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Endocrine
Endocrine for the boards
60
Medical
Post-Graduate
07/06/2010

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Term
Initial basal insulin dose
Definition
0.2-0.3 U/kg/d
Term
Initial prandial insulin dose
Definition
0.05-0.1 U/kg/meal
Term
Insulin rate in DKA
Definition
Bolus of 0.15 U/kg, drip at 0.1 U/kg/h with goal of glucose drop of 50-100/h
Term
Insulin in HHONK
Definition
ONly after volume replacement. 0.1 U/kg bolus and drip at 0/1 U/kg/h. D/c drip and change to SQ at glucose of 200
Term
BP control in DM
Definition
<130/80, Type 1 with proteinuria,start with an ACE. Type 2 with microalbuminuria (30-300), use an ACE or ARB, or if macroalbuminuria (>300) use an ARB.
Term
Pituitary tumor apoplexy is...
Definition
hemorrhagic infacts, characterized by sudden HA, stiff neck, fever, ophthalmoplegia (sometimes) and hypopituitarism
Term
Sheehan syndrome
Definition
silent pituitary infarct, assoc. with obstetric hemorrhage and hypotension. Presents with amenorrhe, no post-partum lactation, fatigue 2/2 central hypothyroidism or secondary adrenal insufficiency.
Term
Lymphocytic hypophysitis
Definition
Destructive lymphocytic infiltration, causing hypopituitarism and symptoms of a mass lesion. Associated with ACTH and adrenal insufficiency. Occurs after pregnancy.
Term
Synthroid replacement in hypopituitarism
Definition
Adjust by measuring free T4 levels
Term
ACTH replacement in hypopituitarism
Definition
hydrcortisone or prednisone BID, adjust clinically.
Term
LH / FSH replacement in hypopituitarism
Definition
Men testosterone gel or patch daily, IM 1-3 weeks, adjust with testosterone levels. Need LH/FSH/GnRH injection for spermatogenesis.

Women estrogen, progesterone or OCPs / patches. Need LH/FSH injection for ovulation / in vitro.
Term
GH replacement in hypopituitarism
Definition
SQ based on IGF-1 levels
Term
Vasopressin in hypopituitarism
Definition
Desmopressin, nasal spray, tablets, IM, SC, IV
Term
GH deficiency
Definition
Increased fat, decreased muscle and bone density, decreased strength, endurance and well being. Test is GH stimulation test.
Term
Pure mineralocorticoids
Definition
Aldosterone, fludricortisone (used for replacement)
Term
Mostly glucocorticoids
Definition
Prednisone, dexamethasone, betamethasone, triamcinolone
Term
Equal mineralo- and glucocorticoid
Definition
Hydrocortisone - used for replacement in adrenal insufficiency
Term
Low free T4 without elevated TSH
Definition
Central hypothyroidism. Adjust T4 to clinical s/s - TSH is unreliable.
Term
Surgery is primarily indicated for all pituitary tumors except...
Definition
Prolactinoma
Term
Hyperprolactinemia causes
Definition
Non-prolactinoma serum PRL <150 - from dopamine interference from antipsychotics, verapamil, reglan, pregnancy, hypothyroidism, renal dz, hypothalamic dz.

Multiple mass lesions from pituitary stalk effects, PRLoma, other masses.

All must be evaluated with CT or MRI.
Term
Hyperprolactinemia symptoms and tx
Definition
Galactorrhea, oligomenorrhea, amenorrhea, EC, decreased libido, infertility, osteopenia.

Tx with dopamine agonist - cabergoline or bromocriptin. Taper to off. If poorly responsive, transsphenoidal surgery or gamma knife.
Term
Testing for GH
Definition
IGF-1 levels are best test.

Inverse relationship with glucose. Insulin suppression should raise it in hypoGH and glucose administration should suppress it.
Term
GH adenoma treatment
Definition
Octreotide and lanreotide work in 60% of patients but only modestly reduce tumors.
Term
DI testing
Definition
water deprivation test. Inability to concentrate urine with desmopressin administration indicated central DI.
Term
Pregnant women and prolactinomas, acromegaly, cushing dz
Definition
D/c dopamine agonists, somatostatin analogues. Keep synthroid. Cushing disease has high risk of prematurity and stillbirth - surgery to correct if not near term.
Term
T3 is checked to evaluate
Definition
Thyrotoxicosis, where T3 > t4
Term
Thyroglobulin levels are elevated in
Definition
hyprtthyroid and destructive thyroiditis
Term
Use of TSH, TSI or Thyrotropin stimulating IgG anitibodies
Definition
Rarely used - euthyroid Graves ophthalmopathy, Graves in pregnancy, atyipcal hypo/hyper thyroid dz.
Term
Free or total T3 level when...
Definition
Suppressed TSH with normal T4
Term
Hyperthyroid treatment in pregnancy
Definition
PTU. Methimazole has negative effects on embryogenesis.
Term
Cosyntropin stim test
Definition
Tests adrenal insufficiency. Normal persons increase serum cortisol to 18.5 one hour after receiving 250 ng of cosyntropin. Use 1 ng for those suspected to have partial deficiency.
Term
Medications to treat Cushings syndrome
Definition
Ketoconazole, metyrapone (cortisol inhibition), mifepristone (steroid effect inhibition) mitotane (toxic to adrenal cells)
Term
MRI indications of malignant adrenal lesions
Definition
> 6 cm, high CT attenuation (mets >20 HU), irregular borders (primary), necrosis (primary), vascular and hyperintense.
Term
Removal of adrenal tumors
Definition
All functioning tumors, all > 6 cm, and some 4-6cm.
Term
Pheo testing
Definition
Clonidine 0.3 mg suppression test - norepi < 500 is negative for pheo. Urine is specific.
Term
Pheo tx
Definition
Surgery. Pre-treat with Alpha-blockers, THEN BB / CCB.
Term
Diagnosing primary aldosteronism
Definition
Clinically - HTN, hypokalemia, metabolic alkalosis.

Tests - aldosterone : renin ratio > 20 is positive ( > 10 if on ACE / ARB ). Salt loading test (PO or IV) is confrimation.
Term
In hyperaldosteronism, surgery is indicated for...
Definition
solitary nodule. B/l adrenal hyperplasia is treated with spironolactone or eplerenone.
Term
Progestin challenge in amenorrhea
Definition
bleeding means normal estrogen and outflow tract, no bleeding means low estrogen and / or anatomic defect.
Term
Diagnosing Cushings
Definition
Dexamethasone suppression test, PM salivary cortisol, 24-cortisol
Term
Dexamathasone suppression test
Definition
Give 1mg dexamathasone. Measure next AM cortisol - < 2 is normal, > 5 is Cushing, 2-5 needs salivary or free cortisol measurements.

Can also suppress with 0.5 q6 x 48h.
Term
PCOS Criteria
Definition
ovulatory dysfunction, evidence of hyperandrogenism, US of polycystic ovaries (2 of 3). DOes not cause virilazation or cushingoid. Test total serum testosterone.
Term
PCOS tx
Definition
Spironolactone + prgestin OCP, metformin, clomiphine (for live births)
Term
Types of destructive thyroiditis
Definition
subacute (deQuervain), postpartum, silent / painless. Tx with BB and steroids, then synthroid if neeed
Term
Medicine for Graves Dz
Definition
Methimazole, except 1st trimester. Then PTU (LFT abnormalities).
Term
Amiodarone induced thyrotoxicosis
Definition
Type 1 - iodine induced (iodine deficient, meth / PTU tx) and Type 2 - destructive (prednisone tx)
Term
Anti-TPO ab
Definition
Hashimotos thyroiditis
Term
TSH goal with synthroid replacement tx
Definition
1-2.5
Term
Thyroid US findings in malignancy
Definition
Microcalcifications, incr central vasc, hypoechogenic, irregular border, taller
Term
Thyroid US findings for benign mass
Definition
comet tail, inc peripheral vasculature, hyperechoic, halo, cystic
Term
Management of follicular thyroid neoplasm
Definition
remove nodule - cannot distinguish malignant vs benign except on histology
Term
When to biopsy a thyroid nodule
Definition
> 1 cm, risk factors, US characteristics. Must biopsy > 3cm multiple times to reduce sample error.
Term
Anti actetlycholine receptor
Definition
Myesthenia gravis
Term
Klinefelter syndrome
Definition
46, xxy. Assoc with primary hypogonadism. Infertile.
Term
Lab tests in amenorrhea
Definition
FSH (ovarial failure if > 35), PRL, TSH, Free T4.
Term
Prolactin effects...
Definition
suppressed FSH, GnRH
Term
Serum testosterone levels
Definition
> 350 ng/dL - normal
200- 350 additional testing for level of free / bioavailable testosterone level required
< 200 - hypogonadism
Term
PSA in testosterone replacement
Definition
Get baseline, if doubles or is >4 or continues to increase after 6 months, stop therapy and start urology w/u
Term
Treat male infertility with...
Definition
GnRH or HCG, with FSH added for lack of spontaneous puberty
Term
DDx in secondary amenorrhea
Definition
PCOS, Ashermans (endometrial scarring), hyperprolactinemia, mosaic Turner, autoimmune oopharitis, hypothalmic, stress, pregnancy, hyperprolactin, Cushing.
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