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305 Cards in this Set

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  • Back
What type of Diabetes is characterized with immune destruction of beta cells in islets of langerhans
Type 1
What type of DM has greater concordance with monozygotic twins
Type 2
How do you make the diagnosis of DM
In adults non pregnant patients FG 126 or greater on 2 seperate occasions
What is Impaired fasting glucose
110-125
How do we screen for gestational diabetes
oral glucose tolerance test
Mechanism of sulfonylurea
insulin secretagogues
Side effects of sulfonylurea
Hypoglycemia
Weight gain
GI side effects
Mechanism of Metformin
Decrease Hepatic gluconeogenesis
Increases insulin sensativity
Conditions where Metformin is not prescribed
Creatnine > 1.4
cardiac failure
respiratory failure
Hx of lactic acidosis
ETOH abuse
Liver disease
Use of contrast
Thiazolidinediones mechanism
improves peripheral insulin action
Thiazolidineiones are Contraindicated in what conditions
CHF due to fluid retension
What function has to be montiored if Thiazolidineiones are prescribed
Liver function test
Exenatide (Byetta) mechanism
Alter GI hormone action and slows absorption of carbs
What to do to avoid wt gain with insulin
Give Metformin with insulin
What diabetic drugs are contraindicated in CHF
Metformin
Thiazolidinediones
What are some PTH dependent causes of hypercalcemia
1. Primary hyperparathyroidism
2. Familial hypocalciuric hypercalcemia
3. Lithium
When symptomatic how does hypercalcemia presents
Nephrolithiasis
Osteopenia/Osteoprosis
Bone Pain
Fatigue/Weakness/Depression
Why do we need to order urinary calcium in hypercalcemia
to rule our familial hypocalciuric hypercalcemia
Osteitis Fibrosa
Skeletal findings of hypercalcemia which leads to bone resorption and cortical bone loss
What are the indications for parathyroidectomy
parathyroidectomy is indicated for all less than 50 y/o with any 1 of the following
serum ca >1 above upper normal
fragility fx
gfr < 30
t score below 2.5
contraindication to med survelliance
Familial hypocalciuric hypercalcemia
Asymptomatic
mild hypercalcemia
slightly increased PTH
Low urinary calcium
Positive family hx
Calcium to Crcl ratio less than 0.01
treatment for Familial hypocalciuric hypercalcemia
Generally none
Thiazide induced hypercalcemia
multifactorial-dehydration, decreased renal calcium clearence
usually resolve after few weeks after d/c thiazide
Thiazide induced hypercalcemia
multifactorial-dehydration, decreased renal calcium clearence
usually resolve after few weeks after d/c thiazide
Name causes of PTH independent hypercalcemia
Malignancy
Vitamin D intoxication
Sarcoidosis
What is the cause of hypercalcemia in malignancy
PTHrp secreted by tumors
Serum PTH is suppressed in all cases of hypercalcemia due to malignancy
What causes hypercalcemia in sarcoidosis
Granulomas and lymphoma express high levels of 1 alpha hydroxylase and thus can generate 1,25 dihydroxyvitamin D from circulating 25-hydroxyvitamin D
Levels of 1 25 dihydroxyvitamin D in sarcomas/lymphoma
Increased
What are primary causes of decreased testosterone or male hypogonadism
Klinefelter syndrome
Testicular trauma
Radiotherapy
Chemotherapy
Autoimmune/infectious disorder
What are secondary causes of decreased testosterone or male hypogonadism
Constitutional delay in puberty
Neuroleptic drugs
sleep apnea
Thyroid/Adrenal disorder
Pituitary tumor
What is the cause for genetic androgen resistance
Testicular feminization
5 alpha reductase deficiency
What do males with hypogonadism present with
decreased libido
Decreased potency
Decreased ejaculate volume
Infertility
Gynocomastia
How do you diagnose male hypogonadism
document low levels of testosterone
How can you distinguish primary vs secondary causes of male hypogonadism
Measure LH and FSH

Primary-> LH, FSH are elevated
Secondary-> LH, FSH are decreased or normal
What workup is needed for secondary hypogonadism
Exclusion of Kallmann syndrome
Measure Prolactin
Measure pituitary function
MRI brain
Klinefelter Syndrome
Presence of 47 XXY chromosome
Small testes
Gynecomastia
FSH increased
Testosterone levels are down
Kallmann Syndrome
Secondary hypogonadism
ANOSMIA
Decreased FSH, LH
Decreased Testosterone
What are clinical features of prolactinomas in Women
Galactorrhea
Oligomenorrhea
Amenorrhea
What clinical features do men present with in prolactinomas
Decreased libido
Impotence
Differential diagnosis of hyperprolactinoma
Pregnancy
HYPOTHYROIDISM
Chest wall lesions
Chronic renal/Liver failure
Postpartum state
Surgery
Seizure
Stalk disruption due to lymphoma
DRUGS
what drugs may cause hyperprolactinoma
DA antagonists
Antidepresssants
Cimetidine
Verapamil
Opiates
How does hyperprolactinemia occurs in hypothyroidism
TRH stimulates secrection of prolactin
What is the diagnostic approach to hyperprolactinemia
1. rule out pregnancy
2. Measure TSH to r/o hypothyroidism
3.review meds
4. MRI
5.If tumor present eval other pituitary fxn and visual feilds
What is t he 1st line treatment for macroprolactinoma
Medical treatment
What is the 1st line treatment for non functioning tumor that causes stalk effect
Surgical resection
Side effects of DA agonists
nausea/vomiting
Nasal stiffness
nightmares
postural hypotension
Most common cause of cushing syndrome
prolonged use of supraphysiologic dose of glucocorticoids
What are the causes of overproduction of endogenous cortisol
1. Cushing disease
2. Adrenal tumors
3. Ectopic ACTH
What is the best screening test for cushing syndrome
24 hour urinary free cortisol
Low dose dexamethasone suppression test
What other conditions may lead to increased urinary free cortisol
depression
etoh
acute illness
What needs to be done in clinical suspicion is high for cushing syndrome and 24 hr urinary cortisol in normal
repeat the test in one month
What is the screening test for subclinical cushing syndrome with adrenal incidentaloma
1mg dexamethasone suppression test
What are ACTH independent causes if cushing syndrome
adrenal adenomas
adrenal carcinomas- may produce adrenal androgens
What are causes of ACTH dependent cushing syndrome
pituitary adenoma
Ectopic secretion of ACTH
What should be the next step once cushing syndrome has been confirmed
Measurement of ACTH
What should be the next step once once cushing syndrome has been confirmed and ACTH is suppressed
Obtain CT of adrenals
What should be the next step once once cushing syndrome has been confirmed and ACTH is normal or mod increased
May do a 8mg Dexamethasone test if pituitary ACTH- Dexameth will suppress the ACTH and ectopic will not.

Pituitary tumor vs ectopic production of ACTH
How can we distinguish between pituitary vs ectopic production of ACTH
Obtain MRI to look for pituitary tumor if no abnormalities found in sella- Inferior petrosal sinus sampling
How do you interpret a Inferior petrosal sinus sampling
If central to peripheral ACTH concentration gradient exist ACTH is coming from pituitary
What should be next step if tumor secreting ACTH is in the pituitary
Proceed with transsphenoidal exploration
What is the treatment for failed transsphenoidal surgery for pituitary ACTH or undetectable source of ectopic ACTH
B/L adrenalectomy
What is the treatment for adrenal adenoma
resection of adenoma
What is the treatment if complete resection of adrenal adenoma is not achieved
ketoconazole
After surgical exicision of adrenal tumor what is the period of cortisol deficiency
1 year during which need to be replaced with steroids
Name some causes for hypopituitarism
Pituitary tumors
pituitary surgery
Radiotherapy
What is the most common cause for extrasellar for hypopituitarism
Craniopharyngioma
What is pituitary apoplexy
pt p/w acute sx of cortisol deficiency. apoplexy is pituitary hemorrahge.
Thunderclap HA
Visual disturbance
Opthalmoplegia
How do deficiencies in gonadotropin axis are manifested
low concentration of Testosterone
Low or normal LH and FSH
What is the most common cause for central hypogonadism
Hyperprolactinemia
MEN 1 is characterized by what neoplasms
Parathyroid
Pancreatic
Pituitary
Is genetics involved with MEN 1
It is familial and inherited as AD with high penetrance
Gene is on chromosome 11
What is the most common manifestation of MEN 1
Primary hyperparathyroidism
What is the treatment for hyperparathyroidism in MEN 1
Resection
What type of hormones are secreted by islet cell neoplasia in association with MEN 1
Pancreatic polypeptides
Gastrin
Insulin
VIP
Glucagon
Somatostatin
ACTH
What is the most common type of pituitary tumor associated with MEN 1
Prolactinoma
How do we screen for MEN 1
Family screening
may check serum Ca or PTH
MEN 2A tumors
Medullary carcinoma of thyroid
Pheochromocytoma
primary hyperparathyroidism
MEN 2B tumors
Medullary carcinoma of thyroid
Pheochromocytoma
Mucosal neuromas
What is the rule of 10 with pheo's
10 % mallignant
10% extra adrenal
10% familial
What are common sx of pheo
HA
Palpatations
sweating
What are multiple endocrine conditions that pheos may be a part of
MEN 2A
MEN 2B
What lab test are required for the dx of pheo
Increased urinary excretion of free cathecholamines( epi, norepi) and Metanephrines(metabolites of catecholamines)
What factors may have false positive for pheos
pt on labetalol, MAOI, stress, acute MI, abrupt withdrawl of clonidine
What is the screening test for pheo
24 HOUR URINARY Metanephrines
OR
Plasma fractionated metenephrines
What is the treatment for Pheo
RESECTION
What drug is used after diagnosis has been established prior to surgery
Phenoxybenzamine
doxazosin
Nicardipine
What is the role of bb in pheo
BB may be necessary to control reflex tachycardia after effective alpha blocker
What is hirsutism
excessive androgen induced hair growth in androgen sensitive areas of female body
What conditions include excessive androgen production by the ovaries
PCOS
What conditions include excessive androgen production by the adrenal cortex
CAH
ACTH dependent cushing disease
Name some clinical features of hyperandrogenism
hirsutism
menstural abnormalities
masculanization
What is the work up for hirsutism
Serum testosterone
DHEAS
Prolactin
Screen for cushing syndrome
What labs suggest adrenal tumor causing virulization/hirsutism and how to detect it
DHEAS greater than 7ng/dl
Testosterone greater than 200
Need CT or pelvic U/S
What is the most common cause for hyperandrogenism
PCOS
What are the diagnostic criteria for PCOS
1. Oligomenorrhea or amenorrhea
2. Clinical or biochemical hyperandrogenism
3. Exclusion of cushings syndrome or CAH
What is the enzyme involved with late presenting CAH
21 hydroxylase deficiency`
Treatment for hirsutism
OCP for PCOS- they suppress LH and in turn suppress ovarian testosterone production
Spironolactone
What are the causes for hypocalcemia
Hypoparathyroidism
Psuedohypoparathyroidism
Vitamin D deficiency
Chronic renal failure
Calcium sequestration
What are the causes of hypoparathyroidism
Thyroidectomy
Hypomagnesemia-it deceases secretion and effect of PTH
What is psuedohypoparathyroidism
PTH end organ resistance to action of PTH-
skeletal abnormalities, short stature, retardation
What is Chvostek's sign
tapping facial nerve ->contraction of facial muscle-
Seen in HYPOCALCEMIA
Name some atypical features of hyperthyroidism in elderly
wt loss
apathy
a fib
CHF
Increased FT4
Increased or normal TSH
Pituitary tumor secreting TSH
What is the triad of GRAVES disease
Hyperthyroidism
Ophthalmopathy
Dermopathy
What causes Graves disease
Autoantibodies with TSH like activity
Name some causes of hyperthyroidism
Graves disease
Painless lymphocytic thyroiditis
subacute painful thyroiditis
multinodular goiter
Toxic thyroid adenoma
Exogenous hyperthyroid
Describe painless lymphocytic thyroiditis
more common in postpartum females,autoimmune dz
p/w transient hyperthyroid-transient hypothyroid and then euthyroid
Order TPO antibodies +
What is the treatment for painless lymphocytic thyroiditis
bb for hyperthyroid for sx tachycardia and thyroid replacement for hypothyroid state
How does subacute painful thyroiditis presents
painful tender goiter
fever, malaise, myalgias
hx of URI
Odynophagia
elevated ESR
What is the treatment for painful subacute thyroiditis
NSAID or steroids
What cause of hyperthyroidism in which cardiovascular sx dominate
Multinodular goiter
Radioisotope scan demonstrate intense uptake in the nodule with suppressed uptake in the rest of the gland
How do you treat toxic adenoma
Toxic thyroid adenoma

Surgery, RAI
What drugs are used to treat Graves disease
Methimazole
PTU
How do Methimazole and PTU work
They block thyroid hormone synthesis and may decrease production of TSI
In what conditions of hyperthyroidism than radioactive iodine may be used
Graves dz
Toxic multinodular goiter
What are the indications for subtotal thyroidectomy
1. Thyrotoxic patients with large goiter or suspicious looking nodule
2. Pt with graves who are very young or pregnant
Delirium
Fever
Tachycardia
Hypotension
Vomiting
Diarrhea
Coma
Thyroid storm
What is the treatment for thyroid storm
Need to be started immediately
PTU to block thyroid synthesis
Sodium iodide is given to inhibit thyroid hormone synthesis
Propranalol to control adnergic manifestations
What is the most common cause for hypothyroidism
Autoimmune thyroid disease- Hashimoto thyroiditis
What test confirm the diagnosis if hypothyroidism
low FT4
Increased TSH
What Thyroid test do you expect with Central hypothyroidism
Low FT4
Normal or low TSH
What test need to be ordered in case of central hypothyroidism
MRI head
pituitary function test
What are the recs for pregnancy and hypothryoidism
1. Adequate replacement before conception
2. May need to increase replacement dose during pregnancy
What are the risk factors for overt hypothyroidism in subclinical hypothroidism and may need replacement.
Increased age
presence of thyroid antibodies
TSH levels greater than 10
What is the most common malignancy that mets to thyroid
Renal cell ca
What needs to be done if thyroid nodule is found
1. TSH
2. FNA
3. If negative FNA yearly F/U with TSH
4. If non diagnostic FNA repeat FNA.
5. If FNA positive or suspicios->Surgery
Papillary thyroid ca
Most common type of thyroid ca
Spreads through lymphatics
mets to lungs and bones
Follicular thyroid ca
spreads through blood
Mets to lung, bone, brain
What type of thyroid ca has best prognosis
Papillary thyroid ca
The most dangerous type of thyroid ca
Anaplastic carcinoma prognosis 3 months
What is the treatment for differentiated thyroid ca
Surgical resection
Tests results for hyperthyroidism
Low TSH
Increased FT4

Need to order T3 if normal FT4
Lithium use can cause what type of thyroid problem
Hypothyroidism
What are some causes of hypocalcemia related to Vit D def or response to vit D
Nutrional def
Ricketts
malabsorption
CRF
Liver disease
Androgen excess occurs from what two main categories of etiolgies
Ovaries- PCOS
Adrenocortical - CAH, ACTH dependent cushing disease
Name four main causes for hirsutism and virilization
idiopathic hirsutism
PCOS
Late onset CAH
Tumors of adrenals and ovaries
What is the test used to confirm the diagnosis of GH defieciency
The GH stimulation test

LOW IGF-1 only SUGGESTS GH defieciency
Name a side effects of Sulfonylurea
Hypoglycemia
Name a side effect of Metformin
Lactic acidosis
What is psuedo cushings syndrome
hypercortisolism in pt with depression and alcohol abuse
How do we distinguish between pseudocushings and cushings disease if screening test are euivocal
2 day dexamethasone and CRH test
What is 2 days dexamethsone and CRH test
dexamethasone is given for every 6 hours for 8 doses then CRH is given- In pseudo cushing the CRH cannot overcome the dexamethasone suppression and cortisol is not elevated. In cushings syndrome the cortisol is elevated
Increased bone resorption and disorganized bone remodeling is associated with what disease
pagets
Elevated alkP
pain and bone deformity
these clinical signs are associated with what disease
paget's
What radiological test can be offered if pagets disease is suspected
radiological bone survey and then
Bone scan
What are the indications for medical therapy for pagets disease
pain
dz involving weight bearing bones
ALP > 1000
neurological complications like nerve entrapment
What is the treatment for pagets disease
bisphosphanate
How do you distinguish between graves disease and postpartum thyroiditis
Graves disease has presence of TSI- autoantibodies with TSH like activity but postpartum thyroiditis does not.
What is another name for painless lymphocytic thyroiditis
Postpartum thyroditis
How do you treat subacute thyroditis
BB for hyperthyroid phase
Thyroid replacement for hypothyroid phase
How do you distinguish between the hypercalcemia associated with malignancy and hyperparathyroidism
Check PTH
- elevated in hyperparathyroidism
- Decreased in Malignancy related hypercalcemia
Cortisol, Aldosterone, and sex hormones deficiency
primary adrenal failure
ACTH deficiency with cortisol and adrenal sex hormones deficiency
Secondary adrenal failure
Causes for primary adrenal failure
Addison disease
TB
B/L adrenal hemorrhage due to sepsis
Anticoagulation or lupus anticoagulant
Congenital enzyme deficiency
Ketocanozole
Adrenal mets
What cancer commonly mets to adrenals
Lungs Ca
In what type primary vs secondary that mineralocorticoid deficiency is not present
Secondary
What is the most common cause for ACTH def i.e secondary adrenal failure
Use of prolonged steroids and suppression of hypothalamic -pituitary- adrenal axis
Clinical features of primary adrenal failure

Aldosterone def
hyponat
Hypotension
Hyperpigmentation
Hyperkalemia
clinical features of secondary adrenal failure
No hyperkalemia
Pale complexion
What is cosyntropin test
cortisol response to synthetic ACTH
Appropriate response increase in cortisol by 7 from baseline
absolute value greater than 18
What test is used to eval for primary adrenal failure
cosyntropin test
What test is used to eval for secondary adrenal failure
Insulin - hypoglycemia test
Metyrapone test

they test for ACTh responce to hypoglycemia or inhibition of adrenal steroidogenesis
Treatment for primary adrenal failure
Glucocorticoid and Mineralocorticoid
Treatment for secondary adrenal failure
Glucocorticoid
DEXA bone scan 1.0-2.5 below SD
Osteopenia
DEXA bone scan below 2.5 SD
OR
Fragility fracture
Osteoprosis
Name causes of osteoprosis
postmenopausal
senile
Hypogonadism
hyperparathyroidism
Hyperthyroidism
Hypercortisolism
malnutrition
Alcoholism
Neoplastic d/o
Methotrexate
Osteogensis imperfecta
What are clinical features of Osteoprosis
Occurrence of fractures with minimal trauma
normal serum level of ca, alp, phos
What is the treatment for osteoprosis
Bisphosphonate
Calcium
Vitamin D
What are causes for osteomlacia
Vitamin D def
Poor PO intake- ETOH, Jail
Malabsorption- Celiac disease
Liver disease
Name clinical features of Osteomlacia
Bone pain
Muscle weakness
Fractures
Levels of these in Osteoprosis
Calcium
Phosphate
ALP
Calcium normal
Phosphate normal
ALP normal
Levels of these in osteomalacia
Serum ALP
Serum Ca
Serum PO4
Serum ALP increased
Serum Ca low
Serum PO4- Low
In cases due to Vit D def leading to osteomalacia what happens to parathyroid
Secondary hyperparathyroidism
Looser zones
Pseudo fractures
narrow lines of lucency seen in cortical bones
OSTEOMALACIA
Compare and contrast Osetoprosis and Osteomalacia
AS ABOVE
What size of incidental adenoma is worrisome for carcinoma
6 cm
If incidental adenoma is found what needs to be done next as far as screening is concerned
Screen for
Pheo with 24 hr urine metanephrines
Cushing syndrome with 1mg overnight dexamethasone test
Primary aldo with PR/PRA ratio
When is needle biopsy indicated for incidental adenoma
if malignant mets are suspected
What needs to be done if functional adrenal adenoma is detected
Surgical excision
What needs to be done if nonfunctioning adrenal adenoma is detected size 4cm or less
Repeat CT in 3 months
if size increasing ->surgery
if size stable repeat scan in 1 yr
What needs to be done if adrenal adenoma is 4cm or greater or increasing in size
Surgical excision
Hypokalemia
Increased urinary potassium concentration
Mineralocorticoid excess i.e primary aldo
How do you screen for primary aldo
ratio of plasma aldo/plasma renin activity
THEN
NEED A CT OF ADRENALS
How do you distinguish between aldosterone producing adenoma vs bilateral adrenal hyperplasia
selective adrenal venous sampling- unilateral aldosterone gradient help direct surgical excision
What is the treatment for adrenal aldosteronoma
Surgical resection
What is the treatment for b/l adrenal hyperplasia producing aldosterone
Aldactone
What are PTh dependent causes for hypercalcemia
Primary hyperparathyroidism
Familial hypocalciuric hypocalcemia
Thiazide induced hypercalcemia
Lithium
Hypogonadism
Diabetes
Liver dysfunction
Hyperpigmentation
Hereditary Hemochromotosis
Name some causes of primary amenorrhea
imperforate hymen
TESTICULAR FEMINIZATION
no uterus
vaginal atresia
psych d/o
heavy exercise
hyperprolactinoma
thyroid/adrenal d/o
Causes of secondary amenorrhea
PCOS
Chemotherapy
Ovarian tumors
Stress
Wt loss
Hyperthyroidism
Sheehan syndrome
outflow tract abnormalities
What is the workup for secondary amenorrhea
R/O pregnancy
check PRL
Check TSH
How can we distinguish between ovarian vs Hypoyhalamic-pituitary reasons for secondary amenorrhea
Elevated FSH and low Estradiol levels indicate priamry ovarian failure
low Estradiol levels and low FSh levels indicate hypothalamic-pit dysfunction
Estrogen therapy is associated with increased risk what diseases
1. Endometrial ca
2. Breast ca
What needs to done in urinary catecholamines are positive for pheo
need to order CT or MRI of abd to localize pheo
When is MIBG test ordered
If pheo is suspected as a metastatic disease and is used in conjunction with CT or MRI
Autoimmune thyroditis- Hashimoto's thyroditis is associated with what diseases
Addisons disease
Type 1 DM
Hypoparathyroidism
Pernicious anemia
Vitiligo
What bones are involved with osteomalacia vs Pagets dz
Osteomalacia- femoral head, scapulae, metatarsals

Paget dz- sacrum, spine, femur, tibia, skull, pelvis
In pt with subclinical hyperthyroidism i.e Low TSH and normal T4 and T3 what test need to be considered
Evaluate for cardiac arrythmias
evaluate for bone loss with DEXA scan

Increased risk for afib and osteporosis
What is the DDx for gynocomastia
1. Liver disease
2. Aldactone
3. Increase in estradiol due to adrenal ca, HCG producing tumor
4. Anabolic steroids
5. Klinefelter syndrome
Antithyroid peroxidase
Hashimotos thyroiditis
Name complications of Pagets disease
1. Osteogenic sarcoma
2. high output cardiac failure
3. Deafness
4. Excessive bleeding during surgery due to hypervascular bone
Causes for primary hypogonadism in males
Klinefelters
testicular trauma
radiotherapy
chemotherapy
autoimmune d/o
Orchitis
Causes for secondary hypogonadism in males
constitutional delay in puberty
neuroleptic drugs
severe systemic illness
sleep apnea
MDD
hyperprolactinoma
thyroid/adrenal disorder
Pituitary tumor
what are some renal manifesttaion of hypercalcemia
nephrolithiasis
nephrogenic DI
nephocalcinosis
what are possible cause for hypercalcemia due to hyperparathyroidism
primary adenoma
MEN 1, 2A
chronic renal failure--low ca -->high PTH
what are 2 main causes for hypothryoidism
priamry --dec free T4, Inc TSH
secondary--dec T4, variable TSH
what are the goitorous causes for hypothyroidism
Hashimotos thyroiditis
recovery phase after thyroiditis
Iodine def
what are non goitorous casues for hypothyroidism
surgical destruction of thyroid gland
s/p radioactive iodine or radiation, amiodarone
what ar e secondary casues for hypothroidism
hypothalamic or pituitary failure
type of hypothryoidism associated with PBC, Pernicious anemia, Sjorgen syndrome
Hashimotos thyroitditis
Hashimotos is also assocaited with polyglandular syndrome
Addison's
DM
what labs need to be run for hashimotos thyroiditis
anti thyroidperoxidase--anti TPO
anti thyroglobulin- anti Tg
what are renin independent causes for hyperaldo
adrenal hyperplasia
Conn syndorme
carcinoma
what are renin Dependent casues for hyperaldo
renin secreting tumor
RAS
CHF,cirrhosis, Nephrotic- Low effective IV volume
What are some non aldosterone mineralocorticoid reasons for hyper aldo
Cushings syndrome
CAH
11 beta OHSD def
Liddle syndrome
exogenous mineralcorticoid
what test needs to be run if you suspect conn syndrome or adrenal hyperplasia after aldo and renin level have been obtained
salt suppression test
name causes of hypercalcemia
Hyperparathyroidism
FHH
Malignancy
Vit D excess
Increased bone turnover
Thaizides
Adrenal insufficiency
How does Vit D excess occurs to cause hypercalcemia
Granulomatous dz SARCOID, TB, HISTO produce 1-OH with inturn produce 1,25 (OH)D
what are the possible etiologies of increased bone turnover that may cause hypercalcemia
Hyperthyroidism
Immobilzation
Pagets dz
Vit A excess
what kinds of ca can produce PTHrP
Squamous cell lung
renal breast
bladder
hypothermia, hypotension, hypoventilation, AMS
Myxedema coma
Hyponatremia
Hypoglycemia
anemia
Elevated XOL
Elevated CK
Hypothyroidism
when treating myxedema coma what else needs to be replaced concomitantly
Adrenal replcement--Hydrocortisone
what two antibodies need to be ordered for Hashimotos thyroiditis
anti TPO
Anti thyroglobulins
name 3 diseases that hashimotos is assocaited with
PBC
Sjorgen syndrome
Pernicious anemia
what malignancy can casue hyperthyroidism
hCG secreting tumors choricarcinoma
what 3 antibodies you need to order if suspecting graves dz
TSI
Antimicrosomal
antithyroglobulin
ANA
what is the ddx if no uptake is seen on RAIU scan
thyroiditis
thyrotoxicosis factitia
iodine load
struma ovarii
what are posible txt for prolactinoma-macroadenoma
medical-bromocriptine,cabergoline
surgical-transsphenoid resection
radiation-if med and surg fails
increased GH as a result of pituitary adenoma
Acromegaly
what are possible sideffects of DA agonists used to txt prolactinoma
Nausea
vomiting
orthostasis
psychosis
Insulin like growth factor increased
Acromegaly--GH
WHAT ARE CLINCIAL MANIFESTATION OF Acromegaly
arthralgias
jaw enlargement
HA
CTS
Macroglossia
hoarsness
impotense
DM
Cardiomegaly
Colonic polyps
what dx test are run to look for GH adenoma--acromegaly
Increased IGF-1
oral glucose tolerance test--GH not suppressed
MRI pituitary
How do you treat Acromegaly
Surgery
Octeotide
less likely to work...are
Da agonists-bromocriptine
Radiation
Compliaction of long term Acromegaly
Pituitary insuff
Colon ca
Cradiomyopahty
what is the workup for adrenal incidentalomas
rule out subclinical cushing syndrome
rule out hyperaldosteroinsm
rule out pheo
addison disease
adrenal insufficiency
what 3 infections are assocaited with adrenal insuffciency
TB
CMV
Histoplasmosis
What deposition disease are asscaited with adrenal insufficiecny
sarcoid
amyloid
Hemochromotasis
What drugs are asscaoited with adrenal insuff
Ketaconazole
Rifampin
Anticonvulsants
pituitray is displaced and compressed by CSF in multiparous females
Normal pituitary function
Empty sella syndrome
Txt for empty sella syndrome
No txt neccesary
how do u treat hypothyroidism which can cause hyperprolactinemia
txt the hypothyroid state with synthroid
what are the Rf for pituitary apoplexy
DM
radiotherapy
coumadin use
how do u dx pituitary apoplexy
CT or MRI
How do u treat pituitary apoplexy
neurosurgery

Steroids may help with mild cases
what 3 endo conditions that may casue carpel tunnel syndrome
DM
Acromegaly
Hypothyroidsm
how do u screen for acromegaly
IGF-I

DONT CHECK FOR RANDOM GH B/C TOO VARIABLE
how do u confirm the dx of acromegaly
glucose supp test
you give glucose load and one should see a suppression of GH if not you got acromegaly
how do u diagnose the casue for DI
water suppression test-
hourly meaurement of ADH, plasma osm and urine osm
txt for neurogenic DI
DDAVP
txt for nephrogenic DI
Thiazides
what drugs ca cause SIADH
chlopropamide
clofibrate
tegrteol
HCTZ
txt for chronic SIADH

Demeclocycline
txt for asx SIADH
fluid restriction
txt for sx SIADH
hypertonic saline
what is T3 compare to T4
T 4 is prohormone that gets converted to T3 by deiodination in peripheral tissue
what drugs increase TBG
Estrogen
OCP
Preganncy
Tamoxifen
Narcotics
Hepatitis
Biliary cirrhossi
what drugs can dec TBG
Androgens
Steroids
Nephrotic syndrome
what drugs block the conversion of T4 to T3
propranalol
Glucocorticoids
PTU
Amiodarone
what drugs block the new synthesis of new T4 and T3
Lithium
Iodine
PTU
Methimazole
AMiodarine
what is RAIU
give a set dose of radioactive iodine and 24 hrs later place a radiation detector over the thyroid to determine the % of dose that was taken up by the thyroid
when do u see an increase in RAIU
graves
TSH secreting pituitary tumor
hot nodules
hCG seceting tumor
iodine def
when do u see RAIU decreased
thyroiditis---- all types
iodine excess- contrast dye, diet, amiodarine
what is thyroid scan
produces a picture of localization of isotopes...used to nodualr dz
what are risks of subclinical hypothyroidism
chances to overt hypothyroid is high in + anti-TPO
pregnant pt
memory or beaviour problems in elderly
dyslipidemia
cardiac dysfunction
how do u treat pregnant pt with hyperthyroid
PTU
FOR SURGICAL CANDIDATES FOR HYPERTHRROID PT WHAT DRUGS CAN BE GIVEN PRE SURGERY
PTU WITH BB
FOR PT WHO WILL UNDER RADIATION WITH IODIDE WHAT IS A BETTER DRUG PRIOR TO RADATION
METHMIZOLE
SIDE EFFECT OF PTU AND METHIMAZOLE
HEPATIC TOXICITIY
AGRANULOCYTOSIS

NO NEED TO CHECK LFTS JUST WATCH THEM CLINICALLY
most common cause for hypothyroidism
hashimotos thyroiditis
anti TPO
anti thyroglubulin ab
HASHIMOTOS THYROIDITIS
CHRONIC LYMPHOCYTIC THYROIDITIS
PAINLESS THYROIDITIS
LOW RAIU
HASHIMOTOS THYROIDITIS
PAINFUL THYROID GLAND
VIRAL INFECTION ASSOCAITION
LOW RAIU
HIGH ESR
SUBACUTE THYROIDITIS
TXT FOR SUBACUTE THYROIDITIS
ASA OR STEROIDS
WHAT 3 FORMS OF HYPERTHYROID CAN HAVE LOW RAIU
THYROIDITIS
IODINE EXCESS
STRUMA OVARII
WHAT ARE SOME BENEFITS FOR TREATING SUBCLINICAL HYPERTHRYOIDISM..
FOR PREVENTION OF OSTEOPROSIS
PREVENTION OF A FIB
how do u check for euthyroid sick syndrome
the r T3 is low in pituitary hypothyroidism and high in ESS
how do utreat euthyroid sick syndrome
u dont..treat the underlying illness
what is thyroid adenoma
benign area of hyperfunctioning autonomous thyroid tissue
eventually grows and produces thyroxine and suppress TSH
its then called a hot nodule
serum calcitonin increased
? MEN2 A and 2B
Meduallary thyroid carcinoma
what is the general txt for papillary thyroid ca
near total thyroidectomy
radioactive iodine
Total body thyroid scan to look
for mets
If no mets thyroxine--
if Mets give another dose of Iodine
21 or 11 hydroxylase deficiency gives you
forced thru pathway for making DHEA and testosterone with assocaited hirsutism and menstural changes
with 17 hydroxylase def what do you get
increased production of aldosterone and cortisol in adrenals
CAH describe mechanism
21 hydroxylase def
decrease production of cortisol
increased testoesterone and DHEA
hirsutism
low cortisol--high ACTH
increased androgen production and precocious puberty in men and hirsutism in women
describe late onset CAH
partial 21 hydroxylase def
mimic PCOS
screen by testing 17-OH progesterone level
cofirm by ACTH stimulation--excessive rise in 17-OH progesterone
11 hydroxylase def
late onset CAH
hirsutism
androgenism
BUT hypertension and Hypokalemia due to high levels of 11 deoxycortisol which has mineralcorticoid activity
ddx for secondary amenorrhea
hypothalamic amenorrhea
PCOS
hyperprolactiemia
premature ovarian failure
what is the 1st thing you wan tot check for secondary amenorrhea
Preganncy test
why do u give progeserone trial in work up of secondary amenorrhea
to see if there is withdrawl bleeding. If withdrawl bleeding then check FSH, LH, prolactin and TSH.
what do u expect in hypothalamic amenorrhea
low FSH, LH
when you give progesterone trail and no bleeding. what needs to be ocnsidered for 2ndary amenorrhea
outlet obstruction
why do you give BCP which includes estrogen and prg in th elast step of w/u of amenorrhea
to see if menses occurs, if menses resumes after a month or so of est/prg then 2nd ary amenorrhea is due to estrogen def ..if still no menses then its due to endometrial failure
LH:FSH ratio greater than 3
PCOS
what 2 drugs dec LDL and increase HDl and dec Tg
Niacin and Statin
what drug may decrease TG but may increase LDL
Lopid
what drugs can increase HDL
Nicotinic acid
Statin
Lopid
Mod ETOH
exercise
what drugs may lower HDL
bb except labatalol
high LDL
low HDL
High TG
What drug to use
Niacin
what is the ddx for low or no RAI uptake
thyroiditis
facticious hyperthyroidism
how do u tell apart thyroiditis and facticious use of thyroid
get thyroglobulin and ESR..they are both elevated in thyroiditis
how do u check for vit D def in osteomalacia
25 hydroxy vitamin D
how do u treat hyperparathyroidism pt who are not candidate for parathyroidectomy
bisphosphonates