Intro to Endo
What are the types of endocrine disorders and where is the problem located?
-Secondary: pituitary gland
-Tertiary: hypothalamus
What are the two categories of dwarfism and how are they differentiated?
-Proportionate: GH deficiency
-Disproportionate: Achondroplasia- genetic mutation
-Low levels of target hormones + low or normal levels of trophic hormones
-Brain MRI w Contrast- pituitary protocol (may miss micro adenomas), macroadenomas- empty sella
How are pituitary adenomas categorized?
-Microadenomas: 10 cm or less
-Macroadenomas: 11 cm or more
What is the best initial screening test for thyroid disease?
TSH
What is the most common cause of anterior hypopituitarism?
Pituitary Adenoma
Which is not a symptom of Sheehan's syndrome?
A. inability to produce breast milk
B. headaches, low blood pressure
C. Excessive hair gain
D. irregular/absent periods
Sheehans syndrome: severe blood loss during childbirth or increased coat due to pregnancy
C.
-Hair loss
-fatigue is also a symptom
If you order RAIU in an elderly patient with an enlarged thyroid with palpable nodules and NO skin or eye changes what would you see?
patchy areas of high and low uptake
-Toxic multi nodular goiter
What causes the actual disease of hypothyroidism
anti-TSH antibodies
How does T4 and TSH differentiate pituitary vs. thyroid disorders?
-elevated TSH and decreased T4 = thyroid disorder
-decreased TSH and T4 = pituitary disorder
Fill in the blank:
Bone is composed of calcium and phosphate in a chemical arrangement called ____________.
__________ __________ provide the framework in which hydroxyapatite crystals can form. What is this answer made up of?
Blank 1: hydroxylapatite
Blank 2: Osteoid matrix
-collagen and non collagenous proteins
A patient presents to the ER with a fever of 104F, tachycardia, and vomiting. An ECG was performed and found the patient is tachycardia with a-fib with a-flutter. This patient was admitted to the ICU. A thyroid panel was ordered and is pending. What is the likely diagnosis and what should the labs show?
-Thyroid Stomr
-extremely elevated T3 and T4, decreased TSH
A female patient presents to the primary care office complaining of difficulty swallowing, neck and ear pain and a hoarse voice. She reports she felt a large lump on her neck. On physical exam a nodule on her thyroid that is over 1cm that is fixed in place, does not move with swallowing and has irregular feeling margins. What are the next steps you should take to evaluate the nodule?
-Thyroid labs- usually WNL
-Fine needle aspirate: best initial test
-RAIU: cold nodes highly suspicious for malignancy, hot or normal- low suspicioun
-US: determine if cystic or solid, can help obtain specimen during FNA with Bx, monitor a suspicious nodule
-Total thyroidectomy is warranted for ALL cancers except for anapestic
Which of the following statement is false?
A. Papillary type thyroid cancer is the least aggressive
B. Follicular type thyroid cancer metastasizes to the blood first because of the vasculature close to the the thyroid gland
C. Medullary type thyroid cancer causes symptoms from secretion of calcitonin
D. Anaplastic type thyroid cancers are seen in elderly patients and are most aggressive, thyroidectomy is not recommended.
B. Follicular type metastasizes to lungs, bone, brain and liver
What labs are typically seen in Graves disease?
-extremely low or undetectable TSH
-circulating TSH receptor antibodies, thyroid stimulating immunoglobulin abs, peroxidase antibodies, thyroglobulin antibodies = positive
-RAIU: diffuse uptake
What are the three zones of the adrenal cortex and what is made in each one?
- zona glomerulosa (mineralocorticoids –aldosterone)
- zona fasciculata (glucocorticoids – cortisol)
- zona reticularis (steroid hormones – androgens: DHEA).
A 45 year old woman presents to the ER with her daughter who reports her mom is confused and thinks that she is living in the 1930s. Her vitals are: T- 94F, P- 40bpm, R- 15bpm. The patient's daughter reports that her mom has a history of mixing up her medications and sometimes accidentally takes too many of her hydrocodone that she is prescribed for her broken leg. Her labs show that she has acute kidney injury and rhabdo. What is the likely diagnosis of this patient?
Myxedema crisis/coma: life threatening severe hypothyroidism
A female patient presents to the primary care office with chronic inflamed thyroid gland. On exam the thyroid was found to be asymmetric, hard, "woody". The patient notes that this has been going on for a while and 2 years ago her thyroid labs were WNL. What is the only way to diagnosis this condition?
-Fibrous thyroiditis (Riedel)
-biopsy!! differentiation with carcinoma is difficult
-thyroid labs are normal at first, as tissue fibrosis patient will develop hypothyroidism
-RAIU is decreased in the involved area, thyroid antibodies may be present
What is the most accurate test to measure bone density? What is a T score for Osteoporosis?
DEXA: Dual-Energy X ray Absorptiometry
< -2.5 for osteoporosis
A patient presents with weight loss, tachycardia, heat intolerance, warm moist skin, diffuse enlarged thyroid. They are complaining of that they have loss vision on the outer wall of both of their eyes. What labs would you want to order and what results would you see?
-elevated T3 and T4, elevated TSH
-RAIU: diffuse uptake
-Pituitary MRI: adenoma
-DX: TSH secreting pituitary adenoma
Name 4 signs and symptoms of anterior hypopituitarism.
-Low GH, High LDL
-Low Prolactin: no lactation
-Low ACTH: adrenal insufficiency
-Low TSH:hypothyroidism
-Low gonadotropins (LH and FSH): infertility, amenorrhea, low libido
-Low ADH: diabetes insipidus (Central)
-Low Melanocyte stimulating hormone: hypo pigmentation
What are four symptoms of hypoparathyroidism?
•Signs of hypocalcemia: perioral numbness, tetany, carpopedal spasms, muscle or abdominal cramps, paresthesias, hyperreflexia, teeth/nail/hair defects, seizures.
•Chvostek sign - contraction of eye, mouth, or nose muscles elicited by tapping along the course of the facial nerve anterior to the ear.
•Trousseau sign - spasm in the hand and wrist with compression to the forearm (blood pressure cuff).
A patient presents with hyperpigmentation of her knuckles and crises of palms. She is complaining of confusion, nausea, vomiting, abdominal pain. Labs were ordered and show the following:
Plasma cortisol: decreased
Plamsa ACTH: high
Standard ACTH test/stimulation test: cortisol is low, ACTH is elevated
What is the most likely diagnosis?
Primary adrenal insufficeincy
An adult female lives in the North Pole and presents with bone pain, muscular weakness, hypocalcemia, and an antalgic gait. On physical exam it was noted to have bowing of long bones. What would the labs show for this patient?
-Osteomalacia
-low vit D, calcium, phosphate, high alkaline phosphatase
-x rays: looser lines- transverse fracture like radiolucent lines
-thyroglobulin antibodies, antimicrosomal antibodies, thyroid peroxidase antibodies
-Patient has hashimoto