Behavioral Science Flashcards
excessive growth of hair in women in androgen-dependent areas, typically the upper lip, chin, neck, chest, lower abdomen, & perineum
hirsutism
Cosmetic disturbances are due to increase in number and thickness of coarse dark terminal hairs.
What is the difference between hirsutism & virilization?
In virilization the magnitude of androgen excess is greatly increased. In virilization the woman has temporal hair recession: male-pattern baldness, deepened voice, increased muscle mass, clitoral enlargement, signs of defeminization
Distinguishes thyrotoxicosis from anxiety
Cognitive impairment, tachycardia, fatigue accompanied with desire to be active, warm dry hands (rather than cool and clammy)
Psychiatric treatment plan for endocrine disorders
Treat the underlying endocrine condition first and the psychiatric aspects typically resolve.
Diagnostic for thyrotoxicosis
Elevated T4 with depressed TSH
Treatment for thyrotoxicosis
Beta blocker to manage symptoms
Propylthiouracil
Methimazole
Radioactive iodine
Risk of radioactive iodine treatment for hyperthyroidism
Lifelong hypothyroidism that presents within 1-2 years of tx
Preferred antipsychotics for psychosis in hyperthyroidism
Quetiapine
Olanzapine
Common presenting complaints with hypothyroidism
Progressive cognitive dysfunction with slow comprehension, impaired attention, recent memory, abstract thinking
Personality changes may also be present.
Frequently present with DEPRESSION
Most sensitive diagnostic for autoimmune thyroiditis (Hashimoto)
Antithyroid peroxidase antibody with hypothyroidism or goiter
What drug used long term has increased risk of causing hypothyroidism?
Lithium
Low T4 and FTI with a normal or minimally elevated serum TSH in the absence of clinical hypothyroidism
Euthyroid sick syndrome
Mechanism appears to be to conserve body nitrogen during states of severe stress
Significantly inhibit secretion of TSH
Glucocorticoids
Dopamine
Causes of false positive results of dexamethasone suppression test
Obesity Depression Acute stress Alcohol withdrawal Drugs: estrogens, phenytoin
Hypercortisolism with major mood disorder or alcohol withdrawal
Pseudo-Cushing’s syndrome
Agents used to inhibit cortisol biosynthesis in treatment of Cushing’s
Aminoglutethimide
Metyrapone
Ketoconazole
Why should antidepressants be avoided in hypercortisolism?
May precipitate manic episode
Misdiagnosed conditions that were really adrenal insufficiency (Addison’s)
Depression
Hypochondriasis
Conversion disorder
Diagnostic for primary adrenal insufficiency
Clearly elevated serum ACTH
Abnormal Cortrosyn test
Low 8 AM serum cortisol or 24 hour urinary free cortisol excretion
Treatment of Addison’s disease
Glucocorticoid and mineralocorticoid replacement
Patients at risk for HPA suppression
Treatment with supraphysiologic doses of glucocorticoids for more than 2 weeks
Causes of hypoparathyroidism
Accidental damage in thyroidectomy or radical neck surgery for cancer
Magnesium deficiency (alcoholism)
Neck irradiation
Autoimmune disorder
Drug of choice for diabetic neuropathy
Gabapentin
Most common causes of fasting hypoglycemia
Insulin Sulfonylureas Alcohol Salicylate Propranolol
