ENDOCRINE

Question 1

rapid onset hirsutism suggests…

hirsutism in general should make you think…

Answer 1

high androgen levels due to androgen secreting neoplasm

pcos

Question 2

tumor in kids that causes precocious puberty with estrogen secretion

Answer 2

granulosa cell tumors

Question 3

botulism vs GBS

Answer 3

botulism is descending paralysis with early cranial involvement and pupillary changes

GBS is ascending symmetrical paralysis over days

Question 4

what level do you treat hypercalcemia?

Answer 4

> 14 mg/dL

treat with NS hydration plus calcitonin

Question 5

niacin deficiency
sx?
tx?

Answer 5

B3 deficiency
PELLAGRA ( dementia, dermatitis, diarrhea)

niacin replacement

Question 6

thiamine (B1) deficiency

Answer 6

beri beri or wenicke-korsakoff

ass with alcoholics or weight loss surgery

Question 7

riboflavin deficiency

Answer 7

B2 deficiency

cheilosis, glossitis, seborrheic dermatitis

Question 8

pyridoxine deficiency

Answer 8

B6

irritability, depression, dermatitis, stomatitis

Question 9

B12 deficiency

Answer 9

cyanocobalamin deficiency

macrocytic anemia and peripheral neuropathy

Question 10

what can be elevated in a patient with B12 deficiency?

Answer 10

methylmalonic acid

Question 11

kallman syndrome

Answer 11

decreased GnRH and decreased FSH/LH

anosmia +/- renal agenesis

Question 12

ADH deficiency is known as…

Answer 12

central diabetes insipidus

Question 13

2 hormones of the posterior pituitary

Answer 13

ADH and oxytocin

Question 14

central DI vs nephrogenic DI

presentation of DI?

Answer 14

central is decreased ADH production
nephrogenic is decreased response to ADH in kidneys

high volume urine output and excessive thirst resulting in volume depletion and hypernatremia -> can lead to confusion, lethargy

Question 15

classically what medication can cause nephrogenic DI?

Answer 15

lithium

Question 16

best diagnostic test to determine central vs nephrogenic DI

Answer 16

vasopressin (desmopression) stimulation test

central = urine V will decrease and urine osmolality will increase

nephro = no effect

Question 17

treatment for central and nephro DI?

Answer 17

central = vasopressin

nephro = tx underlying cause + HCTZ, amiloride, and NSAIDs

Question 18

acromegaly

usually caused by?
presentation?
dx?
tx?

Answer 18

overproduction of GH

usually d/t pituitary adenoma
enlarging soft tissue = increased hat, ring sizes, carpal tunnel, OSA, body odor, coarsening of facial features, deep voice, big tongue

best initial test is IGF-1
most accurate test is glucose suppression test (glucose should suppress GH)

tx: transphenoid resection of the pituitary
or meds
-ocreotide (somatostatin will suppress GH)
-pegvisomant (GH receptor antagonist)

Question 19

should a head MRI ever be an initial diagnostic test?

Answer 19

NO!! never first test for endocrine disorders

Question 20

if prolactin is elevated, next tests?

Answer 20

pregnancy test
thyroid function tests
BUN/Cr (kidney disease can elevate prolactin)

Question 21

best first initial test for thyroid issues

Answer 21

TSH

Question 22

findings and tx for hyperthyroid dz:
1 graves dz
2 subacute thyroiditis
3 painless silent thyroiditis
4 exogenous thyroid hormone use
5 pituitary adenoma

Answer 22

1 proptosis, TSH receptor abs, low TSH, high RAIU –> tx with radioactive iodine (ablation)

2 tender thyroid, low TSH, decreased RAIU –> tx with aspirin

3 normal exam, low TSH, decreased RAIU –> no tx

4 involuted/nonpalpable gland, low TSH, decreased RAIU –> stop exogenous use!

5 HIGH TSH, MRI of head –> surgery

Question 23

thyroid nodules must be biopsied when?

Answer 23

must FNA nodule if it is >1 cm if they have normal thyroid function

Question 24

cardiac sx of hypercalcemia?

Answer 24

short QT and htn

Question 25

tx for acute hypercalcemia

Answer 25

saline hydration at high volume and bisphosphonates (aledronate, pamidronate, zeledronic acid) if that doesnt bring ca down, you can use calcitonin

Question 26

labs seen in primary hyperparathyroidism

Answer 26

``` high PTH high serum Ca low phosphate ekg with short QT alk phos may be elevated due to bone effects ```

Question 27

tx for primary hyperparathyroidism

Answer 27

surgical removal of parathyroid glands or cinacalcet if nonoperable

Question 28

labs seen in hypocalcemia due to low albumin

Answer 28

low albumin causes a decrease in total calcium but free calcium is normal = no sx

Question 29

signs of hypocalcemia

Answer 29

``` chvosek sign (facial nerve hyperexcitable) carpopedal spasm perioral numbness mental irritability seizures tetany (treausseau sign) prolonged QT ```

Question 30

tx for hypocalcemia

Answer 30

replace ca and vit D orally if mild sx IV if severe

Question 31

HPA axis

Answer 31

hypothalamus --> CRH --> pituitary gland ---> ACTH ---> adrenal glands ---> cortisol

Question 32

cushings syndrome | 4 main causes

Answer 32

hypercortisolism! pituitary overproduction of ACTH (cushing disease) adrenals unknown source extopic ACTH (cancer, carcinoid)

Question 33

dx tests for hypercortisol/cushings

Answer 33

best initial test = 24 hr urine cortisol (second best option is overnight dexamethasone suppression) if 24 hr urine is elevated = confirms hypercortisolism if suppression on dexa test occurs, can rule out hypercortisolism ACTH testing is best test to identify the SOURCE of hypercortisolism - -low ACTH means adrenal source - -high ACTH means either pituitary of ectopic --> scan brain with MRI if high ACTH and nonsuppressible

Question 34

``` addisons disease aka? presentation? dx? tx? ```

Answer 34

chronic hypoadrenalism weakness, ams, n/v, hypoNa, HyperK, hyperpigmentation hypoglycemia, hyperK, met. acidosis, hypoNa, high BUN, EOSINOPHILIA if pituitary failure = ACTH is low if primary adrenal failure = ACTH high cosyntropin test (synthetic ACTH) --> if normal should cause a rise in cortisol tx steroids

Question 35

acute adrenal crisis presentation? first step?

Answer 35

profound hypotension, fever, confusion, coma high eosinophils, hyperK, hypoNa, hypoglycemia draw cortisol level and give HYDROCORTISONE **hydrocortisone is more important than diagnosis in acute adrenal crisis

Question 36

``` primary hyperaldosteronism main causes? presentation? dx? tx? ```

Answer 36

solitary adenoma or bilateral hyperplasia high BP despite low renin and hypokalemia best initial test is ratio of aldosterone to renin only do a CT if testing shows: 1) low K, 2) high aldosterone, and 3) low renin adenoma = surg laparotomy bil, hyperplasia = tx w eplerenone or spironolactone

Question 37

pheochromocytoma presentation? dx? tx?

Answer 37

nonmalignant autonomous lesion of adrenal medulla that produces catecholamines despite high BP episodic htn, headache, sweating, and palpitations best initial test is free plasma metanephrines and 24 hr urine metanephrines then do CT tx phenoxybenzamine (alpha blocker) --> surg removal

Question 38

DM diagnosis

Answer 38

2 fasting BG >125 single glucose >200 with symptoms or increased glucose on oral glucose tolerance testing or hgA1c>6.5% (best test to follow therapy effect)

Question 39

how does exercise help in DM

Answer 39

exercising muscle does not need insulin so it decreases insulin requirement/decreases insulin resistance by decreasing adipose tissue

Question 40

best initial med for DM? mech? but it is contraindicated in?

Answer 40

metformin - it bocks gluconeogenesis (does not increase weight gain and does not cause hypoglycemia) contraindicated in renal dysfunction (can accumulate and cause met acidosis)

Question 41

sulfonylureas

Answer 41

not first line for DM since they increase insulin release from pancreas and increase weight gain

Question 42

if oral agents are not controlling DM, start patient on...

Answer 42

insulin insulin glargine = 1x/day long acting NPH would be 2x/day long acting + lispro or aspart (short acting) goal is hgba1c<7%

Question 43

DKA tx

Answer 43

large volume saline and insulin

Question 44

best indicator of severity of DKA?

Answer 44

serum bicarbonate **if very low (big anion gap), there is risk of death

Question 45

all DM patients should receive

Answer 45

``` pneumococcal vaccine yearly eye exam yearly foot exam statin if LDL>100 acei/arb if BP >140/90 or if urine + microalbuminuria aspirin if >30yo ```

Question 46

tx for DM associated gastroparesis (decreased bowel mobility due to decreased stretch feedback)

Answer 46

metoclopromide and erythromycin (increase gastric mobility)

Question 47

retinopathy seen w DM? | tx?

Answer 47

nonproliferative retinopathy --> tighter gluc control proliferative retinopathy (vitreous hemorhage and neovascularizatuion) --> laser photocoagulation

Question 48

to dx amyloidosis

Answer 48

abdominal fat pad biopsy