Dit - Endocrine Pt 2

Front 1

What are the two MCCs of hyperparathyroidism?

Back 1

1) Parathyroid adenoma
2) Parathyroid hyperplasia

Front 2

Surgical removal of the parathyroid is indicated in ONE of 5 criteria is met, what are the five criteria?

Back 2

1) Symptomatic
2) Serum Ca is 1mg/dl over high normal
3) 24 hr urine Ca >400mg
4) Cr clearance is reduced by 30%
5) Bone mineral density T-score < -2.5 at any site
AND 6) Age <50

Front 3

How does mgmt of parathyroid dz differ in the following cases?

1) Parathyroid adenoma and surg is indicated
2) Parathyroid hyperplasia and surg is indicated
3) Either case, surg not indicated

Back 3

Adenoma w/ surg: remove the adenomatous gland, biopsy the others

Hyperplasia w/ surg: remove 3.5/4 glands, place a clip on the last .5 or put it in the forearm so you can get it out later

no surg: avoid thiazides, give bisphosphonates, lots of hydration

Front 4

What is the TX for hyperparathyroidism d/t Chronic Renal Dz

Back 4

Hyperphosphatemia: Ca-carbonate (Tums), dec daily phosphate (protein)

Osteodystrophy: Calcitriol, vit D analog, or Calcinet to supress PTH secretion

Front 5

What is the TX for a prolactinoma?

Back 5

DA agonist: Cabergoline
if unsuccessful: trans sphenoidal removal + radiation

Front 6

What are the symptoms of Acromegaly?

Back 6

Growth in face, hands and feet over 12 yrs
Course facial features, macroglosia, enlarged jaw, spaced teeth
Glucose intolerance in 50%, DM in 10%

Front 7

How do you Dx Acromegally?

Back 7

Screen: elevated IGF-1 (Insulin like growth factor)

Confirm: Oral glucose suppression test (75g glucose, measure GH at 1 and 2 hrs, if GH is elevated> 1ng/mL = acromegaly)

Front 8

What is the Tx for acromegaly?

Back 8

Trans-sphenoidal resection + radiation

no surg: 1) Octreotide (GH inhibitor) 2) Cabergoline (DA agonist) 3) Pegvisomant (GH-r' antagonist)

Front 9

What is Sheehan's syndrome?

Back 9

Postpartum hemorrhage --> hypotension --> pituitary infarction --> hypopituitarism

Front 10

What are signs of Sheehan's syndrome in

Weeks after delivery:
Months/ years after delivery:

Back 10

Weeks after delivery: inability to lactate, lethargy, anorexia

Months/ years after delivery: Inability to resume menses, mild fatigue, anorexia, loss of sexual hair

Front 11

HYQ: A pt with elevated BP, palpitations, headache, excessive perspiration is found to have elevated urine VMA --> what effect would giving a B-blker have on this pt?

Back 11

Pheochromocytoma

Must give alpha blocker 1st, a B-blker will cause HTN d/t unopposed alpha-adrenergic vasoconstriction d/t high levels of epi

Front 12

HYQ: what is a lactotroph adenoma?

Somatotroph adenoma?

Back 12

Lactotroph: pit tumor secreting PRL

Somatotroph: pit tumor secreting GH

Front 13

HYQ: Most likely cuase of :
+ increased PTH
-- decreased serum Ca
+ increased serum P

Back 13

Vit D deficiency with Renal failure

Low Ca --> increased PTH --> low P, but cant excrete it d/t renal failure so it is incr.

Front 14

HYQ: Which marker is best for the Dx of an androgen-producing adrenal tumor in a woman?

DHEA/ DHEA-S/ Testosterone?

Back 14

DHEA-S

T + DHEA are made by the ovaries

Front 15

HYQ: What is the most specific lab finding in making the Dx of primary hyperaldosteronism?

Back 15

High Aldosterone:Renin ratio

Front 16

What is the next step in the mgmt of a pt with hyperprolactinemia not d/t an obvious drug cause?

Back 16

Look for a pit adenoma with MRI, check TSH level

Front 17

What is the next best step in the mgmt of a pt found to have an absent pituitary on MRI (empty sella)

Back 17

If no Sx = No Tx

If Sx = replace hormonal deficit

Front 18

What are the two MCC of cushing's syndrome? what tests would help you distinguish between the two?

Back 18

1) exogenous steroid use; Labs: low serum cort

2) pit adenoma (Cushing's dz); Labs: dexamethasone supression test shows supression only at high dose

Front 19

What drugs are known for causing elevated prolactin levels?

Back 19

Phenothiothiazines, Antipsychotics (Rispiradone, Haloperidol), Methyldopa, Verapamil

Front 20

What lab abnormalities (Ca/P/PTH/AlkPhos) do you see in the following diseases:

1) Paget's dz
2) Osteomalacia/ Rickets
3) Chronic Renal Failure

Back 20

1) Paget's dz = + AlkPhos
2) Osteomalacia/ Rickets= -Ca/ +PTH/ -P
3) Chronic Renal Failure= -Ca/ +PTH/ +P

Front 21

What lab abnormalities (Ca/P/PTH/AlkPhos) do you see in the following diseases:

1) Primary Hyperparathyroidism
2) Hypoparathyroidism
3) Pseudo hypoparathyroidism

Back 21

1) Primary Hyperparathyroidism = +PTH/ +Ca/ -P/ +AlkPhos
2) Hypoparathyroidism = -PTH/ -Ca/ +P
3) Pseudo hypoparathyroidism = +PTH/ -Ca/ +P

Front 22

What lab abnormalities (Ca/P/PTH/AlkPhos) do you see in the following diseases:

1) Osteoperosis
2) Osteopetrosis

Back 22

No changes, really.

Front 23

Calcitonin is secreted by ______ cells and functions to ____.

Back 23

Calcitonin:
secreted by parafollicular cell
Inhibits bone reabsorption

Front 24

Mnemonic for hypercalcimia in cases of hyperparathyroidism

Back 24

Stones, Bones, Abdominal groans, and Psychiatric overtones

Kidney stones, GI upset, osteitis fibrosa, osteo -perosis/malacia/arthritis, Lethargy + fatigue, depression.

Other: proximal arm weakness, keratitis, conjunctivitis, HTN, itching

Front 25

Primary Hyperparathyroidism

Path:
Sx:
Labs:
Tx:

Back 25

Primary Hyperparathyroidism

Path: MCC is Adenoma, 2nd: hyperplasia of all 4 glands
Sx: Osteopenia with hypercalcemia
Labs: +PTH/ +Ca/ -P
Tx: surgical resection

Front 26

HypOparathyroidism

Path:
Sx:

Back 26

HypOparathyroidism

Path: MCC is d/t surg, 2nd: autoimmune
Sx: Tingling in lips and fingers, tetany, cataracts, dental hypoplasia, + Trousseau's, + Chvostek's

Front 27

Pseudohypoparathyroidism

Path:
Sx:

Back 27

Pseudohypoparathyroidism

Path: Pt non-responsive to PTH
Sx: skeletal abnormalities, Albrights hereditary osteodystrophy, short stature, Seizures

Front 28

Pseudohypoparathyroidism

Labs:
Tx:

Back 28

Pseudohypoparathyroidism

Labs: - Ca/ +P/ +PTH
Tx: Ca and VitD supplementation

Front 29

HypOparathyroidism

Labs:
Tx:

Back 29

HypOparathyroidism

Labs: - Ca/ +P/ -PTH
Tx: Ca and VitD supplements

Front 30

Primary Hyperparathyroidism

Labs:
Tx:

Back 30

Primary Hyperparathyroidism

Labs: +PTH/ +Ca/ -P
Tx: surgical resection

Front 31

QH: What three causes of hyperparathyroidism are assoc with decreased Ca with increased PTH?

Back 31

Malnutrition
Malabsorption
Renal dz

Front 32

QH: _____ is the MC pituitary tumor

Back 32

Prolactinoma

Front 33

What dz is associated with these complications:

Spinal cord compression, vision loss 2ndary to pressure of tumor on optic nerve?

Back 33

Acromegally

Front 34

NS: for a child with extremely advanced growth for their age, perform a work up for____.

Back 34

Gigantism, perform a work up for GH

Front 35

What endocrine disorder is common in pts with acromegaly?

Back 35

Insulin resistance/ DM-II

Front 36

Pts with hypopituitarism need to have their hormones replaced. What do you give for:

TSH
LH/FSH
GnRH:

Back 36

TSH: Levothyroxine

LH/FSH: T for men, Estrogen-Progesterone pill for women

GnRH: Leuprolide

Front 37

Pts with hypopituitarism need to have their hormones replaced. What do you give for:

PRL:
ACTH:

Back 37

PRL: no need to replace

ACTH: for cortisol: hydrocortisone, dexamethasone, prednisone.
For mineralocorticoid: Fludrocortisone

Front 38

QH: ____ is the MCC of cushing's syndrome

Back 38

Excess corticosteroid administration

Front 39

QH: ____ is the the cause of Cushings Dz, and the 2nd MCC of Cushings syndrome

Back 39

Excess ACTH production by a pituitary adenoma

Front 40

What type of cancer can cause Cushing's syndrome?

Back 40

Small Cell Lung Cancer causing Paraneoplastic ACTH production

Front 41

What Sxs in an H&P would alert you of Cushings syndrome?

Back 41

Purple striae, buffalo hump, acne, cataracts, moon facies, weakness, depression, impotence, HTN, increased hair growth

Front 42

Dexamethasone supression test

What d/o are supressed with High dose?

Back 42

Pituitary tumor

Front 43

Dexamethasone supression test

What d/o are NOT supressed with High dose?

Back 43

Adrenal tumor, Small Cell Lung Ca

Front 44

What is the Tx for Cushing's Syndrome?

Back 44

Surgical resection of tumor, Octreotide

Front 45

What is Conn's Syndrome?
What is the hallmark Lab finding?

Back 45

Excess Aldosterone secretion caused by a unilateral adrenal adenoma

Lab: PAC:PRA ratio (Plasma Aldosterone Concentration: Plasma Renin Activity

Front 46

What two conditions can cause Hyperaldosteronism?

Back 46

Conn's syndrome (Adrenal adenoma)

Increases RAS activity d/t poor renal perfusion

Front 47

What labs do you expect in hyperaldosteronism?

Back 47

Decreased K+, Increased Na+.... along with HTN, Muscle weakness, lethargy, polyuria, and polydipsia

and Metabolic alkalosis, increased 24hr urine aldosterone

Front 48

Hyperaldosteronism Tx?

Back 48

Surgery, Spironolactone, Eplerenone

Front 49

Name 4 conditions that cause hyperaldosteronism 2ndary to poor renal profusion

Back 49

Renal Artery Stenosis
CHF
Nephrotic Syndrome
Cirrhosis

Front 50

What is addison's Dz?

Back 50

Primary adrenal insufficiency

Autoimmune destruction of adrenal cortices. It is assoc with a fm hx of vitiligo, and is the only dz to cause bronzing of the skin

Front 51

What causes secondary adrenal insufficiency?

Back 51

Decreased ACTH production or insufficent ACTH production by the pituitary

Front 52

What is Tertiary adrenal insufficiency?

Back 52

Insufficient CRH secretion by the hypothalamus

can be 2ndary to chronic corticosteroid use

Front 53

QH: increased skin pigmentation is seen in pts with _______

Back 53

Seen in Addison's Dz d/t increased MSH production accompanying ACTH production.

It is not seen in secondary or tertiary insufficiency

Front 54

What lab abnormalities would you expect with Adrenal insuficiency?

Back 54

Decreased Na and increased K, Eosinophilia

Front 55

Mnemonic for Eosinophilia

Back 55

DNAAACP

Drugs, Neoplasm, Allergy [Asthma (Churg Strauss)] Addisons, AIN, Collagen vascular dz, Parasitic (Loefflers eosinophilic pneumonitis d/t Ascaris lumbricoides

Front 56

Treatment for Adrenal insufficiency

Back 56

Replacement
Glucocorticoids: steroid
Mineralocorticoid: fludracortisone
DHEA

Front 57

What are the 3 types of Congenital Adrenal Hyperplasia and what are their features?

Back 57

1= HTN; [_]1=Virilization
17-alpha: HTN
21-alpha: Virilization [90% MC]
11-beta: HTN and Virilization

Front 58

Pheochromocytoma

Path
H/P
Labs
Tx

Back 58

Path: adrenal medulla tumor that secretes epi and nor-epi
H/P: diaphoresis, headache, tachycardia, HTN
Labs: VMA in urine
TX: surgery, alpha and beta blockers

Front 59

QH: what do you suspect in a pt with intermittant HTN and tachycardia?

Back 59

Pheochromocytoma

give alpha blocker before Beta blocker

Front 60

QH: MEN IIa and IIb are assoc with mutations of the ____ proto-onco gene

Back 60

RET

Front 61

QH: MEN I is aka ____ and MEN IIa is aka _____

Back 61

MEN I: Wermer syndrome
MEN IIa: Sipple syndrome

Front 62

What are the 3 P's of MEN1
the 2 P's of MEN IIa
and the 1 P of MEN IIb

Back 62

MEN I: Pituitary, Parathyroid, Pancreas
MEN IIa: Parathyroid, Pheochromocytoma, Medullary thyroid
MEN IIb: Pheochromocytoma, Medullary thyroid, Mucosal neuroma

Front 63

Poor feeding, thick tongue, umbilical hernia,

What is the TX?

Back 63

Cretinism

TX: Levothyroxine

Front 64

QH: _______ is commonly the first sign of cretinism

Back 64

Prolonged jaundice