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This section is a free preview of the Endocrine Section of the full PANCE/PANRE Review Course.  Full course has video that is (0:55:29) and 65 questions, answers, and detailed explanations.

 

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Endocrine Preview Questions (7 Questions)

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Endocrine Blueprint Preview Lecture Notes :

Endocrine Blueprint
PANCE Blueprint

Diseases of Thyroid
Hyperparathyroidism-
Should be suspected when high serum calcium levels are detected
Primary hyperthyroidism occurs due to PTH activation of osteoclasts leading to more bone reabsorption causing elevated calcium levels
This also causes increased intestinal absorption of calcium
Most common cause of primary hyperthyroidism is due to parathyroid adenoma

Hyperparathyroidism
Diagnosis of primary hyperparathyroidism is made with a high PTH or one that is in the normal range but elevated inappropriately given the elevated given the patients hypercalcemia
Patients with primary hyperparathyroidism are usually asymptomatic
Elevated isolated serum calcium level should be repeated.
Malignancy is another cause for hypercalcemia.  Malignancy and Primary Hyperparathyroidism account 90 percent of cases of hypercalcemia

Hyperparathyroidism
If malignancy is present, the PTH level is usually normal or low, where as in primary hyperparathyroidism the levels are usually high
Familial hypocalciuric hypercalcium (FHH) is due to an inactivating mutation of the calcium sensing receptor in the kidneys.  See a hypercalcemia with a mildly elevated PTH concentration
Family history of hypercalcemia that is symptomatic is helpful for coming up with the diagnosis
Thiazide diuretics reduce calcium urine excretion and can cause mild hypercalcemia
Lithium decreases parathyroid gland sensitivity to calcium, and decreases urinary excretion.

Hyperparathyroidism
Secondary Hyperparathyroidism is when the parathyroid appropriately responds to a reduced level of calcium.  This causes elevated PTH, the calcium absorption from the intestines to increase and increase bone reabsorption.
Secondary Hyperparathyroidism has an elevated PTH and a low or normal calcium
Secondary hyperparathyroid may come from renal failure and impaired calcitrol production and inadequate calcium uptake.  Vitamin D Deficiency can cause.

Hyperparathyroidism
Normocalcemic Primary Hyperparathyroidism-secondary hyperparathyroid causes need to be ruled out.  Normal calcium and elevated PTH.  Vitamin D deficiency can cause
Clinically most the time hyperparathyroidism can be asymptomatic
Classic symptoms if present “bones, stones, abdominal moans, and psychic groans.” Anorexia, nausea, constipation, polydipsia, bone pain, kidney stone, muscle weakness, polyuria, and psychiatric psychosis.

Hypoparathyroidism
Most common cause is neck surgery on the thyroid or parathyroid
After surgery hypoparathyroidism may be transient or may be permanent
Clinically will see a low PTH and low serum calcium
Calcium and vitamin D supplementation are the mainstays of hypoparathyroidism treatment
Symptoms of hypoparathyroidism include:   tingling in hands and feet, involuntary muscle movements, muscle cramps, fatigue, irritability, anxiety, and depression
Long term hypoparathyroidism can cause cataracts, dry skin, coarse hair, and brittle fingernails

Hyperthyroidism
Many disorders can cause hyperthyroidism:  Graves Disease, Hashiomotos Thyrotoxicosis, Toxic Adenoma, Toxic Multiple Nodular Goiter, Iodine Induced Hyperthyroidism, Trophoblastic Disease from Germ Cell Tumors, TSH mediated hyperthyroidism, Thyroiditis, and exogenous and ectopic hyperthyroidism
Graves Disease is the most common cause of hyperthyroidism.
Graves Disease is an autoimmune disorder that causes thyrotropin (TSH) receptor antibodies, which stimulate thyroid gland growth and thyroid hormone synthesis and release.

Hyperthyroidism
Hashimoto’s Thyroiditis is an autoimmune disease that causes patients initially to present with hyperparathyroidism and high radio iodine uptake similar to Graves disease but eventually go hypothyroid
Hypothyroid develops because of the infiltration of the thyroid gland with lymphocytes
Toxic adenoma and multinodular goiter result from focal or diffuse hyperplasia of the thyroid follicular cells whose functional capacity is independent regulation of TSH.
Toxic multinodular goiter tends to be more common in areas where iodine uptake is low
Thyroid adenomas are not related to iodine uptake
Iodine Induced Hyperthyroidism can occur after an iodine load such as IV contrast for CT scan, or amiodarone administration.

Hyperthyroidism
Iodine Induced Hyperthyroidism is rare
Trophoblastic or germ cell tumors can be rare causes of hyperthyroidism
Can occur as a hydatidiform mole in women
Can occur in Choriocarcinoma in men with testicular germ cell tumors via direct stimulation of the TSH receptors
TSH mediated hyperthyroidism is when there is a pituitary adenoma producing TSH.  Therapy is directed at removing the tumor

Hyperthyroidism
Thyroiditis is a group of heterogenous disorders that result from inflammation of thyroid tissue with transient hyperthyroidism
Thyroiditis has hyperthyroid phase, then hypothyroid phase and then a recovery of thyroid function
Exogenous and ectopic hyperthyroidism occurs from taking too much thyroid hormone or it being produced by other parts of the body.
Exogenous thyroid hormone can be produced by struma ovarii, which is from a functioning ovarian neoplasm.

Hyperthyroidism
Thyroid hormone effects almost every organ system in the body.
Skin-hyperthyroidism causes increased sweating due to increased caloric burning
Hyperthyroidism causing softening of nails, thinning of hair, and can cause hyperpigmentation
Stare and lid lag occur in patients with hyperthyroidism because of sympathetic overactivity
Patients with graves disease can get exophthalmus because of inflammation of the extraocular muscles and orbital fat and connective tissue.

Hyperthyroidism
Hyperthyroid patients have lower serum total and HDL cholesterol
Hyperthyroid patient can have impaired glucose tolerance if untreated
Hyperthyroidism can result in lower serum cortisol concentrations
Dyspnea can occur with hyperthyroidism because oxygen consumption and CO2 production increase
Can be tracheal obstruction due to large goiter
Respiratory muscle weakness can cause dyspnea with hyperthyroidism

Hyperthyroidism
Weight loss with hyperthyroidism is due to increased metabolic rate and increased gut motility.
Dysphagia may occur because of goiter
RBC mass index is increase with hyperthyroidism
May have a normochromic normocytic anemia
Hyperthyroidism can be associated with ITP
Urinary frequency and nocturia are common with hyperthyroidism
Woman with hyperthyroid may see high serum estradiol, high LH, and may get oligomenorrhea and anovulatory infertility

Hyperthyroidism
Thyroid hormone stimulaters bone reabsorption, bone loss
May see increased urinary calcium excretion
Hyperthyroidism can cause psychosis, agitation and depression
Treatment of hyperthyroidism includes beta blockers, PTU or methimazole, or radioactive iodine
Beta Blockers are for symptomatic treatment of hyperthyroidism
PTU or methimazole are thyroid hormone antagonists
Radioactive iodine is indicated for graves disease
Surgical removal of thyroid gland is an option if necessary

Hypothyroidism
Several different causes of hypothyroidism
Primary hypothyroidism is when there is decreased secretion of T3 and T4 which results in a increase int TSH secretion
Chronic autoimmune (Hashimoto’s) Thyroiditis- most common cause of hypothyroidism.  When there is cell and antibody mediated destruction of thyroid tissue
Iatrogenic Hypothyroidism-caused by thyroidectomy radio iodine treatment, or external radiation and there is less secretion of T3 and T4 as a result of it

Hypothyroidism
Iodine related hypothyroidism-excess or iodine deficiency can cause hypothyroidism.  Iodine excess causes the inhibition of iodide organification from T4 to T3 synthesis.  Iodine deficiency causes the inability to synthesize thyroid hormone.
Drugs such as PTU and methimazole can cause hypothyroidism. Lithium, Amiodarone and Ethionamide have been known to cause hypothyroidism.
Infiltrative disease such as fibrous thyroiditis, hemochromatosis, scleroderma, leukemia, and cystinosis are rare causes of hypothyroidism
Hypothyroidism in infants and children are caused by agenesis and dysgenesis of the thyroid

Hypothyroidism
Transient hypothyroidism can be caused by post partum thyroiditis, subtotal thyroidectomy, or patients post radioactive iodine therapy with Graves disease
Secondary Hypothyroidism is caused by lack of TSH secretion from the anterior pituitary gland
Tertiary (Central) is caused by lack of TRH secretion form the hypothalamus
Hypothyroidism affects essentially every organ system

Hypothyroidism
Hypothyroidism causes decreased sweating, skin discoloration, hair to be coarse, non pitting edema (myxedema), vitiligo, and alopecia
Hypothyroidism cans cause periorbital edema
Hypothyroidism can cause normochromic normocytic anemia
Hypothyroidism causes decreased cardiac output and reduction of heart rate and cardiac contractility. Hypertension can be caused from an increased in peripheral vascular resistance.  Increased cholesterol can be seen from decreased cholesterol metabolism

Hypothyroidism
Fatigue, shortness of breath on exertion and rhinitis can be caused by respiratory muscle weakness with hypothyroidism
Hypothyroidism causes decreased gut motility, constipation, and decreased taste sensation, and gastric atrophy
Hypothyroidism can cause oligomenorrhea, amenorrhea, or hypermenorrhea.  This can lead to infertility.  Decreased libido, erectile dysfunction, and delayed ejaculation are possible in hypothyroidism
Hypothyroidism left untreated can cause hashimotos encephalopathy, myxedema coma, and carpal tunnel syndrome

Hypothyroidism
Hypothyroidism can also cause joint pain, aches, and stiffness.  There is an increased incidence of gout with hypothyroid patients.
Hypothyroidism can cause hyponatremia
Standard treatment of hypothyroidism is replacement therapy.  Synthetic thyroxine (T4) or combination T3 and T4 therapy. There is also T3 alone therapy

 

NCCPA Topic List:  Blueprint Topic List

Diseases of the Thyroid Gland
Hyperparathyroidism
Hypoparathyroidism
Hyperthyroidism
Hypothyroidism
Neoplastic disease
Thyroiditis

Diseases of the Adrenal Glands
Corticoadrenal insufficiency
Cushing syndrome
Neoplastic disease
Diseases of the Pituitary Gland
Acromegaly/gigantism
Diabetes insipidus
Dwarfism
Neoplastic disease
Pituitary adenoma

Diabetes Mellitus
Type 1
Type 2
Lipid Disorders
Hypercholesterolemia
Hypertriglyceridemia

 

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