UW3 (08 Endo) Flashcards
HyperCalcemia
Lab tests? 3
Treatment? 2
When to add thiazide?
- Repeat test
- PTH
- PTHrp + Vit D
- Calciferol / Calcitriol
- Calcium
• If U-Ca ↓ + PTH ↑ Add Thiazide
Anabolic steroid
Symptoms? 3
Withdrawal symptoms? 2
Labs? 6
- Testicular atrophy
- Acne
- Gynecomastia
- Libido ↓
- Erectile dysfunction
- FSH ↓ + LH ↓
- LDL ↑ + HDL ↓
- Hb ↑ / RBC ↑
Thiazolidinedione
Pioglitazone (actos)
Rosiglitazone (Avandia)
Effects? 2
- ↑ Na reabsorption @ kidney
* ↑ Fluid retention
Subclinical HypoThryoid (Hashimoto Thyroiditis)
Diagnostic lab?
Treatment indication based on TSH?
Treatment indication based on TPO Ab?
• TSH↑, T4 n, TPO Ab ⊕
- TSH > 10
- TSH 7-10 + Age < 70
- TSH 7-10 + Age > 70 + Symptoms
- TSH < 7 + Age < 70 + Symptoms
- TPO Ab ⊝ with:
- Goiter
- Pregnancy
- Cholesterol ↑
- Ovulatory dysfunction
- Infertility
- Symptomatic
• TPO Ab ⊕
Euthyroid Sick Syndrome
Lab results
Early / Mid
Late / Severe?
- T4 n + T3 ↓ + TSH n
* T4 ↓ + T3 ↓ + TSH ↓
HyperThyroidism @ pregnancy (treatment)
- PTU @ T1 (MM = teratogen)
* MM @ T2-3 (PUT ↑ liver failure)
DM2
Starting insulin treatment indication? 2
- Failed 2 oral agent
* A1c > 9%
SulfonylUrea toxicity
2 medication therapy?
- Glucose / Dextrose
* Octreotide (↓ insulin)
Pheochromocytoma
3 classic symptoms?
Diagnosis? 6
Treatment? 3
4 surgery complications + management?
• Headache, Sweating, HR ↑
- 24h U-metanephrine
- 24h U-catecholamine
- Plasma Metanephrine
- CT / MRI
- MIBG
- Octreotide scan
- Wide body MRI
- PET
- Alpha blocker
- Beta blocker
- Resection
- BP ↑ (Nitroprusside, Phentolamine, Nicardipine)
- BP ↓ (NS, Vasopressor)
- Gluc ↓ (Dextrose)
- HR ↑ / Arrhythmia (Lidocaine, Esmolol)
Rapid thyroid enlargement
Arm raise causes: Facial Plethora, Neck vein engorgement
Diagnosis?
Thyroid Lymphoma
CanaGliflozin / DapaGliflozin
Mediation class?
5 side effects?
• SGLT-2 inhibitor
- UTI
- Vaginal candida
- K ↑ / Lipid ↑
- KetoAcidosis
HyperParaThyroidism
Causes? 2 major
Labs? 3
Surgery indication? 3
Surgery complications? 3
- Parathyroid Adenoma / Carcinoma
- MEN 1, 2A
- Ca ↑, PTH n↑, U-Ca ↑
- Age < 50, Symptomatic, U-Ca > 400
- Osteoporosis, Kidney stone, CKD
Bilateral Tempral Hemiagnosia & HyperPigmentation – after L+R adenomectomy
Diagnosis?
Management?
- Nelson’s syndrome
- Pituitary adenoma development after bilateral adenoectomy for cushing syndrome
- If ACTH ↑↑ –> MRI brain
- Surgery / Radiation
PostPartum Thyroiditis
PE?
Labs?
Study findings?
- Non-tender goiter
- T4 ↑ / TSH ↓ / TPO Ab ⊕
- RAIU ⊝
1° hyperthyroidism pituitary adenoma
Labs? 4
Treatment? 2
- TSH n↑
- T3 ↑ / T4 ↑
- α-sub ↑
- Somatostatin
- Surgery
Thyroid Nodule
Evaluation / Diagnostic?
1) US
a. US suspicious / Cancer risk –> FNA
b. No US finding / No cancer risk –> TSH
2) TSH
a. If TSH n↑ –> FNA
b. If TSH ↓ –> I123 Scintigraph
3) Iodine Scintigraph
a. Cold –> FNA
b. Hot –> Treat hyperthyroidism
Differentiated thyroid cancer
What types are differentiated? 2 Initial diagnostic? Why? When to do thyrodetomy? 4 When to do neck dissection? When to do thyroid lobectomy?
- Papillary & Follicular
- US neck / Lymph (to stage cancer)
- Large papillary thyroid cancer
- Extra thyroid tumor extension
- Distant metastasis
- History of radiation @ neck / head
- Involvement of adjacent neck structure or regional lymph nodes.
- Papillary cancer < 1cm + No lymph node involvement
Patient has Weight ↓, Weakness, HyperPigmentation
Suspicious for adrenal failure
Lab tests & results? 4
Diagnostic test? 3
- Eosinophil ↑
- K ↑
- Na ↓
- Gluc ↓
- Cortisol
- Consyntropin
- CT
Class of mediation? Side effects?
1) SulfonylUrea, Glyburide, Glipizide, Glimepiride
2) Maglitnide, Nataglinide, Repaglinide,
3) Metformin
4) Pioglitazone, Rosiglitazone
5) Exenatide, Liraglutide
6) Sitagliptin, Saxagliptin
7) Acabose, Miglitol
8) Canaflifloxin, Dapagliflozin
1) Insulin ↑ (Weight↑, Avoid @ CKD)
2) Insulin ↑ (Gluc ↓)
3) Biguanides (LA, Diarrhea, Avoid @ Liver / CKD / CHF)
4) Thiazolidindones (Weight ↑, Fluid retention)
5) GLP-1 (Weight ↓, Pancreatitis)
6) DDP4-I (Weight ∅, NasoPharyngitis)
7) α-gluc-I (Diarrhea, Flatulence)
8) SGLT2-I (Gluc ∅, DKA , UTI, BP ↓)
Amiodarone effects @ thyroid
Which is more common, Hypo or Hyper?
Frequency of monitoring?
HypoThyroidism more common than HyperThyroidism
Monitor TSH q3m
Amiodarone effects @ thyroid
What effect can it have it on conversion?
What effect can it have on thyroid hormone production?
What effect can it have on thyroid gland?
Lab test & treatment for each type?
- Conversion [T4–>T3] ↓
- TSH n↑/ T4 ↑ / T3 ↓
- Euthyroid, No treatment
- High I2 causes Thyroid hormone production ↓
- TSH ↑ / T4 ↓
- LevoThyroxine
- High I2 casues Thyroid hormone production ↑
- TSH ↓ / T4 ↑ / T3 ↑ / RAIU ↑ / US = vascularity ↑
- PTU / MMI
- Thyroid gland destruction
- TSH ↓ / T4 ↑ / T3 ↑ / RAIU ∅ / US = vascularity ↓
- Steroids
Thyroid binding globulin
What can cause high TBG? 2
What can cause low TBG? 3
Associated labs & management?
- Estrogen (OCP, Pregnancy, HRT) / Hepatitis
- T4 ↓ / T3 ↓ / TSH ↑
- ↑ Thyroid med
- Androgen, Steroids, Protein ↓ (Nephrotic, Starvation), Liver disease
- T4 ↑ / T3 ↑ / TSH ↓
- ↓ Thyroid med
Estrogen induced thyrotoxicosis
Mechanism?
Study finding? Labs?
T4 ↑ / T3 ↑ –> TSH ↓
RAIU ⊝ / T-Ig↓
Definition of
Vitamin D insufficiency
Vitamin D deficiency
Treatment?
- Insufficiency = Vit D 20-30
- Deficiency = Vit D < 20
- Calciferol 50ku/w x8w –> Vit D > 30
- Calcitriol 2ku/d (3-6ku/d @ malabsorption)
Incidental adrenal mass
Evaluation? 3
Surgery indication? 3
- Electrolyte
- DexaMethason Suppression
- 24h urine (Catecholamine, Metanephrine, VMA, 17-keto steroid)
- Functional tumor
- Malignancy / Heterogenous
- Size > 4cm
TSH ↓ / T3 n / T4 n
Diagnosis?
Initial management?
Treatment indication?
SubClinical HyperThyroid
Repeat test @ 6-8w
TSH < 0.1
TSH > 0.5 + (Age > 65, Heart disease, OsteoPorosis, Nodular Thyroid)
1° Ovarian Insufficiency
Labs? 3
Treatment?
Estrogen ↓
FSH ↑ / LH ↑
Estrogen + Progestin
Statin
High medication? 2
Moderate medication? 5
AtorvaStatin 40-80mg
RousuvaStatin 20-40mg
AtorvaStatin 10-20mg RousuvaStatin 5-10mg Simvastatin 20-40mg Prvastatin 40-80mg Lovastatin 40mg
Statin therapy indication
High statin indication?
Moderate statin indication?
- Age < 75 + (ACS / Angina / CABG / TIA / CVA)
- LDL > 190
- Age > 40 + DM + ASCVD risk > 20%
- Age > 75 + (ACS / Angina / CABG / TIA / CVA)
- Age > 40 + DM + ASCVD risk < 20%
- ASVCD risk 7.5-20%
Patient has mood swings, hypertension, osteoporosis
Diagnosed with cushing syndrome
Associated lab results? 3
- Gluc ↑
- K ↓
- Aklalosis / HCO3 ↑
Male in puberty
Breast mass < 4cm
Diagnosis?
Management?
Course?
- GynecoMastia
- Reassess / Observe
- Resolve < 1y
GDM cause?
When to screen?
- Human placental lactogen increase
* Screen @ GA 24-28w
CAH types
1) Hypertension?
2) Hypotension?
3) Low potassium?
4) High potassium?
5) Ambiguous genitalia @ F
6) Ambiguous genitalia @ M
7) Low sodium & low glucose?
1) 11b-OH, 17a-OH
2) 21-OH
3) 11b-OH, 17a-OH
4) 21-OH
5) 11b-OH, 21-OH
6) 17a-OH
7) 21-OH
Exercised induced amenorrhea
Labs? 3
PE?
Complications? 2
- LH ↓ –> Estrogen ↓ / Cholesterol ↑
- Atrophy @ breast / vagina
- Osteopenia / Osteoporosis / Infertility
Vitamin B12 deficiency
Treatment effects?
Follow up?
- ↑ K cellular use
- ↓ K @ serum
• Monitor K within 48h
Patient with fatigue, weight loss, myalgia, hyperpigmentation
Diagnosed with Addisons (adrenal insufficiency)
Lab results? 4
- Na ↓
- K ↑
- Cl ↑
- Metabolic Acidosis
HypoCalcemia
Lab findings
1) Normal PTH
2) Normal Vit D
3) Vitamin D deficiency
4) Hypo-parathyroidism
5) Pseudo-Hypot-parathyroidim
6) Hyper-phosphatemia
HypoCalcemia
Differential
1) PO4 ↓ + Ca ↑
2) Ca ↑ + PO4 ↑
3) Ca ↓ + PO4 ↓ –> PTH ↑
4) PTH ↓ –> Ca ↓ + PO4 ↑
5) Ca ↓ + PO4 ↑–> PTH ↑
6) PO4 ↑ + PTH ↑
Precocious Puberty (evaluation)
1) Normal bone age + pubic hair
2) Normal bone age + breast
3) Older bone age + LH ↑
4) Older bone age + LH ↓
• Precocious Puberty (evaluation)
- Premature adrenarche
- Premature thelarche
- Central precocious puberty
- Peripheral precocious puberty
Fever, Neck pain, Tender thyroid, suspicious for subacute thyroiditis
Lab test? 4
Study resuts?
- TSH ↓ / T4 ↑
- ESR ↑
- TPO Ab ⊕
- RAIU ↓
Diseases of
MEN 1
MEN 2a
MEN 2b
- Pituitary
- HyperParaThyroid
- Pancreatic
- Medullary Thyroid Cancer
- PheoChromoCytoma
- HyperParaThryoid
- Medullary Thyroid Cancer
- PheoChromoCytoma
- Neuroma / Marfanoid
Congenital Hypothyroidism
Management? 3
- LevoThyroxine
- US thyroid
- Endocrine referra
Glucagonoma (pancreatic tumor)
Endocrine manifest?
Skin manifest?
At risk for what cancer?
- Diabetes
- Necrotic Migratory Erythema
- Liver malignancy
- Erythematous / Scaly
- Itchy / Painful
- Central clearing
- Borders elevated & crusty
Necrotic migratory erythema
Prolactinoma
Pre-menopausal symptoms? 5
Post-menopausal symptoms? 2
Symptoms at male?
Diagnostic? 5
Treatment? 2
- Amenorrhea
- Infertility
- Galactorrhea
- Hot flashes
- Osteoporosis
- Headache
- Vision changes
- Impotence
- Gynecomastia
- Infertility
- Libido ↓
- Prolactin > 200
- Check: Cr / TSH / T4
- MRI brain
- Dopamine Agonist (cabergoline)
- TransSphenoid surgery
Thyroiditis
Diffuse goiter
Hypo symptoms
3 types, 2 labs
Small / Non-tender goiter
Mild & short – Hyper symptoms
Spontaneous recovery
2 labs
Post viral / Fever
Painful & tender goiter
3 labs, 3 treatment?
- Chronic / AutoImmune / Hashimoto
- TPO Ab ⊕, RAIU ⊕ / ⊝
- Painless / Silent
- TPO Ab ⊕, RAIU ⊝
- SubAcute / deQuervain
- ESR ↑ / CRP ↑ / RAIU ⊝
- Propranolol / Atenolol, NSAID, Steroid
Diabetic neuropathy
SSRI (2 med, 2 use, 3 avoid)
TCA (3 med, 3 use, 5 avoid)
Gaba (2 med, 3 use, 3 avoid)
- Duloxetine / Venltafaxine
- Depression / Anxiety
- Restless leg / Sexual dysfunction / Glaucoma
- AmiTryptyline / Nortryptyline / Desipramine
- Depression / Anxiety / Insomnia
- QT ↑ / Ortho BP ↓ / Sexual dysfunction / Urinary retention / Glaucoma
- Gabapentin / Pregabalin
- Restless leg / Tremor / Insomnia
- Substance abuse / Peripheral edema / COPD
Lithium induced Hypothyroidism
Mechanism?
Treatment? 2
• ↓ T3 & T4 synthesis & release
- Continue Lithium
- Add Levothyroxine
Breast development = n
No pubic or axillary hair
1° Amenorrhea > 15y
Diagnosis?
Additional PE findings? 2
Imaging study finding?
Lab finding?
• Androgen Insensitivity
- Blind vaginal pouch
- CyrptoOrchitism
- US vagina = No uterus
- Testosterone = n @ male
Diagnosis?
Cortisol low
ACTH ↑
ACTH test = minimal response
Cortisol low
ACTH ↓
ACTH test = minimal response
- 1° = Adrenal gland
* Central = Pituitary
Central adrenal insufficiency
Lab & diagnostic?
Associated condition & lab?
- Na ↓ / ACTH ↓
- ACTH test = minimal response
- MRI brain
- Hypothyroidism
- TSH ↓ / T4 ↓ / T3 ↓
HyperThyroidism (complications)
Cardiac? 2
Endocrine? 1
- Arrhythmia
- CardioMyopathy
• Osteoporosis
Bisphosphonate
4 indications ?
- History of fracture
- Osteoporosis (T < -2.5)
- Osteopenia (T -1 to -2.5)
- Fracture risk > 20%
- Hip fracture risk > 3%
HypoAldosterone / Conn (lab check)
- HTN + K ↓
* Aldosterone : Renin > 30
Delayed Puberty @ boys
PE? 2
Diagnostics tests? 6
- No testicle size ↑ by 14y
- Delayed growth spurt
- Bone age
- FSH / LH
- TSH
- Testosterone
- Prolactin
How do these affect thyroid medication?
- Cholestramine
- Iron / Calcium / Aluminum
- PPI / Sucralfate
- Estrogen
- Tamoxifen
- Androgen
- Steroids
- Rifampin
- Phenytoin
- Carbamazepine
- ↓ Levothyroxine absorption - increase thyroid med
- ↑ TBG - increase thyroid med
- ↓ TBG - decrease thyroid med
- ↑ Thyroid hormone metabolism - increase thyroid med
Menopausal HRT
Benefits? 5
Risks? 5
- Symptoms ↓
- Bone ↑ / Fracture ↓
- Colon cancer ↓
- DM2 ↓
- Mortality ↓ < 60y
- VTE
- Breast cancer
- CAD > 60y
- CVA
- Gall bladder disease
- Pubic & Axillary hair ⊕
- Acne
- Girls = hirsutism / Oligomenorrhea
- Boys = normal testis
Diagnosis?
Precocious puberty / Non classical CAH
Grave’s Disease (management)
- 3 Medication indication? What medication?
- What to do radiation treatment?
- Thyroidectomy indication? 6
- Follow up?
- Propranolol
- Mild symptoms
- Old age
- Pregnancy
• Moderate / Severe
- Large goiter
- Thyroid cancer suspicion
- Opthmalopathy
- Obstructive symptoms
- Medication intolerance @ pregnancy
- 1° HyperParathyroidism
• T3 / T4 check @ 4-6w –> q3m
Metformin
Contraindications? 3
- Alcohol abuse
- Sepsis
- CHF
