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Endocrinology STEP 2

Terms in this set (63)

congenital hypothyroidism
Weakness
Athony
Umbiical hernia
Tongue protrussion
Breath difficulty
Most common cause of congenital hypothyroidism
Thyroid dysgenesia
Thyrod changes in pregnancy
High total T4
High TBG
Normal free T4
Infants of diabetic mothers
- First trimester.- Neural tuberosos defects, heart defects
- Second trimester.- Macrosomia, organomegaly and polycythemia
Side effects of radioactive iodine
- Worsening of oftalmopathy
- Radiation effects
- Hypothyroidism
Hyperosmolar Hyperglycemic Syndrome (HHS)
a life threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.
Most common cause of primary adrenal insufficiency
Autoinmune adrenalitis
Addison's disease
Hyperkalemia
Hyponatremia
Hypotension
Hyperpigmentation
Hyperaldosteronism
excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium
Most common causes of primary hyperaldosteronism
- Bilateral adrenalinas hyperplasia
- Aldosterone producting tumor
DKA & HHS: Treatment
* Fluid replacement. Normal Saline
* Insulin administration. Regular
* Correct electrolyte imbalances.
Most common cause of hypothyroidism
Hashimoto's thyroiditis
- Anti thyroid peroxidase ab
Worse side effect of antithyroid drugs
Agrannulocytosis
Primary hyperparathyroidism
Excess secretion of PTH from one or more parathyroid glands
Acromegaly/Gigantism marker
IGF-1
Potassium shifts
insulin, beta-stim -> K+ into cell
acidosis -> K+ out of cell
Most common nonfuctioning hypophisary adenomas
Gonadotrophs
Most common functionin hypophisary adenomas
Lactotrophs
Subacute thyroiditis (de Quervain's)
Symptoms: Self-limited hypthyroidism often following a flulike illness. Jaw pain, very tender thyroid, early inflammation. Lab Values: Elevated ESR. Pathophysiology: Granulomatous thyroid inflammation. Treatment:
Painless thyroiditis (silent thyroiditis)
1) Hyperthyroidism
2) Hypothyroidism
3) Euthyroidism
Neonatal thyrotoxicosis
Methimazole PLUS Beta-blocker
radioactive iodine uptake
Test to measure the amount of radioactive iodine taken up by the thyroid gland; indicator of thyroid gland function.
- High in High thyroid hormona production
- Low when the thyroid hormone release is high
PTH independent hypercalcemia
PTH-related protein (PTHrP)
- squamous (head, neck, lung), renal, bladder, breast ovarian carcinoma

Osteolytic metastases
- breast, non-small cell carcinoma of lung, non-Hodgkin's lymphoma, multiple myeloma

Increased production of 1,25 - dihydroxyvitamin D by lymphoma

Increased interleukin-6 in multiple myeloma
Cushing's syndrome
a condition caused by prolonged exposure to high levels of cortisol
high dose dexamethasone suppression test
High dose of steroid at 11pm --> measure serum & urine cortisol at 8am
Pituitary-dependent Cushing syndrome: urinary cortisol decreases to <50%
Primary adrenal or ectopic ACTH production: no decrease in cortisol
Best preventive drug therapy for diabetic nephropathy
ACEi
Chemestry in hypothyroidism
High transaminases
Hyperlipidemia
Hyponatremia
High creatine kinase
diuretic induced hypokalemia
Seen in primary hyperaldosteronism
PAC/PRA ratio
Used for diagnosis of Primary hyperaldosteronism
- Higher than 20
Most common cause of osteomalacia
Vitamin D deficiency
Most common cause of rapid once hirsutism
Androgen producido tumor
- High DHEA
- Normal DHEAs
Most common common complication of thyroidectomy
Hypocalcemia
Nonclassic Adrenal Hyperplasia
Female with very mild 21-alpha hydroxylase deficiency may present in adolescence or adulthood with oligomenorrhea, hirtsutism, and/or infertility.
17-hydroxylase deficiency
↓ 17 KS, ↓ 17 OH, retain salt, hypertension; male pseudohermaphrodite
First step in evaluation of precocious puberty
Bone age evaluation
Best marker in DKA ressolution
Anion Gap
Anion Gap
= Na - (Cl + HCO3)
Normal is between 8 and 12
Heart disease associated with acromegaly
Concentric myocardial hypertrophy
polycystic ovary syndrome (PCOS) treatment
Treatment Plan
Medications
■ Low- dose contraceptives to suppress ovaries.
■ Spironolactone to decrease and control hirsutism.
■ Provera tablets 10 mg daily for 7 to 10 days (repeat every 2 months to induce menses).
■ Metformin (Glucophage) used to induce ovulation (if desires pregnancy). Warn reproductive-aged diabetic females (who do not want to become pregnant) to use birth control.
■ Weight loss reduces androgen and insulin levels.
hypothyroid myopathy
- Muscle pain, cramps, weakness involving the proximal muscles
- Delayed tendon reflexes and myoedema
- Occasional rhabdomyolysis
- Features of hypothyroidism
- Normal ESR, elevated CK
Desmopressin
ADH agonist treatment of Diabetes insipidus
Euthyroid sick syndrome
Low T3
Normal T4
Normal TSH
After an acute illness. DO NOT treat, repeated TSH later after patient gets better
Corrected Calcium
(serum Ca) + [(4 - albumin)(0.8)]
Gluconeogenesis substrates
1) glycerol 3-phosphate
2) lactate
3) glucogenic amino acids
Metabolic Syndrome (Syndrome X)
A genetic metabolic disorder characterized by diabetes, hypertension, atherosclerosis, centrally distributed obesity, and elevated blood lipids
VIPoma
Water diarrhea, hypokalemia, dehydration and flushing - LOKS like a carcinoid tutor
Secondary hypogonadism
Low testo, FSH, LH
Causes: hyperPRL, anabolic steroid abuse, Cushing, congenital deficiency (Kallman=GnRH deficiency+anosmia+/-midline defects, cleft palate)
Check FSH, LH, Ferritin, PRL
secondary amenorrhea
no menses for 3 months
secondary amenorrhea causes
1) pregnancy - UPT
2) hypothyroidism - TSH
3) prolactin - level
4) meds
5) HPO axis
Inmobilization hypercalcemia
Increased ostocleastic bone reabsorption
Graves disease
an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos
Hypertension
Anxiety
Weight loss
Sheehan syndrome
pituitary insufficiency post-partum, low TSH ACTH, hypotension
Pheocromocytoma - labs?
-High plasma free metanephrines (most sensitive test)
-High urinary catecholamines
Thyroid lymphoma
Hashimoto's predisposes
B symptoms
Rapid enlarging goiter
Compressive symptoms
Pemberton's sign
facial flushing (facial plethora), distended head and neck superficial veins, inspiratory stridor, increased JVP upon raising both arms above head. Positive in SVC syndrome (associated with small cell lung carcinoma/mediating mass )
Thyroid storm treatment?
1. Propanolol
2. PTU
3. Iodine solution
4. Hydrocortisone
Pregnant Hypothyroidism
Increase levothyroxine dose when the patient gets pregnant
side effect of untreated hyperthyroidism
Bone loss
First step in thyroid module diagnosis
US and THS
ACTH stimulation test
a test that is necessary for a definitive diagnosis of hypoadrenalism, such as addisons disease is
Refeeding syndrome
24-48hrs of therapy d/t fluid shifts: bradypnea, lethargy, confusion, weakness
Hypophosphatemia
Hypomagnisemia
Hypokalemia
Follicular thyroid cancer
histopathological demonstration of INVASION OF CAPSULE AND BLOOD VESSELS is required for differentiating follicular cancers from follicular adenomas
-follicular thyroid cancers have the propensity to invade bld vessels and metastasize to distal organs
Mil- alkali syndrome
Hypercalcemia
Low GFR
Hypovolemia
Increased bicarbonate reabsorption
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