Assessment of Endocrine Disorders 2

Question 1

Management of endocrine disorders

Answer 1

need to understand metabolism, reproductive physiology, bone metabolism & growth

relies on history & physical

Question 2

Practice for endocrine disorders

Answer 2

linked to understanding of hormone secretion, action & feedback control principles

Question 3

Evaluation of endocrine disorders

Answer 3

measuring hormone concentration, function & feedback

Question 4

What is important to assess endocrine disorders?

Answer 4

understanding physiology (feedback loops)

Question 5

What are the 3 causes of endocrine dysfunction?

Answer 5

hormone excess
hormone deficiency
hormone resistance

Question 6

What does clinical evaluation of endocrine dysfunction include?

Answer 6

physical exam
ROS
presenting symptoms
family & social history
meds
knowledge of disease prevalence & pathophysiology

Question 7

How to measure hormones

Answer 7

immunoassays
plasma & urinary samples
correct interpretation in clinical context

Question 8

When is a suppression test used?

Answer 8

assess endocrine hyperfunction

Question 9

When is a stimulation test used?

Answer 9

asssess endocrine hypofunction

Question 10

Treatment of endocrine disorders

Answer 10

replace hormone deficiency

suppress excessive hormone production

Question 11

What do you screen for in hypothyroidism?

Answer 11

TSH (confirm w/ free T4)

screen women after age 35

Question 12

How should you screen for thyroid nodules & neoplasia?

Answer 12

physical exam of thyroid

fine needle aspiration biology

Question 13

What do you screen for in hyperparathyroidism?

Answer 13

serum calcium
PTH
assess comorbid conditions

Question 14

What is the major role of the thyroid gland?

Answer 14

metabolism

Question 15

What are some common HPI findings for hyperthyroidism?

Answer 15

weight loss
anxiety
heat intolerance
increased appetite

Question 16

What are some causes for hyperthyroidism?

Answer 16

Graves disease
Subacute thyroiditis
Amiodarone (Beta blocker that induces thyroiditis)

Question 17

What are some hyperthyroid differential possibilities?

Answer 17

general anxiety or panic
mania
cancer
exopthalmos

Question 18

What are some common HPI findings for hypothyroidism?

Answer 18

fatigue
weight gain
cold intolerance
depressed mood
less metabolism (no appetite)

Question 19

What are some potential causes of hypothyroidism?

Answer 19

Hashimoto thyroiditis
Iodine deficiency
Drugs (PTU, methimazole)
Subclinical hypo w/ elevated TSH

Question 20

What are some differential possibilities for hypothyroidism?

Answer 20

depression
chronic fatigue syndrome
heart failure
anemia

Question 21

How do you examine the thyroid?

Answer 21

posterior approach

Question 22

What is an enlarged thyroid gland?

Answer 22

goiter

Question 23

How does Grave’s disease present?

Answer 23

Proptosis

Exopthalmos

Question 24

What is associated with hyper PTH?

Answer 24

bones, stones, abdominal moans & psychic groans

increased calcium & PTH

Question 25

What do the PTH glands regulate?

Answer 25

regulate calcium levels (no effect on metabolism)

Question 26

How do you assess for hypocalcemia?

Answer 26

Trousseau (muscle spasm w/ BP cuff) & Chvostek signs (facial muscle twitch)

Question 27

Symptoms/signs of excess PTH hormone secretion

Answer 27

``` bone disease (osteopenia) nephrolithiasis increased production of calcitriol hypophosphatemia prox renal tubular acidosis gout anemia ```

Question 28

Clinical manifestations of hypercalcemia

Answer 28

polyuria polydipsia muscle weakness bradycardia & hypertension vomiting, nausea

Question 29

Direct Abnormalities of Primary Hyperparathyroidism

Answer 29

nephrolithiasis & bone disease (b/c prolonged PTH excess)

Question 30

symptoms attributable to hypercalcemia

Answer 30

anorexia nausea constipation polydipsia & polyuria

Question 31

What are potential causes of hyperparathryoidism?

Answer 31

PTH adenoma & carcinoma multiple endocrine neoplasia chronic renal failure

Question 32

What should be included on differential consideration of HPTH?

Answer 32

``` hypercalcemia of malignancy multiple myeloma familial hypocalciuric hypercalcemia vit D intoxication sacroidosis hyperthyroidism ```

Question 33

What are common causes of hypoparathyroidism?

Answer 33

surgical removal of glands in thyroidectomy DiGeorge syndrome hereditary autoimmune syndrome

Question 34

What are some signs & symptoms of hypo PTH & hypocalcemia?

Answer 34

neuropsych (seizures, anxiety) neuromusc (numbness around mouth) CV (hypotension) Autonomic

Question 35

Cushing's syndrome

Answer 35

caused by overproduction of ACTH by pituitary or ingestion of exogenous corticosteroids

Question 36

What are some presentations assoc w/ Cushing's syndrome?

Answer 36

``` HTN Central obesity weakness hirsutism depression ```

Question 37

What are some signs of Cushing syndrome?

Answer 37

overproduction of cortisol ``` round or red face purple streaks across skin buffalo hump bruising excessive hair growth ```

Question 38

What are causes of adrenal insufficiency?

Answer 38

primary (Addisons) secondary (pituitary failure or excess exog steroids)

Question 39

What are some clinical manifestations of adrenal insufficiency?

Answer 39

``` hyperpigmentation (b/c increased ACTH)-skin & oral weakness fatigue anorexia nasuea & vomiting hypotension salt craving ```

Question 40

What are some differential considerations for adrenal insufficiency?

Answer 40

hypotension hyperkalemia (renal failure) cancer

Question 41

What is associated w/ pituitary disorders?

Answer 41

usually due to pituitary adenoma

Question 42

How to document endocrine disorders?

Answer 42

``` CC HPI ROS (vague) Medical History Physical Exam ```