USMLE endocrine physical diagnosis
Terms
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- CUSHING'S SYNDROME
- occurs secnodary to corticoid steroid use, nonpituitary neoplasms (i.e. small cell carcinoma of lung), adrenal adenomas & carcinomas, and bilateral adrenal nodular hyperplasia
- CUSHING'S DISEASE
- hypercortisolism due to adrencocorticotropic hormone (ACTH) hypersecretion by the pituitary gland (secondary)
- Symptoms of cushings
- CENTRAL OBESITY, STRIAE, HIRSUTISM, easy brusablity, hypertention, glucose intolerance, HYPOkalemia
- how do u screen for cushing's
- URINARY CORTISOL
- PSEUDOCUSHINGS IS SEEN IN:
- alcoholic pts and depressed pts
- Polycystic ovary disease (Stein-Leventhal syndrome)
- cuases increaed levels of TESTOSTERONE, HIRSUTISM, INFERTILITY, AND MENSTRUAL IRREGULARITY
- ACROMEGALY
- hypersecrtion of GROWTH HORMONE AFTER CLOSURE OF EPIPHYSIS. almost always due to pituitary adenoma
- symptoms of ACROMEGALY
- tall staure, LARGE HANDS AND FEET (GLOVE/SHOE CANT FIT), prominent mandible, prognathism (large jaw), carple tunnel syndrome, headache, visual field defects, hypertorophy of laryngeal tissue causing sleep apnia, htn, CARDIOMEGALY, *COLONIC POLYPS (cancer suseptible!)*,
- GIGANTISM
- increase in GH BEFORE closure of epiphysis closure (childhood).
- AMYLOIDOSIS
- a group of disorders characterized by the infiltration of various organs (kidney, heart, intestines, endocrine) by PROTEIN FIBRILS.
- What does Amyloidosis present with
- MACROGLOSSIA(tongue thickening and carpel tunnel synderome.
- a common presentation seen in Hypopituitarism, amyloidosis, and acromegaly
- Macroglossia (enlarged/thickend tongue)
- Marnon's sign
- redness and itchiness of the skin of the neck overlying the thyroid gland--->suggests GRAVE'S DZ---> serum T3 and T4, and Thyroid Resin are all usually elevated--->sensitive test for THYROXICOSIS is TSH levels
- GRAVE'S DZ (Basedow's dz)
- HYPERTHYROIDISM. the most common cause of THYROTOXICOSIS
- S&S of Grave's dz
- HEAT INTOLERANCE, menstrual irregularities, WEIGHT LOSS, and PERITIBIAL MYXEDEMA
- physio of Grave's
- ANTIBODIES that bind to the TSH receptors on thyroid, which overstimulate T3/T4 release--->hyperfxn of entire thyroid (diffuse goiter)--->high t4/t4-->low TSH
- PLUMBER'S DZ
- an autonous TOXIC ADENOMATOUS HYPERTHYROIDISM. dz of the thyroid-thyrotoxicosis. pts DO NOT PRESENT OPHTHALMOPATHY or Dermopathy...usually older (50+)
- HASHIMOTO'S/chronic LYMPHOCYTIC thyroiditis
- autoimmune (antimicrosomal HYPOTHYROIDISM. and antithyroid peroxidase antibodies) hypothoyroidism---most common cause of hypothy in U.S.
- physical presentation of Hashimoto's
- DIFFUSe, firm, nontender goiter-->suseptible to postpartum thyroiditis
- STROMA OVARII
- thyroid tissue contained in a HYPERTHYROIDISM. dermoid ovarian tumor--->thyrotoxicos with "goiter" presentation in pelvic region instead of throat
- De QUERVAIN'S/Granulomatous SUBACUTE thyroiditis
- HYPOTHYROIDISM. due to the release of preformed THYROGLOBULIN (therfore decrease in free t3/t4).follows VIRAL INFXN! and is uniquely PAINFUL, and tender.
- tx of De quervain's
- aspirin and NSAIDs
- Symptoms of HYPOTHYROIDISM
- constipation, depression, edema, macroglossia, COLD INTOLERANCE, QUEEN ANN'S SIGN (missing later 1/3 of eyebrows), muscle cramps, WEIGHT GAIN, goiter, amenorrhea & galactorrhea, HYPOTHERMIA, HYPONATRIMIA, AND HYPOTENTION
- reltnship of AMIODERONE to the thyroid
- drug has high iodine content and causes HYPOTHYROIDISM 8% of pts.
- MYXEDEMA
- a rare complication of HYPOTHYROIDISM; presents with COMA, severe hypotention, hypoventilation, and hypoxemia.
- CRETINSIM
- a congenital/infantile hypothyroidism.
- Pituitary tumor on optic chiasm
- BITEMPORAL HEMIANOPSIA due to impingement and impingement of the temporal field fibers as they decussate at the optic chiasm
- Chvostek's sign
- tapping on the crainal nerve 7 as it exists the parotid gland (infront of ear) will cause SPASM/CONTRACTION in the facial muscles of that same side (TETANY)--->indicates HYPOcalcimia
- clincal signs of HYPOCALCIMIA
- paresthesias (pricklin/itching/bruring skin sensation), neruomuscular irritability,postive Troussau's sign, and INRCREASED QT INTERVAL (bradycardia).
- pathology of hypocalcimia
- RICKETS in childeren, OSTEOMALASIA in adults
- cause of Hypocalcimia
- HYPOparathyroidectomy--->most commonly due to accidental resection due to thyroidectomy
- Clinical presentation of HYPERcalcimia
- all-BONES, kidney-STONES, abdominal-GROANS, AND psychic-MOANS: bone fractures, osteitis fibrosa; kidney caliculi stones; annorexia, vomitting, peptic ulcers, pancreatitis; anxiety, depression, insomnia
- presentation of HYPOkalemia
- present w/ muscle weakness, muscle cramps, and flaccid paralysis
- presentation of HYPERkalemia
- may lead to areflexia, flaccid paralysis, and EKG abnormalities (prolonged T-waves, prolonged PR, and widened QRS and ventricular tachycardia.
- THYROGLOSSAL DUCTAL CYST
- a midline neck structure and is remenant of the passage of the thyroid gland from teh base of the tongue into the neck
- CAROTID BODY TUMOR
- tumor that arrises from the the carotid body a the bifurication of the common carotid artery
- LIPOMA
- a fatty tumor that can be found anywhere in the subcutaneous tissue
- THYROID BRUIT
- turbulent blood flow heard over the carotid with a stethascope--->usually indicative of GRAVE'S dz
- BRACHIAL CLEFT CYST
- a lateral neck structure usually located near the upper 1/3 of the sternocleidomastoid muscle and is remnant of embryologic dvlpt.
- LARYNGOCELES
- lateral neck swellings that increase in size with valsalva maneuver (forced expiration with mouth/nose closed)
- ADDISON'S DISEASE
- 90% of the adrenal gland must be destroyed for Addison's disease (hypoaldrenalism) to develop; Glucocorticoids, minerilocorticoids, and androgens are thus effected--->lack of negative feed back due to low levels of cortisol causes high levels of ACTH
- Etiology of Addison's disease
- TB, malignancy, sarcoidosis, trauma, histoplasmosis, hemochromatosis (too much iron), amyloidosis, sepsis, CYTOMEGALOVIRUS infxn, and meds (KETOCONAZOLE, RIFAMPIN, ANTICOAGULANTS, AND ANTICONVULSANTS)....presentation of normal adrenals suggest ideopathic hypoadrenalism
- Symptoms of Addisons
- Weakness, hypotention, anorexia, wt loss, and HYPERPIGMENTATION of the skin. Also..HYPOnatremia, HYPOkalemia,and eosinophilia
- present with headache, visual problems, papilledema, personatlity changes
- HYPOPITUITARISM...CRANIOPHARYNGIOMA
- postpartum hemorrhage and necrosis of the pituitary gland presents with
- HYPOPITUTIARISM...Sheehan's syndrome
- Occurs when cerebrospinal fluid fills the sella space and flattens the pituitary gland--->seen in obsese,hypertensives, multiparous(several births) women
- EMPTY SELLA SYNDROME
- the combo of HASHIMOTO'S & ADDISON'S condition
- SCHMIDT'S SYNDROME
- Occurs in less than 5% of pts witha pituitary MACROadenoma (>1cm), and pts complain of headache, neck stiffness, fever, and visual disturbances, and may present with acute adrenal insufficiency
- PITUITARY APLEXY
- Reduced bone mass w/ a normal mineral matrix...secondary to medication (DIPHENYLHYDANTOIN, CORTICOSTEROIDS, HEPARIN), HYPERthyroidism, anorexia nervosa, malabsorptive dz, HYPERparathyroidism, multiple myeloma, immoblization, tabacco or alcoholism
- PREMATURE OSTEOPOROSIS...not induced by menopause decrese in estrogen and may be seen in men as well.
- Reduced bone mineralization of the the matrix...evaluate for vitamin D deficiency
- OSTEOMALACIA (adults) and RICKETS (childeren)
- an inflammatory disorder often seen in pts with RHEUMATOID ARTHRITIS and assoc. with CHEMOSIS and SCLERAL CONJUNCTIVITIS INFLAMMATION
- SCLEROMALACIA
- Increased BONE TURNOVER with formation of DISORGANIZED BONE...presents with pain, enlarging of skull bones("hat can't fit anymore" and hearing loss), skeletal deformaties (bowing of the lower extremeties) and increased WARMTH of the skin overly
- PAGET'S DISEASE
- treat this with intensive hydration using intravenous saline, but BISPHOSPHINATES (inhibitors of bone resorption) would be initial pharmacotherapy...hydrochlorothiazide diuretics should be avoided
- HYPERCALECEMIA
- Growth of coarse, male-pattern hair in women due to androgen excess
- HIRSUTISM...check testosterone, LH, FSH, 17-OH progesterone, and PL levels. Evaluate for ovarian or adrenal tumors
- the most common cause of CONGENITAL ADRENAL HYPERPLASIA
- 21-HYDROXYLASE DEFICIENCY
- Meds that can cause HIRSUITISM
- Anabolic steroids, MINOXIDIL, CYCLOSPORIN, ORAL CONTRACEPTIVES, AND PHENYTOIN
- Gynecomastia is seen in 50-60% of adolescent boys undergoing normal puberty, if it does not resolve what can you suspect
- KLINEFELTER'S SYNDROME (XXY), adrenal tumor, gonadal tumor, hyperthyroidism, hepatic disorders, and drug use, esp. marijuana, and anabolic steroids.