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Endocrinology
N/A
95
Medical
Graduate
07/08/2012

Additional Medical Flashcards

 


 

Cards

Term
Hyperparathyroidism
Definition
  • women >50yo
  • causes: parathyroid adenoma (80%), hyperplasia, carcinoma
  • multiglandular disease and carcinoma more common in persons younger than 30yo
Term
clinical features of hyperparathyroidism
Definition
  • hypercalcemia
  • polydispsia and poluria from hypercalcemia-induced nephrogenic diabetes insipidus
  • nephrocalcinosis adn renal failure from excessive calcium and phosphate excretion
  • bone pain and arthrlagias-cortical bone or diffuse bone demineralization, trabecular bone increase, pathologic bone fractures, cystic bone lesions (jaw most common)
Term
severe hypercalcemia sx
Definition
  • thirst
  • anorexia
  • N/V
  • abdominal pain
  • constipation
  • fatigue
  • anemia
  • weight loss
  • PUD
  • pancreatitis
  • HTN
  • depressed DTRs
  • depression
  • muscle weakness
  • nephrolithiasis
  • cataracts
Term
osteitis fibrosa cystica
Definition
abnormal bony remodeling evident on hand x-rays---subperiostial reabsorption of phalynx tufts
Term
chondrocalcinosis
Definition
pseudogout
Term
S&S of hyperparathyroidism
Definition
"bones, stones, abdominal groans, psychotic moans, with fatigue overtones"
Term
secondary hyperparathyroidism
Definition
  • acute renal failure
  • malignant tumors (breast, lung, pancreas, uterus)
  • multiple myeloma (older persons)
  • granulomatous disorders
  • calcium or vitamin D ingestion
  • familial hypocalciuric hypercalcemia
  • adrenal insufficiency
  • hyperthyroidism
  • certain medications--lithium
  • prolonged bed rest
Term
familial hypocalciuric hypercalcemia
Definition
  • inappropriately high iPTH despite high serum calcium; low urinary calcium; hereditary
  • about 15% of Asian and Native American men with thyrotoxicosis may develop this
  • lasts 7-72 hours
  • often after IV dextrose, oral carbohydrate, or vigorous exercise
Term
primary hyperparathyroidism work-up
Definition
  • parathyroid radionucleotide scan
  • hydration status is important
  • bisphosphonates useful once hydration status normal
  • post-op vit D, calcium +/- magnesium replacement after surgery
Term
secondary hyperparathyroidism pharm tools
Definition
  • phosphate binders
  • vitamin D analogs
  • calcimimetics (cinacalcet = sensipar)
Term
hallmark finding of hypercalcemia
Definition

Ca2+ >10.5mg/dL

serum phosphate often less than 2.5mg/dL

Term
elevated PTH
Definition
confirms diagnosis
Term
EKG findings of hyperparathyroidism
Definition
  • prolonged PR interval
  • shortened QT interval
  • bradyarrhythmias
  • heart block
  • asystole
Term
tx hyperparathyroidism
Definition
  • surgery-hypocalcemia is complication
  • hydration
  • bisphosphonates
  • avoid large doses vitamin A and D, thiazide diuretics
Term
hypoparathyroidism causes
Definition
  • most commonly found after thyroidectomy
  • heavy metal toxicity
  • granulomas
  • Reidel's thyroiditis
  • tumors
  • infection
  • autoimmune problems
  • neck irradiation
  • alkalosis
  • hyperkalemia
  • vitamin D deficiency
Term
functional hypoparathyroidism disease may occur in the presence of what?
Definition
magnesium deficiency
Term
pseudohypoparathyroidism
Definition
results from a group of diseases characterized by hypocalcemia causes by renal resistance to parathyroid hormone
Term
DiGeorge Syndrome
Definition
  • hypoparathyroidism
  • congenital facial and cardiac anomalies
Term
acute clinical features of hypoparathyroidism
Definition
  • PERIORAL NUMBNESS
  • tetany
  • carpopedal spasm
  • cramping
  • convulsions
  • circumoral and distal ext tingling
  • irritability
  • muscle cramps
  • fatigue
Term
positive Chvostek's sign
Definition
facial muscle contraction after trapping the facial nerve-tap masseter and jaw clenches
Term
Trousseau's sign
Definition
carpal spasm with blood pressure cuff inflation--fist clenches
Term
chronic clinical features of hypoparathyroidism
Definition
  • dry skin
  • psoriasis, dermatits
  • brittle nails
  • coarse hair
  • ectopic calcification in cornea--cataracts
  • teeth defects
Term
hypoparathyroidism labs
Definition
  • corrected serum calcium, urinary calcium, PTH levels low
  • serum magnesium low
  • serum phosphate high
  • alk phos normal
  • CT skull-basal ganglia calcifications
Term
EKG changes of hypoparathyroidism
Definition
  • prolonged QT intervals

T-wave abnormalities

Term
tx hypoparathyroidism
Definition
  • emergency = airway maintenance and slow admin IV calcium gluconate
  • calcium 1-2 g/day), vitamin D preparations, calcitril
  • magnesium supplementation
Term
most common cause of hyperthyroidism
Definition
Grave's Disease
Term
Grave's Disease
Definition
  • autimimmune disorder in which autoantibodies attack to the TSH receptors and stimulate thyroid hyperfunctioning--anti-TSH antibodies
  • women 20-40
  • familial tendency- HLA-B8 and HLA-DR3
  • also found in pernicious anemia, myasthenia gravis, DM
  • at increased risk for Addison's disease, alopecia areata, celiac disease, cardiomyopathy, hypokalemic periodic paralysis
  • eye disease, clubbing, vitiligo, goiter, loss of color vision
Term
causes of hyperthyroidism
Definition
  • grave's disease
  • toxic nodular goiter
  • thyroiditis
  • amiodarone
  • subacute thyroiditis-De Quervain's
  • postpartum thyroiditis
  • iodine excess
  • TSHoma
  • exogenous intake thyroxine
Term
S&S of hyperthyroidism
Definition
  • weight loss despite good appetite
  • failure to thrive in infants
  • heat intolerance
  • sweating
  • palpitations
  • agitation
  • emotional lability
  • poor concentration/memory
  • diarrhea
  • pruritis
  • muscle weakness
  • oliigomenorrhea
  • fine tremor
  • goiter
  • tachycardia
  • bounding pule/wide pulse pressure
  • a-fib
  • high-output cardiac failure
  • lid retraction
  • gynecomastia
  • muscle wasting
  • warm, moist skin
  • fine hair
  • stare
  • hyperreflexia
Term
labs for hyperthyroidism
Definition
  • low TSH
  • increased T3, T4, free T4
  • high TSH receptor antibody
  • high antithyroglublin antibody
  • high antithyroperoxidase antibody

 

Term
tx hyperthyroidism
Definition
  • BB
  • methimazole or PTU
  • PTU if pregnant or breasfeeding
  • RAI-radioactive iodine ablation preferred surgery for permanent control-CI in pregnancy
  • ophthalmology responds to steroids
Term
tx graves disease
Definition
  • methimazole if not pregnant
  • PTU if pregnancy
  • propranolol for sx control
Term
thyroid storm
Definition
  • abrupt onset of more florid sx of thyrotoxicosis
  • follows stressful illness, thyroid surgery, radioactive iodine administration

 

Term
sx thyroid storm
Definition
  • high fever
  • tachycardia
  • vomiting
  • diarrhea
  • dehydration
  • marked weakness
  • muscle wasting
  • extreme restlessness
  • confusion
  • delirium
  • emotional lability
Term
thyroid storm mortality rate
Definition
rare, but high
Term
toxic nodular goiter
Definition
  • automonous adenoma with thyrotoxicosis
  • tx = methimazole or PTU (same as graves)
Term
acute and subacute painful thyroiditis
Definition
  • tx sx with corticosteroids and NSAIDs
  • ***ANY HYPERTHYROID STATE WARRANTS RADIOIODINE UPTAKE AND SCAN!!!***
Term
high uptake
Definition
  • graves disease
  • toxic multinodular goiter
  • autonomous thyroid nodules
  • TSHoma
Term
low uptake
Definition
  • thyroiditis
  • severe iodine excess
  • amiodarone-induced thyrotoxicosis type 2
Term
hypothyroidism etiology
Definition

*ALMOST ALWAYS RESULTS FROM AUTOIMMUNE THYROIDITIS, PREVIOUS THYROID SURGERY, OR RADIATION THERAPY

  • Hashimotos thyroiditis- autoimmune destruction
  • radioiodine
  • thyroid surgery
  • antithyroid drugs, amiodarone, lithium
  • infiltrative disease (amyloidosis, sarcoidosis)
  • dysgenesis (congenital)
  • thyroid hormone resistance (acquired-autoimmune)
  • iodine deficiency or excess
Term
S&S of hypothyroidism
Definition
  • fatigue
  • lethargy
  • anorexia
  • constipation
  • depression
  • menstrual abnormalities
  • muscle stiffness
  • memory impairment
  • cold intolerance
  • dry dkin
  • peripheral edema
  • weight gain
  • thinning hair
  • weakness
  • hypotension
  • bradycardia
  • hyporeflexia
  • dementia
  • psychosis
Term
labs for hypothyroidism
Definition
  • elevated TSH
  • low total T4 and free T4
  • T3 might be normal
  • presence of antithyroid peroxidase and antithyroglobulin antibodies in serum confirms autoimmune disease
  • treatment with synthetic T4 is best monitored by serum TSH levels
Term
Hashimotos Thyroiditis
Definition
  • most common thyroid disorder in the US
  • may be a/w other autoimmune or polyglandular syndromes
Term
incidence of Hashimotos
Definition
  • affects 1% of pop
  • affects 5% over age 65
  • tends to be familial
  • more common in women and pts with hepatitis C
  • frequency increases with excess dietary iodine supplementation and exposure to head and neck radiation during childhood
  • certain drugs, such as amiodarone, interleukins, and interferon are also a/w thyroiditis
Term
clinical features of Hashimotos
Definition
  • thyroid is enlarged, firm, finely modular
  • changes may be asymmetric
  • S&S are usually of hypothyroidism (more likely in smokers), but transient thyrotoxicosis can occur
  • usually not painful, although neck tightness occurs
  • depression and chronic fatigue are common and may persist after treatment
  • in the elderly, the gland is atrophic and fibrotic
Term
Hashimotos may be a/w...
Definition
  • xerostomia
  • keratoconjunctivitis
  • mild myasthenia gravis
  • IBD
  • celiac disease
Term
Labs for Hashimotos
Definition
  • antithyroid perioxidase and antithyroglobulin antibodies
  • increase in T4 greater than T3
  • suppressed TSH levels
Term
Imaging for Hashimotos
Definition
  • ultrasonography helps distinguish thyroiditis from goiter or nodules and helps guide fine needle biopsies of suspicious nodules
  • color flow doppler is used to distinguish thyroiditis from graves disease
  • radioactive iodine uptake
Term
treatment of Hashimotos
Definition
lifelong replacement with thyroid hormone for hypothyroidism or large goiter, with watchful waiting in others
Term
subacute thyroiditis
Definition
  • granulomatous
  • de Quervain's
  • giant cell
Term
subacute thyroiditis
Definition
  • most common in young or middle-aged children
  • viral cause is suspected
  • incidence peaks in summer

 

Term
presentation of subacute thyroiditis
Definition
  • acute, painful glandular enlargement with dysphagia, low-grade fever, fatigue, malaise
  • radiation of pain to ears common
  • most common in young and middle-aged women
  • patients may have thyrotoxicosis followed by hypothyroidism
  • manifestations last from weeks to months
  • usually resolve in 12 months
Term
treatment of subacute thyroiditis
Definition
  • aspirin
  • symptomatic
Term
postpartum thyroiditis
Definition
  • occurs soon after partuition
  • usually resolves completely
  • painless, self-limiting
  • manifests with hyperthyroidism 1-6 months after delivery
  • lasts for 1-2 months
  • may not require therapy
  • propranolol is used for cardiac sx
Term

suppurative (infectious) thyroiditis

Reidel's (invasive fibrous, woody, ligneous) thyroiditis

Definition
  • rare
  • fever, pain, redness, and fluccuant neck mass common
  • a/w with bacterial, parasitic, fungal causes
  • tx is abx and surgical drainage
Term
cretinism
Definition
  • congenital hypothyroidism
  • usually asymptomatic at birth-transplacental cross of maternal thyroxine
  • neonatal jaundice, feeding difficulties, choking spells, sluggishness, macroglossia, decreased crying, umbilical hernias, constipation, hypothermia, bradycardia occur first
  • failure to thrive and myxedema, hair and skin coarsening occur later, along with decreased muscle tone
Term
tx of cretinism
Definition
  • thyroxine
  • check TSH 6 weeks from initiating, then at least every 6 months
  • keep TSH below 2.0 for best long-term outcome
Term
myxedema coma
Definition
    • untreated/undertreated hypothyroidism
    • occurs in elderly, often worsened by medication or infection
    • char by AMS, hypothermia, respiratory depression, CHF, hypoglycemia, hyponatremia
    • tx = IV levothyroxine +/- leothyronine (T3)
 
Term
myxedema coma labs
Definition
  • elevated TSH
  • fT4 and/or T3 and TSH low
  • CBC-normocytic anemia
  • electrolytes-low sodium
  • liver-elevated transaminases
  • cortisol, B12- co-autoimmune diease
  • EKG- occult heart disease
Term
most common form of thyroid cancer
Definition

papillary carcinoma (80%)-least aggressive

 

  • others = follicular, medullary, anaplastic-most aggressive, lymphoma/metastatic disease
  • all a/e genetic mutations and translocations
Term
thyroid cancer incidence
Definition
  • women 3x more than men
  • increases with age

 

Term
presentataion of thyroid cancer
Definition
single thyroid nodule; only 5% of all palpable thyroid nodules are malignant
Term
risk factors of thyroid cancer
Definition
  • childhood neck or head irradiation
  • exposure to radioactive isotopes of iodine
  • peak 20-25 years later
  • a/w MED 2
Term
clinical features of thyroid cancer
Definition
  • painless neck swelling
  • single, palpable, nontender, firm nodule
  • hoarseness
  • neck discomfort
  • dysphagia
  • nodule may enlarge over short period of time
  • may have evidence of mets, including thyrotoxicosis
  • gland often stony and hard
Term
clinical features of medullary carcinoma
Definition
  • flushing
  • diarrhea
  • fatigue
  • Cushing's syndrome
Term
clinical features of anaplastic carcinoma
Definition
  • signs of pressure or invasion
  • recurrent laryngeal nerve palsy (hoarseness)
Term
lab studies for thyroid cancer
Definition
  • thyroid function tests often normal
  • TSH
  • elevated serum thyroglobulin in metastatic papillary and follicular cancers
  • FINE-NEEDLE BIOPSY ESSENTIAL
  • medullary tumors have high serum calcitonin and CEA
  • hot nodules on radionucleotide scanning usually benign
  • ultrasound of neck useful for size, location, local mets
  • others = radioisotope scanning, CXR, MRI, CT, PET
Term
treatment of thyroid cancer
Definition
  • surgical resection and near-total thyroidectomy
  • followed by radiation
  • monitor for post-op hypocalcemia
  • radioactive iodine ablation for residual disease
  • mets to bone tx with external radiation
  • mets to brain tx with gamma knife radiation therapy
Term
Addison's Disease
Definition
  • chronic adrenocortical insufficiency
  • most common cause = autoimmune destruction of adrenal cortex (80%)
  • tuberculosis is leading cause in areas of prevalence
Term
adrenal crisis
Definition

may be precipitated by:

  • infection
  • trauma
  • surgery
  • stress
  • lymphoma
  • metastatic cancer
  • amyloidosis
  • scleroderma
  • hemochromatosis
  • cessation of corticosteroid medication
Term
clinical features of addisons
Definition
  • fatigue and weakness
  • anorexia and weight loss
  • irritability/anxiety
  • myalgias and arthralgias
  • may GI sx
  • amenorrhea common in females
  • sensory hypersensitivities
  • salt craving
  • orthostatic hypotension-SBP <110
  • delayed DTRs
  • hyperpigmentation in primary disease (elevated ACTH)-most marked in skin creases, pressure areas, nipple areas
  • other findings = small heart, hyperplasia of lymphoid tissue, scant axillary and pubic hair, hypogonadism

 

Term
Addisonian crisis
Definition
  • hypotension
  • acute pain (abdomen, low back)
  • vomitting
  • diarrhea
  • dehydration
  • hypotension
  • AMS
  • if untreated, can be fatal
Term
labs for Addisons
Definition
  • hyperkalemia
  • hyponatremia
  • hypoglycemia
  • hypercalcemia
  • low BUN
  • eosinophilia
  • neutropenia
  • mild anemia
  • relative lymphocytosis

 

Term
diagnosis of addisons
Definition
  • low 8am plasma cortisol (<3)
  • elevated ACTH (>200)
  • simplified cosyntropin stimulation test- serum cortison rise >20 is normal, anything less is suspicious
  • antiadrenal antibodies in 50%
  • antithyroid antibodies in 45%
  • serum DHEA <1000- a level higher excludes addisons
Term
treatment of addisons
Definition
  • oral hydrocortisone or prednisone
  • many also require fludricortisone acetate for its sodium-retaining effect
  • DHEA given to women with adrenal insufficiency
Term
treatment addisonian crisis
Definition
  • requires IV saline, glucose, glucocorticoids
  • treat underlying cause
Term
Cushing's Syndrome
Definition
  • hypercortisolism
  • may me exogenous or endogenous
  • exogenous form = chronic excess glucocorticoid, most commonly from corticosteroid drugs used to tx other dz
Term
cause of cushings
Definition
  • excess secretion of ACTH by pituitary
  • often results in small, benign pituitary adenoma
  • Cushing's disease = major cause of endogenous Cushing's syndrome
  • most common in premenopausal women
  • adrenocortical tumors
  • nonpituitary ACTH-producing tumors (small cell lung carcinoma)

 

Term
clinical features of Cushing's syndrome
Definition

hypercortisolism

  • obesity-centripetal, extremities appear wasted
  • fat deposition- buffalo hump, mood facies, supraclavicular pads
  • hypertension
  • thirst
  • polyuria with or without glucosuria
  • proximal muscle weakness
  • pigmented striae >1cm wide
  • may present with backache, headache
  • oligomenorrhea or amenorrhea and ED common
  • disorders of calcium- osteoporosis, vertebral fx, hypercalciuria, kidney stones, AVN
  • impaired wound healing, acne, easy bruisability, superficial skin infections
  • emotional lability to psychosis
Term
diagnosis of cushings syndrome
Definition
  • excretion of free cortisol in urine >125 in 24 hours
  • >95 mcg of cortisol per gram of creatinine
  • low dose dexamethasone suppression test
  • MRI identifies primary tumors
Term
treatment of cushings syndrome
Definition
  • transsphenoidal resection of pituitary adenoma
  • hydrocortisol replacement
  • surgical removal is TOC for cushings syndrome
  • adrenal inhibitors = metyrapone and/or ketoconazole may suppress hypercortisolism; parenteral octreotide suppresses ACTH
Term
acromegaly or gigantism
Definition
  • almost always caused by pituitary adenoma
  • involves excessive growth hormone
  • usually sporadic, but may be familial
  • a/w MEN 1
Term
clinical features of acromegaly
Definition
  • excessive growth of hands, feet, jaw, internal organs
  • gigantism = disease before closure of epiphyses
  • doughy, moist handshake
  • macroglossia
  • capral tunnel syndrome
  • deep, coarse voice
  • OSA
  • goiter
  • HTN and cardiomegaly
  • weight gain and insulin resistance
  • arthralgias and arthritis
  • colon polyps
  • hyperhydrosis
  • cystic acne
  • acanthosis nigricans
  • headaches
  • spinal stenosis
  • temporal hemianopsia
  • decreased libido
  • ED
  • menstrual abnormalities
Term
labs for acromegaly
Definition
  • serum prolactin, ILGF-1, glucose, liver enzymes, BUN, TSH, free T4, inorganic phosphorus, calcium measured after an overnight fast
  • serum GH measured 1 hour after glucose syrup ingestion
  • MRI superior to CT for pituitary adenomas- enlarged sella turcica, thickened skull, tufting of terminal phalanges, and thickening of heel pad
Term
treatment for acromegaly
Definition
  • endoscopic transnasal transsphenoidal pituitary microsurgery to remove ademona
  • dopamine agonists if fail surgery
  • somatostatin analongs for persistent disease
  • pegvisomant, growth hormone antagonist, provides sx relief and normalized ILGF-1 in 90%
  • stereotactic radiosurgery for tx failure
Term
dwarfism
Definition
  • the prototype chondroplasia is achondroplasia- the most common nolethal type
Term
clinical features of achondroplastic dwarfs
Definition
  • short limbs
  • long, narrow trunks
  • large heads with midface hypoplasia
  • prominent brows
  • intelligence is normal
  • neurologic complications, bowing of legs, obesity, dental problems, frequent OM
Term
dwarfism facts
Definition
  • substantial reduction in height in T1DM children
  • although not apparent at birth, pituitary dwarfism may present in male infants with hypoglycemia and micropenis
  • children with constitutional growth delay are small, but otherwise normal appearance
Term
labs for achondroplasia
Definition
mutations of FGFR3 gene
Term
treatment of dwarfism
Definition
  • surgical correction of orthopedic problems indicated in achondroplasia
  • use of human GH controversial
Term
diabetes insipidus
Definition
  • uncommon
  • caused by deficiency of or resistance to vasopressin(ADH)
  • secondary Di due to hypothalamic or pituitary pathology- tumor, anoxic encephalopathy, surgery, accidental trauma, infection, sarcoidosis, multifocal Langerhans cell granulomatosis, or metastatic disease
  • vasopressinase-induced DI in late pregnancy and puerperium
  • nephrogenic DI in presence of normal secretion of vasopressin with inappropriate response by kidney
Term
clinical features of DI
Definition
  • intense thirst with fluid intake of 2-20L/day
  • craving for ice water
  • large volume polyuria
  • hypernatremia and dehydration
Term
labs for DI
Definition

no single lab test can diagnose DI

  • glucose
  • BUN
  • calcium
  • uric acid
  • potassium
  • sodium

24 urine collecction

low SG less than 1.006

Term
treatment of DI
Definition
  • desmopressin acetate = TOC for central DI
  • mild cases require no tx- except adequate hydration
  • central and nephrogenic DI respond partially to HCTZ with potassium
  • nephrogenic DI may respond to indomethacin, either alone or in combo with HCTZ, desmopressin, or ameloride
Term
osteomalacia radiography
Definition
  • Milkman lines or Looser zones (pseudofractures) diagnostic
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