UW - Med/Endocrine Flashcards
What results from elevated GH in acromegaly?
Stimulates hepatic production of IGF1
What should be measured when there is clinical suspicion of acromegaly?
IGF1 - if elevated do oral glucose suppression test (if inadequate suppression of GH, rule in acro)
What is neuroleptic maligant syndrome (NMS) and how do you treat?
Recent onset of confusion, fever, muscle rigidity, diaphoresis, and CK of 50k, following treatment by dopaminergic antagonist
Tx = dantrolene (muscle relaxant) and bromocriptine/amantadine as 2nd line
What should you suspected in someone who is hyperthyroid presenting with mild fever and sore throat?
Consider agranulocytosis as a result of Tx w/ PTU or methimazole, making patient susceptible to infection (stop medication immediately)
What is the most common thyroid malignancy?
90-95% are epithelial and >70% of these are PAPILLARY
What is the purpose of the cosynotropin test?
ACTH synthetic analog, if it causes a rise in cortisol (>20micrograms in 1 hr) when administered, primary AI can be ruled out. Small rise in cortisol = primary AI
What are the initial screening tests for supsected AI (primary/central)?
Simultaneous basal early-morning cortisol, adrenocorticotropic hormone (ACTH), and Cosyntropin test
What will occur if propranalol is given to a patient with pheochromocytoma?
Rapid increase in blood pressure, as a result of unopposed alpha-adrenergic activity
What complication are patients with Hashimoto’s Thyroiditis at a higher risk of developing?
60x increased risk of thyroid lymphoma
What is the main treatment for Grave’s disease and contraindications to this treatment?
Radioactive Iodine Therapy - but not w/ pregnancy or very severe opthalmopathy
Why is hypertension and hypokalemia more severe w/ ectopic ACTH secretion?
High levels of cortisol are produced –> saturate 11-betaHSD (enzyme that converts to inactive cortisone) –> now also bind mineralocorticoid-R causing HTN and HoK+
What are the major causes of osteomalacia?
Vit. D deficiency as a result of malabsorption, intestinal bypass surgery, celiac sprue, Chronic liver or kidney disease, renal tubular acidosis, inadequate calcium intake
What does negative ANA ab rule out?
SLE
How can you differentiate thyroiditis from Grave’s disease?
Thyroiditis - thyrotoxicosis from leakage of thyr hormones into circulation from inflammatory dmg to foliccles, w/ reduced radioactive iodine uptake, often in post partum period (increased rad Iod uptake in Grave’s)
What is Osteitis fibrosa cystica (von Recklinghausen disease of bone) and its associated clinical features?
- Osteoclastic resorption of bone –> replacement w/ fibrous tissue (brown tumor) and bone pain
- caused by hyperparathyroid from PT carcinoma
- Xray - subperiosteal resorption of bone on radial aspect of middle phalanges, distal clavicular tapering, salt/pepper appearance on skull, bone cysts, and brown tumors of long bones
What are the diagnostic criteria for PCOS?
> 2-3 of: Androgen excess (hirsituism, acne, androgenic alopecia), Olig/anovulation, Polycystic ovaries on US
AND exclusion of other hyperandrogenic conditions
What useful test can be done in suspected PCOS?
72 hr oral glucose tolerance test (fasting blood glu and HbA1c if OGTT not feasible)
What is the purpose of tight glucose control in diabetes?
Decrease incidence of microvascular complications like retinopathy, neuropathy and nephropathy
What clinical signs are consistent w/ Grave’s disease?
Insomnia, fatigue, weight loss, lid lag, tremor
A-fib from increased sensitivity of beta-adrenoreceptors to sympathetic stimuli
What is the reason for the hemolysis due to G6PD deficiency? Clinical features associated with this?
Hemolysis precipitated by infections or meds that increase OXIDATIVE STRESS (especially sulfa, or fava beans)
Heinz bodies form in RBC membrane
What ion imbalance is prone to occur in patient’s who are hospitalized long term, like after complicated surgery? Which patients are at more risk and how can you treat?
- Hypercalcemia of Immobilization (unknown cause but most likely from increased osteoclastic bone resorption)
- Pts w/ chronic renal insufficiency at increased risk, may get hyperCa2+ as early as 3 days post immobile
- Tx: Hydration and bisphosphonates
What patients are at increased risk of pseudogout?
HyperPTH, post surgical, hypercalcemia
What is euthyroid sick syndrome?
“Low T3 syndrome” - drop in total/free T3 w/ normal T4 and TSH levels
-Occurs from decreased peripheral deiodination of T4 -> T3 due to caloric deprivation, elevated glucocorticoid, inflammatory cytokine levels, and inhibitor of 5’-monodeiodinase (from free FAs and certain meds)
What is Reidel’s thyroiditis?
Inflammatory disease causing fibrosclerosis of thyroid, surrounding tissues and remote non-thyroid structures (retroperitoneum)
-Most have hard goiter
What is a major risk factor of untreated hyperthyroidism and why?
Rapid bone loss from increased osteoclastic bone resorption –> Increased Serum Ca and Urine Ca
What are the causes of hypercalcemia w/ low PTH? Normal/elevated PTH?
Low - Malignancy, Vit D tox, granulomatous disease (sarcoid)
N/H - Primary hyperparathyroidism
How can you differentiate primary from secondary hyperPTH?
PTH levels are much higher in secondary vs. primary
Ca levels are low/normal in secondary
Moderate to severe CKD can increase PTH in secondary via feedback mechanism
What are common offending medications for hyperK+?
Beta blockers, K+ sparing diuretics (AMILORIDE, Triamterene), ACEI, ATRB, NSAIDs
How do diabetic foot ulcers form?
- Chronic unnoticed trauma due to advanced peripheral neuropathy and poor wound healing from microvascular insufficiency
- Often in association w/ Charcot deformity, common on soles of feet over metatarsel heads and tops of toes
What are useful signs of hypercalcemia? What could be the cause in an otherwise healthy patient taking lots of supplements?
- Abdominal pain, constipation, polyuria and polydipsia
- Likely from excessive Vitamin D intake (megadoses of Vit D or multiple V. D containing products)
- Could also be from Granulomatous disease (sarcoid) or lymphoma
What are the signs of malabsorption?
Diarrhea, weight loss, edema and vitamin deficiencies
How may a patient w/ hypothyroid myopathy?
Fatigue, myalgias, proximal muscle weakness, sluggish ankle reflexes, elevated creatine kinase (CK)
What are patients w/ diabetes at risk for post-operatively?
Necrotizing surgical wounds (gray dishwater fluid draining) -> urgent surgical exploration
How can infection precipitate DKA in patients w/ T1DM?
- Systemic release of insulin counterregulatory hormones (catecholamines, cortisol).
- Excess glucagon –> Hyperglycemia, ketonemia, osmotic diuresis, increased lypolysis (increased FFA))
- Diuresis -> renal loss of K+, decrease total body K+
What renally acting drug can precipitate hyperosmolar hyperglycemic state (HHS, aka HONC) and why?
Thiazide diuretics –> reducing intravascular volume, decreases GFR, and activation of counterregulatory hormones (e.g. cortisol & glucagon which increase glucose production)
What are the signs/symptoms of glucagonoma?
Diabetes mellitus, necrolytic migratory erythema (NME- erythematous papules or plaques, large painful inflamed bilsters), weight loss, diarrhea, and anemia, serum glucagon >500
What is urine 5-hydroxyindoleacetic acid excretion and indicator of?
Carcinoid syndrome - diarrhea, weight loss, episodic flushing
What are the clinical signs and symptoms of panhypopituitarism?
- Glucocorticoid deficiency (low ACTH, low cortisol) - fatigue, loss of appetite, hypogycemia, hyponatremia, eosinophilia
- Testosterone deficiency (low/normal FSH and LH, low testosterone) - low libido, erectile dysfunction
- Hypothyroidism (low TSH, low free T4) - cold intolerance, constipation, bradycardia
What are patients w/ mild primary hyperaldosteronism prone to developing?
Diuretic induced hypokalemia, also possibly met alk and mild hypernatremia
What are the major clinical features that can be present in Amyloidosis?
- Asymptomatic proteinuria or nephrotic syndrome
- Restrictive cardiomyopathy
- Hepatomegaly
- Peripheral neuropathy &/or autonomic neuropathy
- Visible organ enlargement
- Bleeding diathesis
- waxy thickening, easy skin bruising
How long after having diabetes mellitus does nephropathy usually occur?
10-15 years
What symptoms are usually present in diabetic retinopathy?
- Asymptomatic until late stage of disease
- poor night vision, curtain falling (w/ vitreous bleed), floaters (during resolution of vitreous bleed)
Which thyroid cancers secrete calcitonin?
Medullary carcinoma
What distinguishes follicular carcinoma on FNA bx? Pathophysiologically?
- Invasion of tumor capsule and blood vessels is necessary to distinguish from follicular adenoma
- Early hematogenous spread to lung, brain and bone
What is the best way to determine a patients risk for diabetic foot ulcers?
Monofilament testing -> measures pressure threshold and sensation on bottom of patient’s foot
What calcium and phosphate levels are present in V. D deficiency?
Low to low-normal serum phosphate and normal serum calcium
How can chronic kidney disease lead to calcium and phosphate and hormone imblanace?
Phosphate retention –> excess binds calcium –> secondary rise in PTH (also from excess phos)
Phosphate also interferes w/ production of calcitriol –> decreased intestinal calcium absorption
What is a key side effect of triamcinolone? How can you confirm?
suppressed endogenous pituitary-adrenal axis and put at increased risk for adrenal insufficiency
-Stress dose of steroids
What abdominal exam finding can be seen w/ DKA and how should it be treated?
- Generalized abdominal pain w/ guarding
- Pt should get serial abdominal physical exams and monitor for improvement of symptoms as the acidosis is corrected (if sx don’t improve w/ correction of DKA consider imaging)
What lab finding is indicative of lupus anticoagulant (as in antiphospholipid ab syndrome or SLE)?
Prolonged PTT
What is the effect of oral estrogen therapies on thyroid function?
Increases TBG (via decreased clearance), normal patients will increase thyroxine to saturate extra TBGs, but hypothyroid patients will require more levothyroxine
What is the effect of chronic liver disease to thyroid hormones?
Decreased TBG production -> decreased total free levels of T3/T4
What lab findings are consistent w/ Hashimoto’s thyroiditis?
-Elevated TSH, low T4, + anti-thyroid peroxidase Abs
What is the primary treatment for PCOS?
Weight loss and Combined hormonal contraceptive therapy (metformin only for insulin resistance - T2DM)
What is the criteria for diagnosing Behcet’s syndrome?
Recurrent oral ulcers + 2 of the following (recurrent genital ulcers; eye lesions - anterior/posterior uveitis; retinal vascularization; skin lesions -erythema nodosum, acneiform nodules and populopustuler lesions, +pathergy test)
What is the next step in management for asymptomatic hyperparathyroidism? How do you distinguish from Familial HH?
- Neck imaging in preparation for parathyroidectomy (to decrease risk of future complications)
- familial hypocalciuric hypercalcemia has low urine calcium in comparison
What are the main contraindications for antithyroid drugs (PTU, methimazole)?
Allergic reaction (2%) and Agranulocytosis (.3%) in both
Meth- 1st trimester teratogen, cholestasis
PTU-Hepatic failure, ANCA vasculitis
What comprises MEN2B disorders?
Mucosal neuromas, pheochromocytoma, medullary carcinoma of thyroid (marfanoid)
