MKSAP Endocrinology

what does initiation of estrogen or raloxifene do in pt taking thyroxine replacement (levothyroxine)?
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what does initiation of estrogen or raloxifene do in pt taking thyroxine replacement (levothyroxine)?
increases thyroxine-binding globulin

--> so there is less free thyroxine, and may require increased doses of levothyroxine
what does initiation of testosterone do in pt taking thyroxine replacement (levothyroxine)?
reduces thyroxine binding globulin

--> so there is increased free thyroxine, and may need to decrease the dose of levothyroxine
what kind of thyroid cancer is radiation exposure during childhood the strongest environmental risk factor for?
papillary thyroid cancer
what is the appropriate next oral diabetes medication to achieve improvement in A1c and weight loss?
liraglutide

(is a GLP-1 receptor agonist)
what does SGLT2 inhibitors increase risk for?
genital mycotic infections

--> should not be given to patient with frequent vulvovaginal candidiasis
what is a side effect of glipizide?
weight gain

(is a sulfonylurea)
most common cause of primary adrenal insufficiency in the US
autoimmmune adrenalitis
what is found in 90% of autoimmune adrenalitis?
positive 21-hydroxylase antibodies
causes of hyperprolactinemia
- physiologic (pregnancy and post-partum)

- hypothyroidism

- pituitary adenoma
(by compressing on the pituitary stalk and decreasing dopamine inhibition of prolactin)

- medications (antipsychotic agents)
what kind of replacement do patients with primary adrenal insufficiency require?
both glucocorticoid and mineralocorticoid replacement
next step after radiographic diagnosis of Paget disease of the bonemeasure serum alkaline phosphatase --> reflects the metabolic activity of Paget diseaseHow is euthyroid sick syndrome (or nonthyroidal illness syndrome) defined?- low T3 - low/normal T4 - low (but detectable) or normal TSHhow to manage low risk osteoporotic women who have been taking oral bisphosphonate for 5 years?can stop bisphosphonate - this does not include women older than 76, current femur neck t score below -2.5, and prior osteoporotic fractureFirst thing to give in a patient with myxedema comaIV hydrocortisone โ€”>what kind of drug is glyburide?sulfonylurealabs in gestational thyrotoxicosis- low TSH - elevated free T4signs and symptoms of hyperthyroidism, with elevated TSH and free T4thyroid-stimulating-hormone-secreting adenomawhat should be tested in all patients with an adrenal mass24-hour urine total metanephrine measurement --> to screen for pheochromocytomawhen is infertility evaluation initiated based on age?- women < 35 yo --> after 1 year of regular unprotected intercourse - women >35 --> after 6 monthswhat can amitriptyline cause false elevated levels of?can cause falsely elevated normetanephrine levelsClassic triad of pheochromocytoma- diaphoresis - headache - tachycardiaFirst medication to give in a patient with myxedema comaIV hydrocortisone - if give thyroid hormone replacement first, can precipitate adrenal crisis (if they have adrenal insufficiency and you just don't know it yet)what are xanthelasmas associated with?hypercholesterolemiac peptide level in surreptitious insulin use?will be DECREASEDwhat should you do to levothyroxine dose in hypothyroid patient once confirm that she is pregnant?empirically increase levothyroxine dose by 30% --> hypothyroid patients are unable to augment their T4 and T3 production to the normal increase that happens in pregnancywhat kind of drug is pioglitazone? what is a side effect?TZD - can cause weight gainwhat should be checked regularly in pts with hypoparathyroidism?- serum calcium - magnesium - creatinine - urine calciumWhat cortisol level after dexamethasone suppression test is considered positivecortisol level greater than 5 ยตg/dL --> can indicate subclinical cushing syndromewhat do all pts with suspected Paget disease of bone need tested?- serum calcium - 25-OH vitamin D - alk phos - imaging studiesADA's fasting blood glucose level that meets threshold for downward titration of insulin to avoid hypoglycemiafasting blood glucose of 70A1c goal for older adults with complex medical history7.5 to 8%first line therapy for toxic thyroid adenomaradioactive iodine OR surgeryliraglutide should be avoided in pts with history of ______pancreatitiswhat test for Cushing syndrome is not impacted by estrogen therapy or sleeping pattersn24 hour urine free cortisolwhat needs to be checked in an incidentally discovered pituitary tumor1) whether it is causing mass effect 2) if it is secreting excess hormones (eg. prolactin and IGF-1) 3) if it has a propensity to grow in the futurehow is hypogonadism best assessed in patient with obesityfree testosterone --> bc can have decreased sex hormone-binding globulin with obesity, which will alter the TOTAL testosterone assessmentwhat can iron deficiency anemia do to A1c level?make it falsely elevated --> due to increased proportion of old blood cellswhat oral diabetes medication can cause euglycemic DKASGLT2 inhibitors "-flozin"next step in diagnosis of diabetes in pt with an abnormal and normal testrepeat the abnormal testtx for patients with multinodular goiter causing impingement on trachea, esophagus, or recurrent laryngeal nerve, or other compressive symptomsthyroidectomywhat is hypocalcemia due to antiresoprtive drugs (such as zolendronic acid or denosumab) due to?vitamin D deficiencywhat electrolyte abnormality can cause hypocalcemia? how?low magnesium --> activates G proteins that stimulate caclium-sensing receptors, which decreases PTH secretion --> causes functional hypoparathyroidismtx of prolactinomadopamine agonists (bromocriptine, cabergoline)what needs to be monitored routinely in hypoparathyroidismurine calciumwhat should be checked if concerned for 2ndary hypothyroidism (for example due to pituitary surgery)free T4 --> cant use TSH as guidenext step in diagnosis of Cushing syndrome (excess cortisol due to any cause)ACTH leveltype 1 amiodarone induced thyrotoxicosisoccurs in pts with underlying multinodular goiter or latent graves - is assoc with increased vascularity on color doppler UStype 2 (destructive type) amiodarone induced thyrotoxicosisaffects pts without thyroid disease - NOT assoc with increased vascularity on color dopplerwhat should be checked in pt with primary hyperparathyroidism who is planned for parathyroidectomy25-hydroxy vit D --> to avoid post op hypocalcemia, which occurs due to rapid flux of serum calcium into bone (hungry bone syndrome)next step in a patient with diagnosis of primary aldosteronism (after imaging)adrenal vein samplingwhat should be assessed in pt meeting fasting and preprandial glucose goals, but not at their A1c goalpost prandial glucoseimmediate treatment for type 2 amiodarone induced thyrotoxicosisprednisone taperwhat pneumonia vaccine should diabetes patients receivePPVS23what should be done before starting gender-affirming hormone therapy in transgender persondiscuss fertility preservation optionswhat electrolyte abnormality is common a few days after pituitary surgeryalterations in SODIUMMCC of ACTH-independent Cushing syndromeadrenal tumorat what GFR is metformin contraindicated?less than 30what class of medication is liraglutideGLP-1 receptor agonistwhen should dilated eye exam be done for type 1 and type 2 DMtype 1 - 5 yrs after diagnosis type 2 - at time of diagnosis (same guidelines for screening for nephropathy with albumin/cr ratio)lab abnormalities related to osteomalacia- low 25 hydroxyvit D, calcium, phosphate - elevated PTH and alk phoswhat should be checked in a pt with hypercalcemia, low PTH, and CXR concerning for sarcoid1,25-dihydroxyvitamin Dwhat is the endpoint for denosumab for pts being treated for osteoporosis?no defined endpoint --> basically just continueosteitis fibrosa cysticadue to abnormally high bone turnover --> due to secondary hyperPTH and increases risk of fracture --> classic radiograph shows subperiosteal resorption of bonenext step in pt with labs consistent with primary adrenal insufficiency21-hydroxylase antibody measurementwhy does iron deficiency anemia increase A1cdue to increase in the proportion of older erythrocytes --> correcting the anemia will increase erythrocyte turnover and increase younger RBCsnext step after diagnosis of cushing syndromeACTH leveltests for Cushing syndrome- 1 mg overnight dex suppression test - 24 hr urine free cortisol - late night salivary cortisolhallmark of primary aldosteronismsuppressed renin levelwhat should be considered in a woman with rapidly progressive hyperandorgenismandrogen-secreting ovarian tumorwhat must be monitored in chronic hypoPTHurine calcium --> hypercalciuria limits therapyelevated 1,25-dihydroxyvitamin D and suppressed PTH is diagnostic for ??vitamin D-dependent hypercalcemiawhat should be tested in all patients with incidental adrenal masstesting for pheochromocytoma --> can be asymptomaticnext step in pt with adrenal mass > 4 cm, density > 10 hounsfield units, contrast washout < 50% at 10 minsadrenalectomylow vit D, calcium, and phosphate with high alk phos and PTHosteomalaciawhat should be given first in pt with myxedema coma?IV hydrocortisone --> bc could have adrenal insufficiencytreatment for type 2 amio induced thyrotoxicosisprednisonewhat is considered positive in a 1 mg overnight dex suppression testcortisol greater than 5how long should you treat osteoporosis with alendronatelow risk women --> can stop after 5 yearswhat is important to monitor in chronic hypoPTH24 hour urine calciumtest for post prandial hypoglycemiamixed meal test --> should consist of the type of food that induces the hypoglycemiadiaphoresis, headache, palpitationspheochromocytomahallmark of primary adrenal insufficiencyskin hyperpigmentation --> from increased ACTH productionwhat should all pts with adrenal incidentaloma be evaluated for- pheochromocytoma - subclinical Cushing syndrome - if have HTN and hypokalemia, eval for primary hyperaldosteronismmitotaneadrenolytic agent used as adjuvant therapy in adrenocortical carcinomaMCC of primary amenorrheagonadal dysgenesis --> usually with Turner syndromehow should hypogonadism be evaluated in obese malesmeasure free testosteroneWhat does cinacalcet do?reduces serum calcium levelat what age should women start being screened for osteoporosis65osteomalaciadisease marked by softening of the bone caused by vitamin D deficiencysymptoms of osteomalaciabone pain and muscle weaknessBest test to check adequacy of vitamin D lecelSerum 25-hydroxyvitamin DHow is paget disease of the bone diagnosed?Radiographic findings of thickened cortical bone, coarseness trabecular markings, distortion and expansion of bone