenoidal surgery remains the treatment of choice
tx failure- sterotactic radiosurgery used in tx failures

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29
Q

is most galactorrhea due to prolatcinoma

A

no, only 40-45%

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30
Q

other txs besides surgery for acromegaly

A

dopamine agonists (bromocriptine, pergolide, cabergoline)
somatostatin
radidation

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31
Q

Short limbs & long narrow trunks, lg. head & mid-face hypoplasia & prominent brow
Intelligence is normal

A

achondroplastic dwarfism :)

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32
Q

complications of achondroplastic dwarfism

A

leg bowing
obesity
dental problems
frequent otitis media

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33
Q

Tx for prolactinoma

A

dopamine agonist- bromocriptine (qhs), cabergoline (2x weekly)

34
Q

main side effect of dopamine agonists

A

naseau

35
Q

signs of pituitary dwarfism

A

not apparent at birth

signs- micro-penis and hypoglycemia

36
Q

gene mutation with achondroplastic dwarfs

A

mutations in FGFR3 gene

37
Q

what does a lack of ADH cause

A

diabetes insipidus

38
Q

diagnosis of diabetes insipidus

A 
high serum osmolality >290
dilute and copious urine output
polydipsia
dehydration
hypernatremia
39
Q

tx for SIADH

A

DDAVP (synthetic vasopressin) intranasally that causes a 50% or greater increase in urine osmolality is diagnostic for diabetes insipidus

40
Q

signs of prolactinoma in men

A

low sex drive
low energy
hot flashes

41
Q

lab workup for men w/ low sex drive

A

total and free testosterone
LH/ FSH
prolactin
TSH

42
Q

what may nephrogenic diabetes insipidus respond to

A

HCTZ or in combo w/ indomethacin

43
Q

Syndrome of high plasma ADH levels decreasing the serum osmolality
( <280mOsm/kg) , high urine osmolality

A

SIADH

44
Q

what must you exclude before a dx of SIADH

A

Diagnosis must first exclude nephrotic syndrome, CHF, & cirrhosis by confirming thyroid, adrenal, renal & cardiac status.

45
Q

what happens during a glucose tolerance test w/ acromegaly

A

growth hormone doesn’t drop

46
Q

The most common cause of ACTH-independent Cushing’s Disease

A

adrenal adenoma (<3 cm in diameter)

47
Q

3 hormones released by adrenal

A

aldosterone
cortisol
epinephrine

48
Q

what is cortisol involved in

A

stress hormone

sleep

49
Q

what 3 hormones are involved in circadian rhythms

A

cortisol
growth hormone
adrenaline

50
Q

common characteristics of cushings

A

truncal obesity, hypertension, striae, ecchymoses, proximal muscle weakness, hypokalemia, osteoporosis, and infertility.

51
Q

what can cause false + labs for cushing’s?

A

anti-seizure Rx
oral contraceptives
rifampin
spironolocatone

52
Q

first test is suspecting cushings

A

24 urinary free cortisol

53
Q

if you order a 24 urine what else do you need to order

A

creatinine to know it it was an adequate collection

54
Q

2nd screening test for cushing’s

A

2mg dexamethasone suppression test

if it hasn’t suppressed that is abnormal

55
Q

3rd screening test for cushing’s

A

8 mg dexamethasone and then check if it is suppressed (points to adrenal source)

56
Q

if suppression did occur with high dexamethasone test where do you suspect the tumor to be?

A

pituitary

57
Q

other conditions that can create a hypercortisol state

A

Depression, Alcoholism, Anorexia Nervosa, Panic disorder, & Withdrawal syndromes (from drugs of abuse - narcotics & alcohol)

58
Q

what is cosyntropin

A

synthetic ACTH

59
Q

with primary adrenal insufficiency what hormone will be high?

A

ACTH and MSH

will have hyperpigmentation

60
Q

present w/ HTH difficult to control
Persistent hypokalemia
Impaired glucose tolerance

A

hyperaldosteronism

61
Q

workup of hyperaldosteronism

A

Aldosterone suppression test combined with increased NaCl (po or IV)
Spironolactone relieves - is diagnostic too
CT of adrenals (hyperplasia or carcinoma)

62
Q

who are most affected by hyperaldosternism

A

women

63
Q

most common cause of primary adrenal insufficiency worldwide

A 
TB
autoimmune adrenalitis (industralized nations)
64
Q

what conditions is prednisone use chronically and can lead to iatrogenic cushings

A

asthma
RA
IBD

65
Q

what is myxedema

A

dough consistency due to high TSH (hypothyroidism)

66
Q

other manifestations of myxedema

A

lethargy
thick tongue
slow mental functioning
coarse hair

67
Q

diagnostics for panhypopituiarism

A 
IGF-1 (low)
plasma testosterone (low) 
TSH (normal-low) 
Free T4 (low)
plasma cortisol response to synthetic ACTH
68
Q

benign tumor but when removed could possibly affect pituitary

A

craniopharyngioma

69
Q

what usually causes hyperaldosteronism

A

adenoma

70
Q

screening test for hyperaldosteronism

A

normalize the K+
then plasma, renin serum aldosterone (want ratio, will be high)
24 hour urine (look for aldosterone)
CT scan of adrenal glands (no contrast)

71
Q

test for hyperaldosteronism

A

saline suppression test

check aldosterone level before and after, confirmed if it doesn’t suppress

72
Q

what can cause hyperaldosteronism

A

bilateral adrenal hyperplasia or carcinoma

73
Q

tx for hyperaldosteronism

A

spironolactone

74
Q

what causes secondary hyperaldosteronism

A

from failure of pituitary secretion of ACTH

women affected more

75
Q

main dx lab for addison’s

A

Low 8AM plasma cortisol (< 5mg/dL) with elevated ACTH (> 200mg/dL)
high ACTH level
high plasma renin/low plasma aldosterone

76
Q

test for pheochromocytoma

A

plasma free metanephrine and
24 hour urine catecholamines
confirm w/ CT or MRI

77
Q

Tumor producing excess of catecholamines & their metabolites

A

pheochromocytoma

78
Q

how do patients w/ a pheochromocytoma present

A

Nearly all affected pts have episodic hypertension while over 50% have sustained HTN with associated headache, sweating, & palpitations.

79
Q

what are pheos associated w/?

A

Neurofibromatosis
Von Hippel-Lindau retinal angiomatosis
Cerebellar hemangioblastoma
Multiple endocrine neoplasia

80
Q

treatment of choice for pheo

A

surgery

81
Q

what must be done before surgery for a pheo

A

B/P controlled for1-2 weeks

use alpha-adrenergic blockers (sins) and beta blockers

82
Q

Crisis tx for pheochromocytoma

A

regitine or nitroprusside to control BP

*DOOS 2 (11 decks)

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