Term
| How many parathyroid glans are typical in a person and where are they found? |
|
Definition
| 4 +/- 1 and they are found posterior to the thyroid gland |
|
|
Term
| What is the function of the parathyroid glands? |
|
Definition
| to maintain extracellular Calcium concentrations by secretion of PTH-- secretion of PTH is directly related to the plasma concentration of ionized calcium |
|
|
Term
| Does PTH increase or decrease serum calcium levels? |
|
Definition
|
|
Term
| What are the three ways in which PTH increases serum calcium? |
|
Definition
1. increasing the release of Ca and Phosphate from the bone matrix
2. increasing Ca reabsorption by the kidneys
3. Increasing renal production of 1,25-dihydroxyvitamin D3 (calcitriol) which increases intestinal absorption of Ca |
|
|
Term
| in hyperparathyroidism, we see increased or decreased levels of Ca and Phosphorous? |
|
Definition
increased Ca
decreased Phosphorous due to a PTH induced phosphaturia |
|
|
Term
| What is the MC cause of a primary hyperparathyroidism? |
|
Definition
| ademona 80%> hyperplasia> carcinoma |
|
|
Term
| What familial disorder is known to be a cause of hyperparathyroidism? |
|
Definition
|
|
Term
| What is the common saying that correlates with the s/sx of hyperparathyroidism? Name the s/sx |
|
Definition
-bones, stones, abdominal groans, psychic moans, and fatigue overtones
-bone pain and arthralgias, renal stones, N/V and abd pain and constipation, depression and disorientation, fatigue and depressed DTRs |
|
|
Term
| a serum calcium level of what is considered suspicious for hyperPTH |
|
Definition
|
|
Term
| What may be seen on an xray of the hands in a pt with hyperPTH |
|
Definition
| osteitis fibrosa cystica aka "brown tumors" |
|
|
Term
| What is the chloride/phosphorous ratio rule of hyperPTH |
|
Definition
| > 33 to 1. This is because there is an increase in chloride secondary to renal bicarb wasting (which is a direct effect of PTH), and because P is low due to a phosphaturia (direct effect of PTH) |
|
|
Term
| What are some findings on EKG of a pt with hyperPTH? in terms of PR, QT, and rate? |
|
Definition
prolonged PR
short QT
bradycardia-->heart block---> asystole |
|
|
Term
| Why should thiazide diuretics be avoided in a pt with hyperparathyroidism? |
|
Definition
| bc they work on the distal renal tubule where Ca is reabsorbed, which causes a decrease in Ca in the blood which will exacerbate the problem |
|
|
Term
| What are two causes of secondary hyperparathyroidism? |
|
Definition
chronic kidney disease
Vit D deficiency |
|
|
Term
| What is another cause of bone destruction besides hyperPTH that would cause increased Ca? How can you differentiate? |
|
Definition
metastatic disease to the bone
measure levels of PTH! |
|
|
Term
| What is the most common tx for symptomatic hyperPTH |
|
Definition
| surgical excision of the parathyroid glands |
|
|
Term
| What is the most common cause of primary hypoPTH |
|
Definition
|
|
Term
| What is pseudohypoparathyroidism? what are the lab values associated with it? |
|
Definition
can be due to a number of diseases characterized by hypocalcemia caused by renal resistance to PTH
-labs: high PTH, low Ca, High P, low urine cAMP |
|
|
Term
| what is DiGeorge's syndrome? |
|
Definition
| congenital hypoPTH with congential facial and cardiac anomalies |
|
|
Term
| Name some of the s/sx of hypoPTH |
|
Definition
| -muscle cramps and spasms, convulsions, parasthesias, cataracts, hair loss, brittle nails, fatigue, anxiety, hoarseness (laryngospasm), wheezing (bronchospasm), HYPERactive DTRs |
|
|
Term
| What are the two signs on PE that are characteristic of hypocalcemia and therefore hypoPTH |
|
Definition
-Chivostek's sign: tapping the facial nerve anterior to the ear produces ipsilateral facial twitching
-Trousseau's Phenomenon: inflation of a BP cuff to 20 mmHg above the obliteration of a radial pulse and holding for 3-5 minutes will cause a carpal spasm |
|
|
Term
| HyperPTH and HypoPTH, describe the DTRs in each |
|
Definition
HyperPTH: hypoactive DTRs
hypoPTH: hyperactive DTRs |
|
|
Term
| what are the lab results for a patient with hypoPTH |
|
Definition
-low serum ionized Ca
-low PTH
-low Mg
-high P
-low urine cAMP |
|
|
Term
| what are the EKG results for a pt with hypocalcemia and therefore the same would be seen for a pt with hypoPTH |
|
Definition
| long QT and T wave abnormalities |
|
|
Term
| What is the treatment for hypoPTH? |
|
Definition
| Calcium (1-2 g/day) and Vitamin D (0.25-1 mcg/d) |
|
|
Term
| in an emergency situation with a pt with hypoPTH, what are the first lines of action |
|
Definition
protect airway
SLOW administration of IV ca gluconate |
|
|
Term
| When a patient presents with new onsetAfib, what endocrine labs must always be ordered? |
|
Definition
|
|
Term
| Describe the chain of thyroid hormone stimulation |
|
Definition
-Hypothalamus produces TRH
-Anterior Pituitary produces TSH
-Thyroid gland produces mostly T4 and a little T3, T3 is the active metabolite and it is converted from T4 mostly in the liver (removal of an iodine atom) |
|
|
Term
| The amount of TSH that the pituitary releases is depended on the level of _______ |
|
Definition
| T4 circulating in the blood |
|
|
Term
| What are the two forms that T4 circulates in the blood? What tests need to be ordered to get an accurate measure of T4? |
|
Definition
bound to protein (so these guys won't enter cells and act as thyroid hormone)
AND free, measurement of the free T4 or the Free T4 Index is the best measurement for T4 |
|
|
Term
| individuals with hyperthyroidism will have _________ Free T4 |
|
Definition
|
|
Term
| an elevated TSH and a low FT4 indicates what? |
|
Definition
| primary hypothyroidism due to disease in the thyroid gland |
|
|
Term
| a low TSH and a low FT4 indicates what? |
|
Definition
| secondary hypothyroidism due to a problem in the pituitary |
|
|
Term
| a low TSH with an elevated FT4 is seen in a pt with what? |
|
Definition
|
|
Term
| What is the last test in the thyroid panel to become abnormal? |
|
Definition
T3, so it is not super helpful.
Can be used to determine severity of hyperthyroid
but rarely helpful in a pt with hypothyroid |
|
|
Term
| In many patients with hypo- or hyperthyroidism, lymphocytes make ___________ against their thyroid that either __________ or __________ the gland |
|
Definition
antibodies
stimulate
damage |
|
|
Term
| What are the two common antibodies that cause thyroid problems and are directed against thyroid cell proteins? |
|
Definition
thyroid peroxidase
thyroglobulin |
|
|
Term
| If a pt with hypothyroidism has positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies this makes a diagnosis of _____________/_____________ |
|
Definition
|
|
Term
| if a pt with hyperthyroidism has positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies this makes a diagnosis of _____________/_____________/___________ |
|
Definition
| autoimmune thyroid disease |
|
|
Term
| How does a radioactive iodine uptake test work? |
|
Definition
| Since T4 contains much iodine, the thyroid has to pull a lot of iodine out of the blood in order for it to make the right amount of T4. If a pt swallows a small amount of radioactive iodine it can be determined if the thyroid is functioning well. High RAIU is seen in pts with hyper- and low is seen in those with hypo- |
|
|
Term
| What are the three top causes of hyperthyroidism? |
|
Definition
1. graves disease
2. diffuse multinodular goiter (Plummer's disease)
3. Adenomas |
|
|
Term
| What are some s/sx of hyperthyroidism? |
|
Definition
-anxiety/nervousness
-heat intolerance/sweating
-weight loss with increased appetite
-loose stools, frequent urination
-fatigue
-heart palpitations/tachycardia
-resting tremor |
|
|
Term
| What are the signs and sx of a thyroid storm and the tx? |
|
Definition
-fever, tachy, v/d, dehydration, marked weakness, delerium, confusion
-BBs, hydrocortisone (impairs peripheral generation of T3 from T4 and provides adrenal support) , thiourea drug (inhibit thyroid hormone release), and iodine (inhibit thyroid hormone release) |
|
|
Term
| What is the best lab to detect hyperthyroid? What else should be ordered? |
|
Definition
|
|
Term
| In a pt with graves disease, an MRI of what should be ordered? |
|
Definition
| the orbits, due to high likelyhood of exopthalmos |
|
|
Term
| How would Graves disease look on a RAIU scan? What would a palpable thyroid gland feel like? |
|
Definition
| -it would show diffuse uptake because every thyroid cell is hyperfunctioning. The thyroid is diffusely enlarged and non-tender |
|
|
Term
| What would a RAUI scan look like on a pt with Plummers (diffuse multinodular toxic goiter)? |
|
Definition
-Hyperfunctioning areas that produce high T4 and T3 levels which results in decreased TSH levels---> this also results in the rest of the thyroid not function (atrophy due to decr TSH)
-patchy uptake on thyroid scan
-gland is bumpy and nodular |
|
|
Term
| What is the pathophysiology of Thyroid Disease? |
|
Definition
| circulating autoantibodies against thyrotropin receptor provides continuous stimulation of the thyroid gland. These antibodies cause release of thyroid hormones and thryoglobulin, and they also stimulate iodine uptake, protein synthesis, and thyroid gland growth |
|
|
Term
| What are the mainstays of tx for hyperthyroidism? |
|
Definition
-Thionamides for children and women who are pregnant (Methimazole and PTU (Propylthiouracil- safe in pregnancy)
-Beta blockers for sx
-Radioactive iodine is the tx of choice in nonpregnant women and adult men
-Surgery for pt's that have contraindication to radioactive iodine or pregnant women who did not take/ could not tolerate PTU |
|
|
Term
| What is the most common cause of hypothyroidism in the US? Worldwide? |
|
Definition
Hashimotos thyroiditis (autoimmune)
Iodine deficiency |
|
|
Term
| What are some signs and symptoms of a pt with hypothyroid? |
|
Definition
-fatigue, lethargy
-anorexia, weight gain
-constipation
-cold intolerance
-menstrual abnormalities
-dry skin and coarse hair
-bradycardia and systolic hypotension and diastolic hypertension
-hyporeflexia |
|
|
Term
| For a patient coming in with sx of hypothyroid, what are the labs and rads that should be ordered? |
|
Definition
-TSH, free T4, T3
-anti-thyroid peroxidase and anti-thyroglobulin ab's
-monospot (fatigue)
-pregnancy
-blood glucose
-CBC (anemia), B12
-CMP (swelling? what the PRO status)
-EKG (fatigued female) |
|
|
Term
| What is the tx for hypothyroidism? |
|
Definition
Levothyroxine (Synthroid) 50-200 mcg/ day
-results are not seen for up to 6 weeks
-start low and go slow |
|
|
Term
| What is myxedema coma? what are the emergent tx? |
|
Definition
a rare condition that can develop after years of untreated hypothyroidism
-pt presents with decr LOC, hypothermia, and respiratory depression
-tx: maintain BP and airway, give IV synthroid and hydrocortisone |
|
|
Term
| What cardiac combination in hypothyroid causes dizziness? |
|
Definition
| bradycardia with systolic hypotension |
|
|
Term
| Describe the edema seen in myxedema? |
|
Definition
|
|
Term
| Describe cholesterol levels in a pt with hypothyroid? |
|
Definition
|
|
Term
| What is a great clinical test to measure DTR relaxation time in a pt with hypothyroid. describe the elicited response |
|
Definition
-check at the brachioradialis tendon
-the contraction will be normal and the relaxation will be slow! |
|
|
Term
| If you can only order one test to diagnosis hypothyroidism, what should you pick? |
|
Definition
|
|
Term
| What is the most common and also least aggressive type of thyroid cancer? |
|
Definition
|
|
Term
| WIll you see iodine uptake with a papillary carcinoma? |
|
Definition
|
|
Term
| What is the second most common type of thyroid cancer which has a worse prognosis and is more malignant than papillary cell? |
|
Definition
| follicular cell carcinoma |
|
|
Term
| What is a variant tumor of follicular that does not uptake iodine? Most follicular carcinomas do avidly absorb iodone |
|
Definition
|
|
Term
| What type of thyroid cancer is associated with Men II? What hormone does it produce? How malignant is it? |
|
Definition
-Medullary carcinoma
-Associated with MEN II so check for pheochromocytoma
-Produces calcitonin
-more malignant than follicular and papillary but less than..... |
|
|
Term
| What is the most malignant type of thyroid cancer? |
|
Definition
| Anaplastic, seen in the elderly and death is likely within a few months |
|
|
Term
| What type of test is a must in a pt with possible thyroid cancer? |
|
Definition
|
|
Term
| List the types of thyroid carcinoma in order from most to least malignant? |
|
Definition
| anaplastic, medullary, follicular, papillary |
|
|
Term
| What is a pearl to remember when prescribing levothyroxine? |
|
Definition
| formulations vary tremendously between manufacturers and generics, so always prescribe the same type the patient has always taken |
|
|
Term
| Name everything you know about Hashimoto's thyroiditis? hormone levels? abs? tx? goiter? |
|
Definition
-most common autoimmune cause of do
-goiter is common
-thyroid studies are either NL or hypo-
-antiperoxidase abs (90%), antithyroglobulin abs (50%)
-Tx: levothyroxine to acheive Eu state |
|
|
Term
| Name all you can about subacute (viral) thyroiditis. Prodrome? Hormone levels? Goiter? Tx? |
|
Definition
-follows viral illness, prodromal: fever and flu like sx
-can cause transient hyper-t, then eu, then hypo-
-painful, tender gland that may be englarged
-Tx; NSAIDs and ASA, steroid if pain is severe |
|
|
Term
| What is fibrous (Riedel's) thyroiditis? |
|
Definition
fibrous tissue replaces the thyroid tissue and the gland becomes firm
-pts may be hypo-T |
|
|
Term
| When does postpartum thyroiditis show up and how long does it last? |
|
Definition
1-6 m post
lasts 2-3 m
give BBs if they have sx |
|
|
Term
| What is suppurative thyroiditis? |
|
Definition
an infection of the thyroid. rare. fluctuant neck mass
tx is ABX and drainage |
|
|
Term
| What are two other names for subacute (viral) granulomatous thyroiditis? |
|
Definition
|
|
Term
|
Definition
| adrenocortical insufficiency due to the destruction or dysfunction of the entire adrenal cortex-- affecting glucocorticoid and mineralocorticoid function |
|
|
Term
| What are the 3 S's used to remember the function of the adrenal glands? |
|
Definition
|
|
Term
| At what percentage of destruction/dysfunction of both adrenal glands are s/sx of addison disease seen |
|
Definition
|
|
Term
| What are some s/sx of a pt with chronic addison dz? |
|
Definition
-hyperpigmentation which may have been present for months to years
-salt craving
-weakness, fatigue, poor appetite, weight loss
-N/V/D
-myalgias and flaccid muscles due to hyperkalemia |
|
|
Term
| what are some s/sx of an addisonian crisis? |
|
Definition
-prominent N/V and pain that may present like an acute abd
-vascular collapse- looks in shock, cyanotic, confused |
|
|
Term
| WHat is a PE finding in females with addison dz? |
|
Definition
| decreased axillary and pubic hair, even total overall body hair, due to loss of adrenal androgens (which are the major source of androgens in the female body) |
|
|
Term
| What is the MCC of chronic primary Addison Disease? |
|
Definition
-idiopathic autoimmune adrenocortical insufficiency resulting from autoimmune atrophy, fibrosis, and lymphocytic infiltration of the adrenal cortex (rarely medulla) causes 80%
-TB is also a cause in areas of the world where it is prevalent |
|
|
Term
| What is the MC cause of secondary adrenal insufficiency? stressed topic by kim lay... |
|
Definition
| cessation of corticosteroid medication |
|
|
Term
| What is the work up for Addison disease? what would a CMP, CBC, CXR, and CT scan show? |
|
Definition
-GOLD STANDARD: rapid ACTH test
-AM plasma cortisol testing
-CMP: low Na, high K, low glucose, high BUN and high Cr
-CBC: normocytic, normochromic anemia
-CXR: small heart in some
-CT: enlarged or atrophic adrenals depending on cause |
|
|
Term
| What is the long term tx for a pt with Addison disease? |
|
Definition
PO gluco- and mineralocorticoids
-Hydrocortisone
-Fludrocortisone (not all pts will need mineral- supplementation each day) |
|
|
Term
| What are the main steps in an emergency situation with a pt with Addison disease? |
|
Definition
-IV NaCl to replace fluid and increase BP
-IV hydrocortisone
-IV glucose |
|
|
Term
| What is the cause cushing syndrome? |
|
Definition
| it is hypercortisolism and it is caused by prolonged exposure to elevated levels of either endogenous glucocorticoids or exogenous glucocorticoids |
|
|
Term
| What are the characteristic physical findings of a pt with Cushing Syndrome? |
|
Definition
| moon facies, buffalo hump, purple striae, supraclavicular fat pads, truncal obesity, thin skin |
|
|
Term
| What are some common complaints of a pt with cushing syndrome |
|
Definition
| proximal muscle weakness, easy bruising, weight gain, hirsutism |
|
|
Term
| What is the MCC of cushing syndrome |
|
Definition
| use of exogenous steroids |
|
|
Term
| What is classic cushing disease? |
|
Definition
| ACTH secreting neoplasms usually due to an anterior pituitary tumor that causes ACTH dependent disease |
|
|
Term
| A pt who has classic cushing disease (due to ant pituitary tumor) might have what extra s/sx not seem in other pts? |
|
Definition
| HA's, nocturia, polyuria, galactorrhea, and visual disturbances |
|
|
Term
| What will be seen on a CMP of a pt with Cushing Disease? |
|
Definition
incr WBC
hyperglycemia
hypokalemia |
|
|
Term
| What are two methods for dx cushing's |
|
Definition
urinary free cortisol level
low-dose dexamethasone suppresion test |
|
|
Term
| what is the tx for cushing's |
|
Definition
based on the primary cause and goal is to reduce cortisol secretion to NL to reduce risk of comorbidities associated with hypercortisolism
-Tumor? surg
-Cant do surg? meds, but they often fail
-Endogenous steroids? Gradually withdrawal them |
|
|
Term
| If a patient has increased cortisol production and abnormal suppression after the dexamethasone suppression test, what would it mean if they also had decr plasma ACTH ? |
|
Definition
| probably an adrenal adenoma or carcinoma |
|
|
Term
| If a patient has increased cortisol production and abnormal suppression after the dexamethasone suppression test, what would it mean if they also had normal or incr ACTH? |
|
Definition
| pituitary or ectopic source |
|
|
Term
| At what size on CT or MRI does an adrenal mass need further investigation? |
|
Definition
|
|
Term
| The majority of benign adrenal nodules are endocrine (active/inactive) adrenocortical (adenoma/carcinoma). what percentage of all masses are these? |
|
Definition
|
|
Term
| What is a pheochromocytoma? what does it produce and what is the main side effect? |
|
Definition
| a catecholamine producing tumor that may precipitate life threatening HTN |
|
|
Term
| What are the three syndromes that are classically associated with a pheochromocytoma? |
|
Definition
-von Hippel-Lindau (VHL) syndrome
-MEN 2
-NF 1 |
|
|
Term
| What are some s/sx of a pheochromocytoma? |
|
Definition
HA, palpitations, diaphoresis, severe HTN
*the spells follow patterns |
|
|
Term
| What is measured in the urine of a pt with suspected pheochromocytoma? |
|
Definition
| catecholamines and metanephrines |
|
|
Term
| What is the tx for a pheochromocytoma? |
|
Definition
|
|
Term
| What are the six H's of pheochromocytoma? |
|
Definition
HTN
HA
Hyperhidrosis
Heart Consciousness (palpitations)
Hypermetabolism
Hyperglycema |
|
|
Term
| What is the rule of 10 for pheochromocytoma? |
|
Definition
| 10% for the following: familial, malignant, multiple/bilateral, extra adrenal, childhood onset, recurrence after surgery |
|
|
Term
| What is released in each part of the Hypothalamic-Pituitary-ADrenal axis?> |
|
Definition
Hypothalamus: CRH (corticotrophic releasing hormone)
Pituitary: ACTH (Adrenocorticotrophic Hormone)
Adrenals: Adrenaline, Noradrenaline, Progesterone--Cortisol, DHEA--testosterone and estrogen, ALdosterone |
|
|
Term
| What is the cause of >95% of the cases of acromegaly/gigantism ? |
|
Definition
| pituitary adenomas that secrete excess amounts of GH |
|
|
Term
| Growth hormone in the circulation stimulates the production of what? What is the main source of this? |
|
Definition
Insulin like growth factor
liver |
|
|
Term
| Name some of the s/sx of acromegaly, and the s/sx associated with a pituitary adenoma |
|
Definition
-facial bossing, arthralgia and large joints, glucose intolerance, cardiomyopathy and HTN, OSA
-HA and bitemporal hemianopsia due to pressure on the optic chasm |
|
|
Term
| What are some labs that may be elevated in addition to GH in a patient with acromegaly? |
|
Definition
| GLUCOSE! liver enzymes, calcium and phosphate |
|
|
Term
| What is diabetes insipidus? What are the two main causes? |
|
Definition
-metabolic DO characterized by defective ability to concentrate urine in the kidneys- resulting the production of large quantities of dilute urine.
-Central: Due to def. of arginine vasopressin (AVP) AKA ADH.
-Nephrogenic: due to renal insensitivity to or resistance to AVP with a reduction in the permeability of the collecting duct to water |
|
|
Term
| What are some strong RFs for the development of DI? |
|
Definition
| pituitary surgery, TBI, pituitary stalk lesions, medications, autoimmune diseases |
|
|
Term
| What part of the pituitary secretes ADH? |
|
Definition
|
|
Term
|
Definition
| extreme thirst and excretion of an excessive amount of dilute urine. Polyuria, polydipsia, nocturia |
|
|
Term
| What are some lab results for DI? |
|
Definition
-urine osmolality low and serum osmolality reg or elevated
-urine dipstick negative for glycosuria
-24 hr collection for vol, >3L per 24 hr
-serum glucose NORMAL |
|
|
Term
| What is the gold standard of tx for central DI? |
|
Definition
|
|
Term
| Dwarfism (achondroplasia) is caused by specific mutations in what gene? |
|
Definition
| fibroblast growth factor receptor 3 (FGFR3) gene |
|
|
Term
| Describe the limb shortening observed in dwarfism (achondroplasia) |
|
Definition
|
|
Term
| What is the most common visual symtpom associated with neoplastic pituitary disease? |
|
Definition
|
|
Term
| Any pt that presents with a pituitary neoplasm should be tested for what? |
|
Definition
| MEN1 (multiple endocrine neoplasia type 1) bc 25% of MEN1 pts get these tumors |
|
|
Term
| What is the most common hormone producing pituitary adenoma? |
|
Definition
|
|
Term
| What hormones are secreted by the ant. pituitary? |
|
Definition
| TSH, ACTH, FSH/LH, GH, Prolactin, Endorphins |
|
|
Term
| Describe the sx associated with the a pituitary adenoma that secretes: prolactin, GH, ACTH, or TSH? |
|
Definition
prolactin- amenorrhea and milk production
GH- acromegaly, gigantism
ACTH- cushing's disease
TSH- hyperthyroidism |
|
|
Term
| What is the MC tx for a pituitary adenoma? |
|
Definition
|
|
Term
| What hormones are secreted by the posterior pituitary? |
|
Definition
|
|
Term
| What is desirable total Cholesterol? LDL cholesterol? HDL cholesterol? |
|
Definition
-<200
-<100, or 70 if at high risk for heart disease (diabetics)
->60 |
|
|
Term
| What is a normal triglycerides level? |
|
Definition
|
|
Term
| What are three endocrine do's that can cause secondary hypercholesterolemia? |
|
Definition
| hypothyroidism, cushing's, hyperparathyroidism |
|
|
Term
| At what age does the USPSTF recommend screening men for lipid DOs? women? those at high risk? |
|
Definition
|
|
Term
| what are some CHD risk equivalents? |
|
Definition
-coronary artery disease
-hx of stroke TIA
-AAA
-DM
-carotid artery disease (>50% stenosis)
-framingham risk score >20% risk in ten years
-peripheral arterial disease |
|
|
