Adult Endocrine Cases

Question 1

What are the different names/methods for capillary glucose monitoring?

Answer 1

FSG (fingerstick glucose), BSG (bedside glucose), “accucheck” (first commonly used monitor in the US)

Question 2

What are the different names/methods for capillary glucose monitoring in the outpatient setting?

Answer 2

HGM (home glucose monitoring), GSM (glucose self monitoring), SBGM (self blood glucose monitoring)

Question 3

What is basal insulin?

Answer 3

The long acting insulin to achieve a more steady state of glucose control (to mimic baseline insulin levels in non-DM pts)

Question 4

How can a bolus of insulin be adjusted?

Answer 4

Can be adjusted at mealtime and based on FSG (“sliding scale”) +/- carb count anticipated to be ingested at the meal

Question 5

What are the ADA guidelines for a DM dx?

Answer 5

FPG >126 or two hour plasma glucose value >200 during a 75g OGTT or HbA1C values >6.5

Question 6

What are other names used for HbA1C?

Answer 6

GHA1c and glycosylated hemoglobin

Question 7

How often should a pt get their A1C checked?

Answer 7

Every 3-4 mo

Question 8

What are the DDx for mental status changes (AEIOUTIPS)?

Answer 8

Alcohol 
Epilepsy with seizure activity 
Infection 
Overdose 
Uremia 
Trauma 
Insulin (high or low blood sugar)* 
Poisoning/psychosis 
Stroke

Question 9

What is the DDx for Abd pain (BAD GUT PAINS)?

Answer 9

Bowel obstruction
Appendicitis, adenitis (mesenteric)
Diverticulitis, DKA*, dystenary, diarrhea, drug withdrawal
Gastroenteritis, gall bladder disease
UTI or obstruction
Testicular torsion or toxins
PNA, pleurisy, pancreatitis, perforated bowel, peptic ulcer, porphyria
Abd aneurysm
Infarcted bowel, IBD
Splenic rupture or infection, sickle cell crisis

Question 10

What is the DDx for HAGMA (GOLD MARK)?

Answer 10

Glycols (ethylene and propylene)
Oxoproline (pyroglutamic acid) or acetaminophen toxicity
L-Lactic acidosis
D-lactic acidosis (colonic metabolization of glucose, starch and other carbs by bacteria)
Methanol
Aspirin
Renal failure
Ketoacidosis (alcoholic, diabetic, starvation)

Question 11

What are the other causes of HAGMA?

Answer 11

Iron and isoniazid

Question 12

What are the differences between DKA and NKHS/HHS?

Answer 12

Fluid deficit is much greater in NKHS; some drugs can contribute to NKHS; N/V, abd pain, ketoacidosis and Kussmaul respirations are typically absent in NKHS

Question 13

What are the similarities between DKA and NKHS?

Answer 13

Insulin deficiency and glucagon excess is absolute or relative; volume depletion, mental status changes; both are critical conditions needing intensive monitoring

Question 14

What kind of monitoring needs to be performed quarterly for DM pts?

Answer 14

HbA1C, review SGM log and foot inspection for ulcerations, etc

Question 15

What kind of monitoring needs to be performed annually for DM pts?

Answer 15

Dilated eye exam, urine protein screening (microalbumin/Cr ratio), monofilament testing

Question 16

What are some features of T1DM?

Answer 16

Absolute insulin deficiency (insulin therapy required), absolute glucagon excess, volume depletion, metal status changes, autoimmune

Question 17

What are some features of T2DM?

Answer 17

Relative insulin deficiency (may or may not be on insulin), glucagon excess relative to body’s utilization/formation, volume depletion, mental status changes, obesity/inactivity/lifestyle

Question 18

What is TPO Ab?

Answer 18

Thyroid peroxidase Ab

Question 19

What is TSI?

Answer 19

Thyroid stimulating immunoglobulin

Question 20

What causes secondary thyroid disorders?

Answer 20

Pituitary dysfunction

Question 21

What causes tertiary thyroid disorders?

Answer 21

Hypothalamic dysfunction

Question 22

What are lab findings associated with primary hypothyroidism?

Answer 22

Increased TSH and decreased T4

Question 23

What are lab findings associated with primary hyperthyroidism?

Answer 23

Decreased TSH and increased T4

Question 24

What are lab findings associated with a TSH producing tumor?

Answer 24

Increased TSH and T4

Question 25

What are lab findings associated with central/tertiary hypothyroidism?

Answer 25

Decreased TSH and T4

Question 26

What does it mean to be euthyroid sick?

Answer 26

Critically ill pt; lab results don’t fit a pattern for primary, secondary or tertiary dysfunction; may be due to protein shifts, protective effect of decreased metabolism or maladaptive process; caution interpreting thyroid testing and treating in this situation

Question 27

What are the limitations to FNA?

Answer 27

Poor technique or a hypocellular sample that may not be adequate for a decision

Question 28

What changes occur with hypercalcemia on EKG?

Answer 28

Shortened QT interval

Question 29

What is the first measure of tx for hypercalcemia of malignancy?

Answer 29

Aggressive volume expansion with isotonic saline

Question 30

What are the RF for osteoporosis?

Answer 30

Estrogen depletion (natural or surgical menopause), age >70, steroid use, anorexia, malabsorption syndromes, obesity, immobility, hypogonadism

Question 31

What are the sx of rapid/acute development of hypercalcemia?

Answer 31

Polyuria, dehydration (volume depletion), renal impairment

Question 32

What are the sx associated with slow/chronic development of hypercalcemia?

Answer 32

More subtle and often not assumed to be a problem by the pt until they develop stones, develop bone problems, have psychiatric issues

Question 33

What is the initial tx for hypercalcemia with shortened QT interval?

Answer 33

Vigorous IV hydration and consider loop diuretic