Assessment of Endocrine Disorders 2 Flashcards
Management of endocrine disorders
need to understand metabolism, reproductive physiology, bone metabolism & growth
relies on history & physical
Practice for endocrine disorders
linked to understanding of hormone secretion, action & feedback control principles
Evaluation of endocrine disorders
measuring hormone concentration, function & feedback
What is important to assess endocrine disorders?
understanding physiology (feedback loops)
What are the 3 causes of endocrine dysfunction?
hormone excess
hormone deficiency
hormone resistance
What does clinical evaluation of endocrine dysfunction include?
physical exam ROS presenting symptoms family & social history meds knowledge of disease prevalence & pathophysiology
How to measure hormones
immunoassays
plasma & urinary samples
correct interpretation in clinical context
When is a suppression test used?
assess endocrine hyperfunction
When is a stimulation test used?
asssess endocrine hypofunction
Treatment of endocrine disorders
replace hormone deficiency
suppress excessive hormone production
What do you screen for in hypothyroidism?
TSH (confirm w/ free T4)
screen women after age 35
How should you screen for thyroid nodules & neoplasia?
physical exam of thyroid
fine needle aspiration biology
What do you screen for in hyperparathyroidism?
serum calcium
PTH
assess comorbid conditions
What is the major role of the thyroid gland?
metabolism
What are some common HPI findings for hyperthyroidism?
weight loss
anxiety
heat intolerance
increased appetite
What are some causes for hyperthyroidism?
Graves disease
Subacute thyroiditis
Amiodarone (Beta blocker that induces thyroiditis)
What are some hyperthyroid differential possibilities?
general anxiety or panic
mania
cancer
exopthalmos
What are some common HPI findings for hypothyroidism?
fatigue weight gain cold intolerance depressed mood less metabolism (no appetite)
What are some potential causes of hypothyroidism?
Hashimoto thyroiditis
Iodine deficiency
Drugs (PTU, methimazole)
Subclinical hypo w/ elevated TSH
What are some differential possibilities for hypothyroidism?
depression
chronic fatigue syndrome
heart failure
anemia
How do you examine the thyroid?
posterior approach
What is an enlarged thyroid gland?
goiter
How does Grave’s disease present?
Proptosis
Exopthalmos
What is associated with hyper PTH?
bones, stones, abdominal moans & psychic groans
increased calcium & PTH
What do the PTH glands regulate?
regulate calcium levels (no effect on metabolism)
How do you assess for hypocalcemia?
Trousseau (muscle spasm w/ BP cuff) & Chvostek signs (facial muscle twitch)
Symptoms/signs of excess PTH hormone secretion
bone disease (osteopenia) nephrolithiasis increased production of calcitriol hypophosphatemia prox renal tubular acidosis gout anemia
Clinical manifestations of hypercalcemia
polyuria
polydipsia
muscle weakness
bradycardia & hypertension
vomiting, nausea
Direct Abnormalities of Primary Hyperparathyroidism
nephrolithiasis & bone disease (b/c prolonged PTH excess)
symptoms attributable to hypercalcemia
anorexia
nausea
constipation
polydipsia & polyuria
What are potential causes of hyperparathryoidism?
PTH adenoma & carcinoma
multiple endocrine neoplasia
chronic renal failure
What should be included on differential consideration of HPTH?
hypercalcemia of malignancy multiple myeloma familial hypocalciuric hypercalcemia vit D intoxication sacroidosis hyperthyroidism
What are common causes of hypoparathyroidism?
surgical removal of glands in thyroidectomy
DiGeorge syndrome
hereditary autoimmune syndrome
What are some signs & symptoms of hypo PTH & hypocalcemia?
neuropsych (seizures, anxiety)
neuromusc (numbness around mouth)
CV (hypotension)
Autonomic
Cushing’s syndrome
caused by overproduction of ACTH by pituitary or ingestion of exogenous corticosteroids
What are some presentations assoc w/ Cushing’s syndrome?
HTN Central obesity weakness hirsutism depression
What are some signs of Cushing syndrome?
overproduction of cortisol
round or red face purple streaks across skin buffalo hump bruising excessive hair growth
What are causes of adrenal insufficiency?
primary (Addisons)
secondary (pituitary failure or excess exog steroids)
What are some clinical manifestations of adrenal insufficiency?
hyperpigmentation (b/c increased ACTH)-skin & oral weakness fatigue anorexia nasuea & vomiting hypotension salt craving
What are some differential considerations for adrenal insufficiency?
hypotension
hyperkalemia (renal failure)
cancer
What is associated w/ pituitary disorders?
usually due to pituitary adenoma
How to document endocrine disorders?
CC HPI ROS (vague) Medical History Physical Exam
