Term
|
Definition
| SOB, CP, hoarseness, dysphagia, SVC syndrome, MYASTHENIA GRAVIS |
|
|
Term
| changes to thyroid pannel in pregnancy |
|
Definition
| increased total T3/4, no change in free T3/4 |
|
|
Term
| changes to thyroid panel in hepatic failure, nephrotic syndrome, steroid use |
|
Definition
| decreased total T3/4, no change in free T3/4 |
|
|
Term
| euthyroid sick syndrome: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
decreased total
decreased free
no change in TSH, uptake, goiter |
|
|
Term
| hashimotos: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
total T4 low
free T4 normal/low
TSH high
uptake low
painless goiter |
|
|
Term
| cretinism: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
free T4 low
total T4 low normal
TSH high
uptake low
painless goiter |
|
|
Term
| secondary hypothyroid: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
total T4 low
free T4 low normal
TSH low
no change in uptake or goiter |
|
|
Term
| graves disease: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
total T4 high
free T4 high
TSH low
uptake high
painless goiter |
|
|
Term
| toxic adenoma: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
total T4 high
free T4 high
TSH low
uptake focal
goiter bumpy |
|
|
Term
| subacute/dequarvaines thyroiditis: free T4, total T4, TSH, iodine uptake, goiter, cuase, tx |
|
Definition
total T4 high
free T4 high
TSH low
uptake low
goiter painful
cause: viral infection
tx: NSAIDS, BB |
|
|
Term
| postpartum/silent thyroiditis: free T4, total T4, TSH, iodine uptake, goiter, tx |
|
Definition
total T4 high
free T4 high
TSH high
uptake low
goiter painless
NSAIDS, BB |
|
|
Term
| iratogenic thyroiditis: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
total T4 high
free T4 high
TSH low
uptake normal
goiter none |
|
|
Term
| subacute lymphocytic thyroidis: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
total T4 low
free T4 low
TSH low
uptake low
goiter painless |
|
|
Term
| chronic lymphocytic thyroiditis: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
total T4 normal
free T4 normal
TSH normal
uptake irregular
goiter painless |
|
|
Term
| fibrous/ridels thyroiditis: free T4, total T4, TSH, iodine uptake, goiter |
|
Definition
total T4 low
free T4 low
TSH high
uptake low
goiter firm |
|
|
Term
| graves disease cause, signs |
|
Definition
Ab to TSH receptors cause hormone production
propotosis, exopthalmos, lid retraction, peritibial myexedema |
|
|
Term
| what drug causes hyperthyroidism |
|
Definition
|
|
Term
| treatment of thyroid storm |
|
Definition
PTU
IV Na ipoxate/iopanoic acid: blocks release
steroids: block conversion
BB
IVF, cooling blankets, glucose |
|
|
Term
| side effect of thionamides |
|
Definition
agranulocytosis
MET is contraindicated in pregnancy |
|
|
Term
| SE of radioactive iodine therapy |
|
Definition
contraindicated in pregnancy and breast feeding
radioactive saldenitis |
|
|
Term
| hashimotos thyroiditis cause and risk factors |
|
Definition
Ab to thyroid peroxidase, anti-microsomal ab, anti-thyroglobulin ab
turner syndrome, down syndrome, lupus, perinicious anemia, middle aged women |
|
|
Term
|
Definition
genetic, maternal hypothyroidism, iodine deficiency, thyroid agenesis
christ like MR, poor feeding, lethargy, poor growth, hypotonicity, large frontalelle, umbilical hernia, enlarged protruding tongue, myexedema, goiter, hypothyroidism, poor bone development |
|
|
Term
|
Definition
iodine deficiency, hashimotos, lithium, thyroid removal
broad facial features, enlarged tongue, deep voice, cold intolerance, fatigue, depression, SOB, weight gain, constipation, sweating, hyperlipidemia, oligomenorrhea |
|
|
Term
| treatmetn of myexedema coma |
|
Definition
maintain BP and respiration
IV thyroxine and hydrocortisone |
|
|
Term
| after treatment for hypothyroidism when do you follow up |
|
Definition
| 6wks, it takes that long for TSH to change |
|
|
Term
| 3 non-toxic goiters and their causes |
|
Definition
endemic: lack of iodine, decreases hormone and increases TSH causing follicle hypertrophy
sporatic: goitrogenic diet (brassica, cabbage, caluiflower, turnips) inhibits hormones
dyshormonogenic: hyreditary enzyme defect preventing hormone production |
|
|
Term
|
Definition
| regions of thyroid become TSH independent and secrete hormone without TSH control causing overall hyperthyroidism, the rest of the thyroid becomes hypofunctional |
|
|
Term
| how to diagnose a thyroid nodule |
|
Definition
hyperthyroid: if hot treat hyperthyroidism, if cold FNA
euthyroid: FNA
hypothyroid: try levothyroxine, if it helps your done, if it doesnt FNA |
|
|
Term
| signs a thyroid nodule is probablly cancer |
|
Definition
head/neck radiation as a child, family history, male, child or elderly, MEN II
solid, non-tender, rapid growth, cold, irregular margins, intranodal vascular pattern, microcalcifications, fixed, solitary, laryngeal nerve paralysis, dysphagia, hoarseness, cervical lymphadenopathy, elevated calcitonin |
|
|
Term
| what is the difference between a follicular thyroid adenoma and carcinoma |
|
Definition
adenoma has a capsule
carcinoma does not have capsule |
|
|
Term
|
Definition
seen in follicular adenoma and carcinoma
lots of cytoplas, tight packed mitochondria, nuclei with prominent nucleoli, radioiodine resistant |
|
|
Term
| what cancers spread hematogenously |
|
Definition
follicular thyroid carcinoma
renal cell carcinoma
hepatocellular carcinoma
choriocarcinoma |
|
|
Term
| signs of papillary thyroid carcinoma |
|
Definition
RET mutation, cuboidal epithelium
20-40yo, radiation to head and neck as child
ground glass, orphan annie nuclei (fine chromatin), psammoma simoma bodies, papillae cuboidal stalk |
|
|
Term
| signs of medullary thyroid carcinoma |
|
Definition
| parafollicular C cell prliferation, cacitonin secretion (NO HYPOCALCEMIA), VIP (diarrhea), serotonin, somatostatin |
|
|
Term
| signs of anaplastic thyroid carcinoma |
|
Definition
| poorly differentiated, seen in elderly with long standing follicular or papillary carcinoma, rock hard thyroid, bulky mass with compression signs |
|
|
Term
| pagets: Ca, P, ALK-P, PTH |
|
Definition
|
|
Term
| osteomalacia: Ca, P, ALK-P, PTH |
|
Definition
Ca low
P low
ALK-P normal
PTH high |
|
|
Term
| renal failure: Ca, P, ALK-P, PTH |
|
Definition
Ca low
P high
ALK-P normal
PTH high |
|
|
Term
| osteoperosis: Ca, P, ALK-P, PTH |
|
Definition
|
|
Term
| osteopetrosis: Ca, P, ALK-P, PTH |
|
Definition
|
|
Term
| primary hyperPTH: Ca, P, ALK-P, PTH |
|
Definition
Ca high
P low
ALK-P high
PTH high |
|
|
Term
| secondary hyperPTH: Ca, P, ALK-P, PTH |
|
Definition
Ca low
P high
ALK-P high
PTH high |
|
|
Term
| primary hypoPTH: Ca, P, ALK-P, PTH |
|
Definition
Ca low
P high
ALK-P normal
PTH low |
|
|
Term
| secondary hypoPTH: Ca, P, ALK-P, PTH |
|
Definition
Ca low
P normal
ALK-P normal
PTH high |
|
|
Term
| pseudohypoparathyroidism: Ca, P, ALK-P, PTH |
|
Definition
Ca low
P high
ALK-P normal
PTH high |
|
|
Term
| signs of hypoparathyroidism |
|
Definition
anxiety, depression, confusion, psychosis, cataracts, prolonged QT, arrhythmia, tachycardia, dental hypoplasia, dry skin, weakness, chosteks, trosseaus, seizure, tetany, numbness, tingling
osteosclerosis, increased bone density |
|
|
Term
| causes of hypoparathyroid |
|
Definition
surgical removal
diGeorge
familial hypoparathyroid: autoimmune polyendocrine syndrome 1
idiopathic |
|
|
Term
| primary hyperparathyroidism causes, signs |
|
Definition
adenoma, hyperplasia, carcinoma
nephrolithiasis, nephrocalcinosis, cholelithiasis, osteofibrosis cystica, pathologic fracture, muscle pain, weakness, PUD, gout, constipation, pancreatitis, depression, sleep disturbance, anxiety, psychosis, decreased memory, stupor coma
HTN, short QT, keratitis, conjunctivitis, puritis
subperosteal bone reabsorption, decreased bone density |
|
|
Term
| treatment of primary hyperparathyroidism |
|
Definition
parathyroidecromy
avoid: thiazides, lithium, prolonged rest, Ca >1000, volume depletion
hydration to avoid renal stones
bisphosphonates, exercise, vitamin D
frequent Ca, CR, bone density monitoring |
|
|
Term
| causes of secondary hyperparathyroidism |
|
Definition
kidney cannot make vitamin D, PTH increases but Ca binds P causing hypocalcemia
vitamin D deficiency |
|
|
Term
| treatment of secondary hyperparathyroidism |
|
Definition
decrease protein
Ca carbonate and Ca acetate bind P in gut
Ca and vitamin D replacement |
|
|
Term
| cause of pseudohypoparathyroidism |
|
Definition
1A: maternal allele of pituitary and kidney mutation (low effect of TSH, GNRH, PTH)
pseudopseudo: paternal allele of all tisue except pitutiary and kidney (low PTH effect) |
|
|
Term
| signs of pseudohypoparathyroidism |
|
Definition
1A: short 4-5th digits, short stature, obesity, MR, seizure
pseudopseudo: skeletal and developmental defects |
|
|
Term
| how is prolactin regulated, what other condition is it associated with |
|
Definition
dopamine decreases it
TRH increases it
thyroid dysfunction causing pituitary increase in TRH will also increase prolactin |
|
|
Term
| paraneoplastic cause of hypercalcemia |
|
Definition
| squamous cell carcinoma of lung |
|
|
Term
|
Definition
| T3 stimulates osteoclast bone reabsorption |
|
|
Term
| when do you do surgery on a hyperprolactinoma |
|
Definition
female with adenoma >3cm that desires to become pregnant
refractory to 2 dopamine agonists
neurological signs |
|
|
Term
| signs of GH releasing tumor |
|
Definition
| enlarged distal bones, arthralgia, nerve entrapment, large tongue, HTN, LVH, deep voice, coarse face, spread teeth, DIABETES |
|
|
Term
| diagnosis of GH excess and lack |
|
Definition
excess: failure to suppress GH after oral glucose load, IGF-1 or somatostatin C elevation
decrease: failure to increase when given insulin |
|
|
Term
| treatment of GH secreting tumors |
|
Definition
lanriotide and octreotide: blocks pituitary response to GNRH
pevisomat: GH receptor antagonist |
|
|
Term
|
Definition
| after removal of adrenal gland, an existing corticotroph tumor rapidly grows and releases ACTH causing hyperpigmentation and mass effect |
|
|
Term
| signs of gondotroph adenoma |
|
Definition
| hypofunction: decreased enegy and libido, amenorrhea, infertility, loss of secondary sex characteristics, mensturation does not occur after medroxyprogesterone |
|
|
Term
|
Definition
| proportional dwarfism, decreased muscle mass, heart disease, increased LDL, growth failure |
|
|
Term
|
Definition
tumor of suprasellar due to rathkes remnent
#1 hypopituitary tumor in kids
causes bitemporal hemianopsia, headache, papilledema, hyperprolactinemia, DI, panhypopituitarism
calcification on MRI |
|
|
Term
|
Definition
| poor lactation, loss of pubic hair, ovarian failure, amenorrhea, weight loss, anorexia |
|
|
Term
|
Definition
central low ADH secretion
nephrogenic: low ADH response
polyuria, polydypsia
isovolemic hypernatremia
central: desmopressin, chlorpromaide
nephrogenic: HCTZ, Na restriction |
|
|
Term
|
Definition
SCC lung, COPD, pneumonia
everything else. |
|
|
Term
|
Definition
brain swelling cause seizure, coma, death, weakness, lethargy
if chronic may be asymptomatic
hyponatremia, concentrated urine
de,eclocycline inhibits ADH effects, water restriction, loop diuretic |
|
|
Term
| conn syndrome: ACTH, ALD, cortisol, high dose dex suppression, low dose dex suppression, renin, Na, K |
|
Definition
ACTH normal
ALD high
cortisol normal
LoDEX not applicable
HiDEX not applicable
renin low
Na high
K low |
|
|
Term
| secondary hyperALD: ACTH, ALD, cortisol, high dose dex suppression, low dose dex suppression, renin, Na, K |
|
Definition
ACTH normal
ALD high
cortisol normal
LoDEX not applicable
HiDEX not applicable
renin high
Na high
K low |
|
|
Term
| addisons disease: ACTH, ALD, cortisol, high dose dex suppression, low dose dex suppression, renin, Na, K |
|
Definition
ACTH high
ALD low
cortiso low
LoDEX not applicable
HiDEX not applicable
renin high
Na low
K high |
|
|
Term
| secondary adrenal insufficiency: ACTH, ALD, cortisol, high dose dex suppression, low dose dex suppression, renin, Na, K |
|
Definition
ACTH low
ALD normal
cortisol low
LoDEX not applicable
HiDEX not applicable
renin normal
Na normal
K normal |
|
|
Term
| tertiary adrenal insufficiency: ACTH, ALD, cortisol, high dose dex suppression, low dose dex suppression, renin, Na, K |
|
Definition
ACTH low
ALD normal
cortisol low
LoDEX not applicable
HiDEX not applicable
renin normal
Na normal
K normal |
|
|
Term
| cushing disease: ACTH, ALD, cortisol, high dose dex suppression, low dose dex suppression, renin, Na, K |
|
Definition
ACTH high
ALD normal
cortisol high
LoDEX no change
HiDEX suppression
renin normal
Na normal
K low |
|
|
Term
| adrenal hyperplasia: ACTH, ALD, cortisol, high dose dex suppression, low dose dex suppression, renin, Na, K |
|
Definition
ACTH low
ALD normal
cortisol high
LoDEX no change
HiDEX no change
renin normal
Na normal
K low |
|
|
Term
| iratogenic cushings: ACTH, ALD, cortisol, high dose dex suppression, low dose dex suppression, renin, Na, K |
|
Definition
ACTH low
ALD normal
cortisol high
LoDEX suppression
HiDEX suppression
renin normal
Na normal
K low |
|
|
Term
| paraneoplastic cushings: ACTH, ALD, cortisol, high dose dex suppression, low dose dex suppression, renin, Na, K |
|
Definition
ACTH high
ALD normal
cortisol high
LoDEX no suppression
HiDEX no suppression
renin normal
Na normal
K low |
|
|
Term
| what are the areas of the adrenal gland and what do they make |
|
Definition
glomerulosa: mineralcorticoids
fascuculate: glucacorticoids
reticularis: androgens
medulla: epi/nor |
|
|
Term
|
Definition
usually silent, if functional causes atrophy of neighboring cortex and opposite adrenal gland due to suppression of ACTH by tumor products
virilizing, associated with li-fraumeni, backwith-weidmann
risk of invasion to adrenal vein, vena cava, lymphatics |
|
|
Term
| paraneoplastic cause of cushing syndrome |
|
Definition
| small cell carcinoma of the lung |
|
|
Term
| signs of cushing syndrome |
|
Definition
| truncal obesity, moon fascies, buffalo hump, acne, abdominal purple striae, laguno hair, osteoperosis, aseptic necrosis of femoral head, DIABETES, MENSTURAL IRREGULARITY, IMPOTENCE, INFERTILITY, cataracts, depression, insomnia, infection |
|
|
Term
| conns syndrome cause, signs |
|
Definition
ALD producing tumor of adrenal gland (primary hyperaldosteronism)
HTN, fatigue, headache, noctural polyuria, parasthesias, polydypsia
saline infusion test does not decrease ALD |
|
|
Term
| treatment of conns syndrome |
|
Definition
spironolactone inhibits ALD if hyperplasia
surgical resection if adenoma |
|
|
Term
| secondary hyperALD cause and tx |
|
Definition
recreased renal perfusion (renal artery stenosis, nephrosclerosis), CHF, cirrhosis, nephrotic syndrome, pregnancy
spironolactone |
|
|
Term
| cause of acute primary adrenal insufficiency |
|
Definition
rapid withdrawal from steroids, stress during chronic disease, massive adrenal hemorrhage
vomiting, abdominal pain, hypotension, vascular collapse, coma |
|
|
Term
| secondary adrenal insufficiency: cause, tx |
|
Definition
| pituitary disease, prednisone |
|
|
Term
| tertiary adrenal insufficiency: cause, tx |
|
Definition
suppression of pituitary axis (withdrawal from chronic steroids)
prednisone |
|
|
Term
| causes of addisons disease |
|
Definition
autoimmune adrenalitis (Ab to 21-hydroxylase, polyendocrine 1 and 2)
TB adrenalitis
metastastic cancer
infection
hematochromatosis
adrenal leukodystrophy
hemorrhage |
|
|
Term
| signs of addisons disease |
|
Definition
| anorexia, nausea, vomiting, decreased memory, depression, HYPOGLYCEMIA, hyperpigmentation, hypotension, hyperkalemia, hyponatremia, EOSINOPHILIA |
|
|
Term
| treatmetn of addisons disease |
|
Definition
prednisone and fludrocortisone
DHEA in women
cortisol supplement in stress |
|
|
Term
| 11b-hydroxylase deficiency: ALD, cortisol, androgens, genitalia, puberty, mensturation, K, Nam BP, marker |
|
Definition
ALD low
cortisol low
androgens high
virilization
early puberty
no amenorrhea
K, Na, BP normal
increased deoxy and androgens |
|
|
Term
| 17a-hydroxylase deficiency: ALD, cortisol, androgens, genitalia, puberty, mensturation, K, Nam BP, marker |
|
Definition
ALD high
cortisol low
androgens low
ambiguous
late puberty
amenorrhea
low K
high Na
HTN
low 17a |
|
|
Term
| 21a-hydroxylase deficiency: ALD, cortisol, androgens, genitalia, puberty, mensturation, K, Nam BP, marker |
|
Definition
ALD high
cortisol low
androgens high
virilization
early puberty
no amenorrhea
K high
Na low
hypotension
high 17-hydroxyprogesterone and androgens |
|
|
Term
|
Definition
| extra-adrenal pheochromocytoma |
|
|
Term
| diagnosis of metabolic syndrome |
|
Definition
minimum 3
waist >40in men >35in women
TG >150
HDL <40
BP >130/85
fasting glucose >100
2h postparandal >140 |
|
|
Term
|
Definition
HbA1C 5.8-6.4
fasting glucose 100-125
2h glucose 140-199 |
|
|
Term
|
Definition
two fasting flucose >126
single glucose >200 with symptoms
HbA1c >6.5
2h glucuse >200 |
|
|
Term
| what is target fasting glucose, HbA1C, post parandial peak in DM |
|
Definition
fasting <130
post parandial <180
HbA1C <7 |
|
|
Term
| what is BP, HDL, and LDL goal in DM |
|
Definition
LDL <100
HDL >40 men >50 women
BP <130/80 |
|
|
Term
| dawn phenomenon cause, signs, tx |
|
Definition
increased nightly GH causes increase in glucose, 3AM and 7AM glucose will be elevated
tx: increases PM basal insulin |
|
|
Term
| somogyi phenemon cause, signs, tx |
|
Definition
overdose of basal PM insulin causes night time hypoglycemia and rebound AM hyperglycemia
3AM glucose shows hypoglycemia
7AM glucose shows hyperglycemia
tx: decrease basal insulin in PM |
|
|
Term
|
Definition
|
|
Term
| signs of diabetic nephropathy |
|
Definition
proteinuria, microalbulinuria, kimmel stril wilson nodules if one area of sclerosis, hayline deposition if diffuse sclerosis
increased BUN/CR |
|
|
Term
|
Definition
proliferative: new vessels, vitreal hemorrhages, retinal detachment
nonproliferative: exudates (cotton wool spots), edema of macula, ischemia, hemorrhages |
|
|
Term
| what is the best predictor of DM retinopathy |
|
Definition
| renal disease (high proteinuria, BUN, CR) |
|
|
Term
| signs of DM autonomic neuropathy |
|
Definition
| postural HTN, impotence, neurogenic bladder, gastroparesis, constipation, diarrhea |
|
|
Term
|
Definition
vomiting, kussmaul respiration, fruity breath, dehydration, polytypsia, polyuria, altered LOC
glucose 400-800, serum and urine ketones, metabolic acidosis with anion gap, hyperkalemia (functional hypokalemia), hypernatremia, hypoP, hypoMg |
|
|
Term
| signs of hyperosmolar hyperglycemia nonketotic syndrome |
|
Definition
polyuria, polydypsia, polyphagia, seizure, tachycardia, hypotension, confusion, lethargy, change in mental status, stroke
glucose >900, alkalosis, high BUN |
|
|
Term
| treatment of hyperosmolar hyperglycemia nonketotic syndrome |
|
Definition
1L NS over 1h then 1L NS over 2h
1/2 NS once stable
when glucose reaches 250 add 5% glucose
give normal levels insulin entire time |
|
|
Term
|
Definition
| reactive, iratogenic (sulfonyurea, insulin), insulinoma, fasting, alcohol, pituitary or adrenal insufficiency, liver failure, glycogen storage disease |
|
|
Term
|
Definition
diaphoresis, palpitations, tremor, HTN anxiety, weakness, headache, visual disturbance, confusion, seizure, mood instability,
becomes hypoglycemic on 72h fast but still has high insulin, elevated insulin and C-peptide
diazoxide stops insulin release, octreotide can help, resect |
|
|
Term
|
Definition
necrotizing migratory erythema expholating rash below waist (hyperpigment after healing)
glossitis, stomatitis, chelitis
abdominal pain, weight loss, anemia, hyperglycemia, LOW AA, INCREASED GLUCAGON, INCREASED GLUCOSE, DM refractory to treatment |
|
|
Term
|
Definition
| DM, diarrhea, steatorrhea, cholelithiasis, hypochloridia, weight loss, increased somatostatin |
|
|
Term
|
Definition
B islet cell tumor
watery diarrhea, hypokalemia, acidosis, nausea, vomiting, anchloridia |
|
|
Term
|
Definition
primary hyperparathyroidism
zollinger ellison
insulinoma
pituitary cushings
prolactinoma
GH pituitary tumor |
|
|
Term
|
Definition
ASSOCIATED WITH RET
medullary thyroid carcinoma
pheochromocytoma
primary hyperparathyroid |
|
|
Term
|
Definition
mucosal neuroma
medullary thyroid carcinoma
marfanoid
pheochromacytoma |
|
|
Term
| what is the best way to test for graves |
|
Definition
|
|
