Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
133 Cards in this Set
- Front
- Back
|
Functioning pituitary tumors are usually chromophobic ademonas that produce what?
|
-adenocorticotropic hormone (ACTH)
-hGH -prolactin |
|
|
Pts w/ pituitary tumors may be seen w/ what?
|
HA and visual disturbances (bitemporal hemianopia)
|
|
|
Pts with function pituitary tumors may be seen with what endocrinologic manifestations?
|
-galactorrhea-amenorrhea (PRL-secreting tumor)
-acromegaly (GH-secreting tumor) -Cushings (ACTH secreting tumor) |
|
|
Pts with non-functing pituitary tumors may present how?
|
s and s of anterior pituitary hypofunction
|
|
|
What is the counter hormone to prolactin?
|
dopamine
|
|
|
What imaging studies are done for pituitary tumors?
|
CT/MRI
|
|
|
What levels are often elevated in pituitary tumors?
|
-GH
-prolactin -ACTH |
|
|
What are some tx options for pituitary tumors?
|
-surgical removal
-radiotherapy -Bromocriptine (dopamine agonist) -hormone replacement |
|
|
What are seen in women with hypopituitarism?
|
-amenorrhea, infertility
-vaginal atrophy, dyspareunia -atrophic breasts -loss of axiallary and pubic hair |
|
|
What is seen in men with hypopituitarism?
|
-loss of libido or impotence, infertility
-soft atrophic tests and loss of 2nd sex characteristics |
|
|
What is seen in an ACTh deficiency?
|
-weakness
-postural hypotension -pallor -hypoglycemia |
|
|
What is seen in pituitary hyperfunction in women?
|
-present earlier
-galactorrhea -infertility -menstrual disorders |
|
|
What is seen in pituitary hyperfunction in men?
|
-present later
-galactorrhea -impotence -signs of pituitary tumor -visual field changes -anterior pituitary failure |
|
|
How is the urine and serum osmolarity in DI?
|
urine is dilute
osmolarity is high (hypernatremia) |
|
|
DI is caused by what?
|
an impaired urinary concentrating mechanism
|
|
|
What are the main symptoms of DI?
|
polyuria and polydypsea
|
|
|
What are the lab findings in DI?
|
-dilute urine w/specific gravity <1.010 and osmolality >300
-serum osmolality >280 |
|
|
What test can be done to differientiate between psychogenic causes of DI and other causes?
|
water deprivation test
|
|
|
What is the tx for acute central DI?
|
aqueous vasopressin
|
|
|
What is the tx for partial ADH deficiency?
|
-chlorpropamide (b/c s/e is hyponatremia)
|
|
|
What disease is characterized by a diffuse toxic goiter and is the most common cause of hyperthyroidism?
|
Grave's Disease
|
|
|
What is Grave's Disease?
|
an autoimmune disorder in which TSH receoptor antiboies are produced
|
|
|
In Grave's Disease, the production of TSH receptor antibodies leads to what?
|
diffuse thyroid enlargement and thyroid hormone production
|
|
|
What disease has a nodular toxic goiter and it affects older people?
|
Plummer's disease
|
|
|
Plummer's disease is characterized by what?
|
discrete areas of autonomously hyperfunctioning thyroid gland
-normal thyroid tissue funcitons are suppressed because of negative feedback on TSH |
|
|
Subactue thryoiditis is another type of hyperthyroid and is caused by what usually?
|
viral infection of the thyroid
|
|
|
What form of hyperthyroidism is caused by excessive ingestion of TH by patients?
|
factitious hyperthyroidism
|
|
|
What metabolic changes are assoiciated with hyperthyroidism?
|
-elevated metabolic rate
-weight loss -increased appetite -sweating -heat intolerance |
|
|
What are some cardio signs of hyperthyroidism?
|
-widened pulse pressure
-sinus tach -a fib -PVCs |
|
|
What are some GI signs of hyperthyroidism?
|
-loose stools
-diarrhea |
|
|
What are some skin signs of hyperthyroidism?
|
-warm
-moist -hair becomes thin and fine |
|
|
What are CNS signs of hyperthyroidism?
|
-fine tremor
-emitional lability and restlessness -brisk return phase of deep tendon reflexes |
|
|
What are some MSK signs associated with hyperthyroidism?
|
-muscle weakness
-fatigue |
|
|
What are some opthalmopathy associated with hyperthyroidism?
|
-exophalmos
-lid lag -lid retraction -tearing -irritation -pain -diplopla |
|
|
What is a thyroid storm?
|
sudden exacerbation of hyperthyroidism
|
|
|
What is a thyroid strom charactertized by?
|
-fever
-agitation -tachycardia -coma -hypotention |
|
|
What is the difference between the goiter of Graves Disease and that of Plummer's disease?
|
-Grave's is uniformly enlarged
-Plummer's is nodular |
|
|
What happens to TSH and T4 in hyperthyrodism?
|
-TSH decreased
-T4 increased |
|
|
What should be the initial tx to stablize cardio function in hyperthyroid pts?
|
beta blockers
|
|
|
What two drugs are used for hyperthyroidism that inhibit TH production?
|
Methimazole and PTU
|
|
|
PTU also inhibits peripheral conversiobn of _____ to ____, and should be stopped after how long?
|
-T4 to T3
-stopped after 1-2 years |
|
|
PTU is often used in what pts?
|
younger pts with mild disease who have a better change of remission
|
|
|
What are some s/e of PTU?
|
-skin rash
-agranulocytosis |
|
|
What is a rapid therapy for hyperthyroidism?
|
removal of the thyroid
|
|
|
What is a problem with radioactive Iodine threatment?
|
it is non reverible and usually results in hypothyroidism
|
|
|
In hypothyriodism, what features are related to calorigenesis?
|
-weight gain
-cold intolerance |
|
|
In hypothyroidism, what features are related to permissive effects?
|
-poor work
-lassitude -poor memory -constipation -weakness -myopathy -hyopreflexia |
|
|
In hypothyrodism, what features are related to growth factor?
|
-hoarse voice
-coarse skin |
|
|
What is the MCC of hypothyroidism?
|
Hashimoto's disease
|
|
|
What is another common cause of hypothyroidism?
|
iopathic atrophy often associate with antithryoid antibodies
|
|
|
What drugs can cause hypothyroidism?
|
-Li
-iodine -amiodarone |
|
|
What are some symptoms of hypothyroidism?
|
-weakness
-lethargy -slowness of throught and speech -sleepiness -fatigue |
|
|
What are some signs of hypothyroidism?
|
-puffy appearance
-nonpitting edema -dry skin -coarse hair -cold intolerance |
|
|
In hypothyroidism, edema of the larynx and middle ear leads to what?
|
voice changes and hearing loss
|
|
|
What can myxedema coma lead to?
|
-respiratory insufficiency,
-hypothermia -hypoglycemia -sluggish cerelbral perfusion -coma -death |
|
|
What are some lab findings seen in hypothyroidism?
|
-T4 uptake is decreased
-radioactive iodine uptake is decreased -TSH is increased |
|
|
Why must you start L-thyroxine therapy slow?
|
because it can cause adrenal insufficiency if started too fast
|
|
|
Subacute thyroiditis is of what etiology?
|
viral (mumps or coxsackeivirus)
|
|
|
What is the process/4 clinical features of thyroiditis?
|
-1-2 week prodrome of malaise, URI symptoms, and fever
2-thyroid gland becomes enlarged, fimr and painful 3-symptoms of hyperthyroidism occur bc of leakage of TH from inflamed thyroid 4-disease lasts for weeks to months then subsides |
|
|
What are some lab finding in subacute thyroiditis?
|
-T4 elevated
-TSH is low |
|
|
What are some tx for subacute thyroiditis?
|
-symptomatic relief
-NSAIDS -B-Blockers |
|
|
Hashimoto's mainly affects what sex?
|
females
|
|
|
What are 3 clinical features of Hoshimoto's?
|
-autoimmune damage leads to thyroid fibrosis and goiter
-pain and tenderness of gland can occur -patients often report symtpoms of hypothyroidism |
|
|
What are 3 lab findings for Hashimoto's?
|
1-antithyroid antibodies in serum
2-T4 levels are decreased 3-TSH is increased |
|
|
What are some tx options for Hashimoto's?
|
-L-thyroxine
|
|
|
Throtoxicosis increases the risk of what cardiac disrhythmia?
|
a fib
|
|
|
What are some cardiac changes associated with hypothyroidism?
|
-increases PR
-low voltage -increased QT -inverted of flat T wave -bradycardia |
|
|
What are some cardiac changes associated with hyperkalemia?
|
-tall peaked T wave
-Widened QRS with tall T wave tx w/ calcium, insulin, and glucose |
|
|
What are some EKG changes associated with hypokalemia?
|
-ST depression
-U wave -Flat T wave |
|
|
How does thyroid cancer usually present?
|
solitary thryoid nodule rather than multiple nodules
|
|
|
Thyroid cancer is associated with what?
|
previous radiotherapy in the neck
|
|
|
What are 5 risk factors for malignant thyroid tumors?
|
1-male sex
2-history of radiotherpay for head or neck 3-nodule grows rapidly 4-nodule appears cold on radioactive iodine test 5-appears solid on ultrasound |
|
|
How is thyroid cancer dx?
|
1-TSH
2-ultra sound or radioactive iodine scintigraphy 3-FNA |
|
|
Over secretion of PTH causes what?
|
hypercalcemia
|
|
|
Most cases of primary hyperparathyroidism is caused by what?
|
parthyroid adenomas
|
|
|
Secondary hyperparathyroidism is usually the result of what?
|
ongoing stimulation of the parathryoid glands due to low serum calcium, which is most commonly caused by chronic renal failure
|
|
|
What are some CNS signs and symptoms of primary hyperparathyroidism?
|
-lethargy
-stupor -fatigue -proximal myopathy -hypotonia -coma |
|
|
What are some GI signs of hyperprathyroidism?
|
-anorexia
-nausea -vomiting -constipation -abdominal pain |
|
|
Hypercalcemia causes what?
|
osteitis fibrosa cystica
|
|
|
osteitis fibrosa cystica are characterized by what?
|
-bone pain
-fractures -deformities -bone cysts -generalized osteopenia -subperiosteal bone resorption in the phalanges |
|
|
What does serum analysis indicate in primary hyperparathryodism?
|
-increased Ca
-elevated PTH levels -decreased phosphate -elevated alkaline phosphatese -decreased bicarb -elevated Cl |
|
|
What may be seen on UA in hyperparathyroidism?
|
hypercalciuria
|
|
|
What may be revealed on a ultrasound or CT for hyperparathyroidism?
|
-parathryoid adenomas and superiostal bone resorption of the phalanges is highly suggest dx
|
|
|
When is emergency therapy indicated in hyperparathyroidism?
|
if serum Ca levels rise above 13-15 mg/dL
|
|
|
What are 4 ways to help tx hyperparathyroidism?
|
1-diurese w/ furosemide and IV NS increases renal calcium excretion
2-Mithramycin inhibits osteoclastic bone resorption, which reduces serum calcium 3-glucocorticoids lower Ca absorption 4-bisphosphonates |
|
|
What is hypoparathyrodism most often caused by?
|
-surgical removal of parathyroid gland
-iodopathic is less common |
|
|
What are some clinical features of hypoparathyroidism?
|
-muscular fatigue
-weakness with circomoral parathesias -Chovstek's sign -Trousseau's sign |
|
|
What are some long term effects of hypocalcemia?
|
-brittle ridged nails
-dry skin -enamel defects of teeth |
|
|
In hypoparathyroidism, calcification of the basal ganglia may lead to what?
Calcification of the lens may lead to what? |
parkinsonian signs and symptoms
-cataract formation |
|
|
What are some lab finding in hypoparathyroidism?
|
-low calcium
-high phosphate -decreased PTH level |
|
|
What test to you always want to order before tx of DKA and HHS?
|
BNP
|
|
|
What are some signs of HHS?
|
-dehydration
-tachycardia -dry mucous membranes -poor skin turgor -postural hypotension -cloudy sensorium -seizures |
|
|
What are some lab finds in HHS?
|
-elevated glucose
-elevated serum osmolality -increased uria:creatinine ratio -mild acidosis may be present |
|
|
What is the tx for HHS?
|
-fluids
-insulin -electrolyte replacement -often sepsis work up b/c usually caused by infection |
|
|
What are some signs of hypoglycemia?
|
-sweating
-pallor -tachcardia -normal blood pressure -dilated pupils |
|
|
Hypoglycemic coma often occurs 2nd to what?
|
-excess insulin
-delayed ingestion of meals -excess physical activity -less commonly by insulinoma |
|
|
In the instance of insulinoma, what is elevated along with the presence of hypoglycemia?
|
serum insulin levels are elevated
|
|
|
What test is effective in dx of insulinomas?
|
CT scan
|
|
|
Cushing's is most often caused by what?
other causes |
-administration of large doses of steriods for tx of primary disease
-increased levels of ACTH -oat cell carcinoma of the lung |
|
|
Pts w/ Cushings exhibit what?
|
-central obesity
-facial plethora -buffalo hump -supraclavicular fat pads -purple striae |
|
|
In Cushing's mild HTN occurs 2nd to what?
|
2nd to vascular effects of cortisol and sodium retention
|
|
|
In Cushings, androgen excess leads to what?
|
-acne
-hirsutism -oligomenorrhea -loss of libido in men |
|
|
What are so catabolic changes in Cushings?
|
-muscle weakness
-muscle break down |
|
|
Why do pts with Cushings bruise easily?
|
-because of enhanced capillary fragility
|
|
|
Increased catabolism in Cushing's leads to what?
|
osteoporosis
|
|
|
In Cushings, glucose levels are elevated and what is also present?
|
leukocytosis
|
|
|
What is the tx of choice for Cushings?
|
transpheniodal pituiatry surgery
|
|
|
Hypofunction of the adrenal cortex is what disease?
|
Addison's
|
|
|
What are some cortisol deficiency related symptoms of Addison's disease?
|
-weakness
-anorexia -fatigue -weight loss |
|
|
Why does hyperpigmentation occur in Addison's disease?
|
occurs 2nd to increased melanocyte-stimulating hormone (MSH); increased MSH is caused by an increase in ACTH due to lack of negative feedback stiulus from cortisol
|
|
|
Hypotension occurs in Addison's because of what?
|
loss of cortisol's pressor effects on the vasculature
|
|
|
What does hypoglycemia often occur in Addison's?
|
because cortisol has anti-insulin effects on glucose hemeostasis
|
|
|
What are some aldosteron deficiency related symptoms in Addison's disease?
|
-hyponatremia
-hyperkalemia |
|
|
Why does hyponatremia occur in Addison's?
|
-bc of lack of aldosterone mediated sodium retention at the distal tubule
|
|
|
Why does hyperkalemia occur in Addison's?
|
-occurs in association with hyponatremia anc can lead to potentially fatal cardia arrhythmias
|
|
|
How does adrenal crisis present?
|
-fever
-vomiting -decreased sensorium -abdominal tenderness -vascular collapse |
|
|
What does serum analysis indicate for Addison's?
|
-hyperkalemia
-hyponatremia -hypoglycemia -increased eosinophil count -decreased cortisol and aldosterone levels |
|
|
The difinitive dx of Addison's relies on what?
|
ACTH testing
|
|
|
What are some EKG changes associated with Addison's disease?
|
-peaked T wave
-prolonged PR -heart block -atrial asystole |
|
|
What is the tx for Addison's disease?
|
-Glucocorticoid and Mineralcorticoid replacement
|
|
|
How is Adrenal crisis treated?
|
-100mg Cortisol infused over 5-10 minutes, follwed by about 300 mg over 24 hrs
-IV NS and mineralcorticoids are also used |
|
|
In Addison's, what are some effects due to alteration of protien/fat metabolism in stress response.
|
-wating
-hair loss -pigmentation changes |
|
|
Primary aldosteronism is characterized by what?
|
autonomous production of aldosterone by the adrenal gland
|
|
|
What is the MCC of primary aldosteronism?
|
-benign adrenal adenoma
-can occur 2nd to bilateral adrenal hyperplasia |
|
|
Autonomous alderstone production by the adrenal gland causes what?
|
increased sodium retention in exchange for K and hydrogen excretion at the distal tubule
|
|
|
Why does HTN occur in primary aldosteronism?
|
expasion secondary to sodium retention
|
|
|
Potassium loss can cause what in Primary Aldosteronism?
|
-muscle weakness,
-tetany -paresthesias -dilute urine |
|
|
In Primary aldosteronism, metabolic alkalosis occurs secondary to what?
|
renal hydrogen loss
|
|
|
Pheochromocytoma is what?
|
a catecholamine producing adrenal tumor
|
|
|
What can pheochromocytoma cause?
|
-HTN
-HA -sweating -palpitations -nervousness -occuring with abdominal palpation or exercise |
|
|
What are some s and s of pheochromocytoma?
|
-episodic HTN
-HA -sweating -palpitations -nervousness -weight loss -hyperglycemia |
|
|
What are the most useful tools to dx pheochromocytoma?
|
-analysis of urinary catecholamines
-vanillylmadelic acid levels |
|
|
What drugs do you want to not use in pheochromocytoma?
|
beta blockers
|
