7. Endocrine Flashcards
Hormone Physiology Pathway
Thyroid/Adrenal/Overies
- TRH (HypoThalamus) -> TSH (Pituitary) -> T3/4 (Thyroid gland)
- CRH (HypoThalamus) ->ACTH (Pituitary) -> Cortisol (Adrenal gland)
- GnRH (HypoThalamus) ->FSH, LH (Pituitary) -> Overies - Estrogen, Progesterone, Testes - Testosterone
Primary adrenal insufficiency
2 type Cause/Sx/PE/Dx/Tx
- Cause
- Primary: autoimmune destory adrenal cortex (low cortisol)
- Secondary: prolong steriod use
- PE: hyperpigmentation
- Lab: Hyponatremia, Hypoglycemia, Hyperkalemia
- Dx: stimulate ACTH morning test (Normal - cortisol increase, None - addision)
- If ACTH test is normal Try CRH
- Give CRH
- ACTH rise + low cortisol = Adrenal problem
- ACTH low + low cortisol = pituitary problem
- Tx: Glucocorticoid (Hydrocortisone) + Mineralocorticoid (Fludrocortisone)
Cushing syndrome
2 cause/Sx/Dx/Tx
- Cause
- Cushing disease: pituitary tumor
- Cushing syndrome: high cortisol (steroid use)
- Sx: Central obesity
- PE: Moon face, buffalow hump, extremity waste, purple striae
- Dx
- Initial test
- Dexametasone test
- Cortisol collecting (24 hr urine)
- Salivary cortisol
- Plasma ACTH check
- ACTH low - adrenal problem
- ACTH high - Pituitary adenoma or ectopic
- High dose dexamethason supressing test (Dex supress ACTH which lead lower cortisol)
- If test fail - ectopic
- If test works - Pituitary adenoma
- High dose dexamethason supressing test (Dex supress ACTH which lead lower cortisol)
- Initial test
DM type 1
Cause/Patient/Presentation/Dx/Tx
- Cause: Autoimmune destruction of beta cell
- Patient: Child
- Sx: Polydipsia, polyruia, polphagia, weight loss
- Dx
- 2 seperate fast glucose 126<
- Random glucose 200<
- A1C 6.5<
- 75g glucose load 2hr later check 200<
- Tx: Insulin
DM type 2
Cause/Patient/Sx/Dx/Screen/Tx
- Cause: Insulin resistance
- Patient: Chaos (chronic HTN, Atherosclerosis, obesity, Stroke)
- Sx: Polydipsia, polyphagia, polyuria
- Retinopathy - cotten wool, hemorrhage
- Nephro - microalbumin
- Neuro
- Macrovascular - Cardiovascular dz
- Dx
- 2 seperate fast glucose 126<
- Random glucose 200<
- A1C 6.5<
- 75g glucose load 2hr later check 200<
- Screen:
- ADA: 45y q3 or BMI 25 above + 1 risk factor
- USPSTF: any 40-70 BMI 25 above
- Tx:
- Diet (most important), exercise
- Glucose - Hgb A1C <7.0
- Lipid - LDL <100, HDL >40, TG <150
- Neuropathy - gabapentin
- Retinopathy - DM control
- Nephropathy - ACE Inhibitors
DM Medication List
- Bigunides Name/MOA/SE
- Sulfonylureas Name/MOA/SE
- Meglitides Name/MOA/SE
- Alpha glucosidase inhibitors Name/MOA/SE
- TZD Name/MOA/SE
- GLP-1 agonist Name/MOA/SE
- DDP4 Inhibitor Name/MOA
- SGLT-2 inhibitor Name/MOA
- Metformin - hepatic low - lactic acid, Cr >1.5
- Glip, glime, Glybu - increase pancrea - weight gain, hypogly
- -glinide - increase pancrea - hypogly
- Acarbose, meglitol - delay instestine - hepatitis
- -glitazone - muscle fat sensitive increase - MI (avandia), CHF
- -glutide, -natide - mimic incretin, delay empty stomach - Contraindiacate hx of gastroparesis, pancreatitis
- -gliptin -inhibit GLP-1 degradation
- -gliflozin - Renal threshold
Hypogonadism
Cause/Sx/Related risk factor/Dx
- Cause
- Primary - testicular malfunction (klinefelter, turner)
- Secondary - hypothalamus or pituitary problem (kallmann)
- Sx: Sex dysfunction, erectile dysfunction
- Related risk factor: Opiate use, sleep apnea, marijuana
- Dx
- FSH, LH high -testicular
- FSH, LH low - hypothalamus or pituitary
Multiple Endocrine Neoplasia
3 type
- MEN 1 = 3 P (Parathyroid hyperplasia, Pituitary adenoma, Pancreatic tumor)
- MEN 2a = 1M, 2P (Medullary thyroid carcinoma, Parathyroid hyperplasia, Pheochromocytoma
- MEN2b = 3M, 1P (Medullary thyroid, marfanoid body habitus, mucosal neromas, Pheochromocytoma)
Pheochromocytoma
Cause/Sx/Dx/Tx
- Cause: tumor (makes catecholamine) in adrenal
- Sx: PHE (palpitation, HA, excessive sweating)
- Dx: 24 hour catecolamine urine collection
- Tx: remove tumor
- Phenoxybenzamine, phentolamine
- give first before BB to prevent unopposed alpha agonism
Primary aldosterone
Cause/PE/Dx
- Cause: MC adrenal adenoma
- Secondary - renal artery stenosis
- PE: HTN
- Dx
- Serum test: ARR >20, Aldosterone>20
- HypoK, Hyepranturemia
- Sailne infuse test (definitive)
- Tx: Spironolactone, if renal - agioplasty
SIADH
Cause/Sx/Dx/Tx
- Cause: high ADH by pituitary or other source (MC stroke, cancer)
- Sx: polyuria
- Dx
- Serum osm low <280
- Urine Concentrate >300
- Tx
- H2O stop
- IV hypertonic saline + demeclocycline
DI
2 type cause/Hx/Sx/Dx/Tx
- Cause
- Central - ADH low
- Nephrogenic - Renal not reponse to ADH
- HX: hx of using lithum for nephro
- Sx: Polyuria, nocturia
- Dx: water deprivation (ADH stimulation)
- Increase osm urine - Central
- No change - nephrogenic
- Tx
- DDAP - Central
- HCTZ - neprho
hyperparathyroidism vs hypoparathyroidism
Cause/Dx/Tx
- hyper
- Cause: Adenoma
- Sx: Bones, Stones, groans, psych
- Dx: Ca high, PTH high, PO4 low
- Tx: IV NS, bisphosphonate
- Severe: calcitonin
- hypo
- Cause: thyroid surgery
- PE
- Trousseau - hand spasm when BP pad to block artery
- Chvostek - tapping face -> twitching
- Dx: Ca low, PTH low, PO4 high
- Tx: Calcium supplement and Vit D
Lab
SIADH vs dehyration vs DI
- SIADH: Na+ low, serum osm low, osm urine high
- dehyration: Na+ high, Serum osm high, urine osm high
- DI: Na+ high, serum osm high, osm urine low
Acromegaly vs Dwarf
Cause/Sx/PE/Dx/Tx
- Acromegaly
- Cause: MC adenoma
- Sx: hat and shoe doesn’t fit
- PE: HTN, enlarge feet and hand
- Dx: insulin like growth factor
- Tx: TSS
- Dwarf
- Cause: MC adenoma
- Sx: short status
- Dx: insulin like growth factor
Pituitary adenoma
Cause/Related dz/Dx/Tx
- Cause: microadenomas
- Related dz and sx
- Prolactinoma - galactorrhea
- Hyperthyroidism - TSH high and TRH low
- Curshing disease - ACTH high, CRH low
- PE: Bitemporal hemianopsia
- Dx: MRI
- Tx: TSS
Hyper vs hypothyroidism
Cause/Sx/PE/Dx/Tx
- Hyperthyroidism
- Cause: MC grave
- Sx: Heat intolerance, palpitation, weight loss, hyperactive
- PE: Goiter, exophalmos
- Dx: low TSH, high T4 (stimulating ab+)
- Tx
- Iodine
- Methimazole/PTU (ok for pregnancy)
- Hypothyroidism
- Cause: MC hashimoto
- Sx: Cold intolerance, bradycardia, weight gain, fatigue
- PE: Periorbital edema
- Dx: hight TSH, low T4 (thyroid antibody)
- Tx
- Levothyroxine
- Tx for drug overdose
- TSH medication therapeutic time
- Hashimoto complication
- TSH T34 both low?
- New born infant with low TSH?
- PTU vs Iodine MOA?
- Most common trigger for Thyroid storm?
- Thyroid storm Dx by?
- BB + dexamethasone
- 4-6 weeks
- NonHodgkin
- Euthyroid Sick syndrome
- Cretinism tx with Levothyroxine
- PTU - Block making + Block conversion to T3,4
- Iodine - block TSH releasing
- Infection
- Thyroid storm should not be waiting for lab, Clinical finding abnormal vital sign and hx
De Quervain’s thyroiditis
Cause/Sx/Dx/Tx
- Cause: viral infection
- Sx: Tender neck thyroid
- Dx: ESR high
- Tx: ASA
Thyroid Carcinoma
MC type/Worst Type/Risk factor/Dx/Tx
- Papillary MC - hx of acne, radiation exposure
- Anaplastic - hx of radiation exposure
- Dx: FNA (papillary), Bx(anaplastic)
- Tx: Surgery
Prolactinoma
Cause/Dx/Tx
- Cause: Pituitary adenoma
- Dx: MRI, Prolactin level 200<
- Tx: Carbergoline, bromocriptine
- TSS if medication fail
DKA vs HHS
Cause/Sx/PE/Dx/Tx
- Cause
- DKA - high sugar -> dehydrate -> ketone -> K low
- HHS - high sugar -> dehydrate -> K low
- Sx
- DAK - abd pain
- HHS - Mental change
- PE
- DKA - kassumal breathing, fruity with acetone smell
- Dx: HHS - 600<, DKA 250< + Ketone
- Tx
- IV fluid NS until 250 glucose -> change to dextros 5%
- Insulin should go with IV fluid
- KCL given
- Bicarb given
- IV fluid NS until 250 glucose -> change to dextros 5%
Gynecomastia
Sx/Hx/Tx
- Sx: Male with enlarge breast
- Hx: hx of using spironolactone
- Tx: SERM - Tamoxifen
Dawn Phenomenon vs Somogy
Insulin type
Explain
- Dawn - hyperglycemia at night - give insulin before sleep
- Somogi - hypoglycemia at night - lower insuline or give snack before sleep
- Insulin type
- Rapid (lispro, aspart) - take same time with meal
- Short (regular) - 30-60 min after meal
- intermittent (humulin N, Novoline N (NPH), humulin L, Novolin L (Lente)) - half day
- long - lantus - before bed all day
Myxedema vs Thyroid storm
Cause/Sx/Tx
- Myxedema
- Cause: Worst form of hypothyroidism
- Sx: Bradycardia, edema
- Tx: IV levothyroxine
- Thyroid storm
- Cause: Worst form of hyperthyroidism MC infection
- Sx: Tachycardia, fever
- Tx
- Propanolol -> PTU (methiazole) -> IODINE -> Hydrocortisone