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7. Endocrine Flashcards

1
Q

Hormone Physiology Pathway

Thyroid/Adrenal/Overies

A
  • 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
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2
Q

Primary adrenal insufficiency

2 type Cause/Sx/PE/Dx/Tx

A
  • 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)
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3
Q

Cushing syndrome

2 cause/Sx/Dx/Tx

A
  • 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
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4
Q

DM type 1

Cause/Patient/Presentation/Dx/Tx

A
  • 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
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5
Q

DM type 2

Cause/Patient/Sx/Dx/Screen/Tx

A
  • 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
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6
Q

DM Medication List

  1. Bigunides Name/MOA/SE
  2. Sulfonylureas Name/MOA/SE
  3. Meglitides Name/MOA/SE
  4. Alpha glucosidase inhibitors Name/MOA/SE
  5. TZD Name/MOA/SE
  6. GLP-1 agonist Name/MOA/SE
  7. DDP4 Inhibitor Name/MOA
  8. SGLT-2 inhibitor Name/MOA
A
  1. Metformin - hepatic low - lactic acid, Cr >1.5
  2. Glip, glime, Glybu - increase pancrea - weight gain, hypogly
  3. -glinide - increase pancrea - hypogly
  4. Acarbose, meglitol - delay instestine - hepatitis
  5. -glitazone - muscle fat sensitive increase - MI (avandia), CHF
  6. -glutide, -natide - mimic incretin, delay empty stomach - Contraindiacate hx of gastroparesis, pancreatitis
  7. -gliptin -inhibit GLP-1 degradation
  8. -gliflozin - Renal threshold
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7
Q

Hypogonadism

Cause/Sx/Related risk factor/Dx

A
  • 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
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8
Q

Multiple Endocrine Neoplasia

3 type

A
  • 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)
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9
Q

Pheochromocytoma

Cause/Sx/Dx/Tx

A
  • 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
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10
Q

Primary aldosterone

Cause/PE/Dx

A
  • 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
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11
Q

SIADH

Cause/Sx/Dx/Tx

A
  • 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
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12
Q

DI

2 type cause/Hx/Sx/Dx/Tx

A
  • 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
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13
Q

hyperparathyroidism vs hypoparathyroidism

Cause/Dx/Tx

A
  • 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
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14
Q

Lab

SIADH vs dehyration vs DI

A
  • 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
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15
Q

Acromegaly vs Dwarf

Cause/Sx/PE/Dx/Tx

A
  • 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
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16
Q

Pituitary adenoma

Cause/Related dz/Dx/Tx

A
  • 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
17
Q

Hyper vs hypothyroidism

Cause/Sx/PE/Dx/Tx

A
  • 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
18
Q
  1. Tx for drug overdose
  2. TSH medication therapeutic time
  3. Hashimoto complication
  4. TSH T34 both low?
  5. New born infant with low TSH?
  6. PTU vs Iodine MOA?
  7. Most common trigger for Thyroid storm?
  8. Thyroid storm Dx by?
A
  1. BB + dexamethasone
  2. 4-6 weeks
  3. NonHodgkin
  4. Euthyroid Sick syndrome
  5. Cretinism tx with Levothyroxine
  6. PTU - Block making + Block conversion to T3,4
    • Iodine - block TSH releasing
  7. Infection
  8. Thyroid storm should not be waiting for lab, Clinical finding abnormal vital sign and hx
19
Q

De Quervain’s thyroiditis

Cause/Sx/Dx/Tx

A
  • Cause: viral infection
  • Sx: Tender neck thyroid
  • Dx: ESR high
  • Tx: ASA
20
Q

Thyroid Carcinoma

MC type/Worst Type/Risk factor/Dx/Tx

A
  • Papillary MC - hx of acne, radiation exposure
  • Anaplastic - hx of radiation exposure
  • Dx: FNA (papillary), Bx(anaplastic)
  • Tx: Surgery
21
Q

Prolactinoma

Cause/Dx/Tx

A
  • Cause: Pituitary adenoma
  • Dx: MRI, Prolactin level 200<
  • Tx: Carbergoline, bromocriptine
    • TSS if medication fail
22
Q

DKA vs HHS

Cause/Sx/PE/Dx/Tx

A
  • 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
    1. IV fluid NS until 250 glucose -> change to dextros 5%
      • Insulin should go with IV fluid
    2. KCL given
    3. Bicarb given
23
Q

Gynecomastia

Sx/Hx/Tx

A
  • Sx: Male with enlarge breast
  • Hx: hx of using spironolactone
  • Tx: SERM - Tamoxifen
24
Q

Dawn Phenomenon vs Somogy

Insulin type

Explain

A
  • 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
25
Q

Myxedema vs Thyroid storm

Cause/Sx/Tx

A
  • 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

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