Block 70,71: Endocrine Flashcards
chronic weakness, weight loss, hyponatremia, hyperkalemia with low-normal cortisol level
primary adrenal insufficiency (addison disease)
initial evaluation for Addison disease
8 AM serum cortisol
plasma ACTH
ACTH stimulation test is faster (cosyntropin test)
Lab values for Eurthroid sick syndrome
Low in total and free T3 levels
normal T4 and TSH
Riedel’s (fibrous) thyroiditits
inflammatory disorder
- fibrosclerosis of thyroid and non thyroid structures
patient has UTI that is treated. comes back days later and has dark urine. with urine sample stains positive with Prussian blue
glucose-6-phosphate dehydrogenase deficiency
a positive Prussian blue stain indicates what in urine
hemosiderin
Heinz bodies
G6PD
Most common cause of primary adrenal insufficiency in developed countires
autoimmune adrenalitis
what is the difference between primary adrenal insufficiency and central adrenal insufficiency
PAI: hyperpigmentation and hyperkalemia
Difference between follicular thyroid cancer and benign follicular adenomas
FTCL invasion of tumor capsule and/or blood vessels. Hematogenous spread to distant tissues
hyperosmolar hyperglycemic state in type 2 diabetes mellitus
severe hyperglycemia and hyperosmolality
altered sensorium
characterize corticosteroid-induced psychosis
delusions, hallucinations
weight loss, tachycardia with proptosis and impaired extraocular motion
graves ophthalmopathy
Graves disease
TSH receptor antibody
what causes Graves ophthalmopathy
T cell activation and stimulation of orbital fibroblasts by TSH receptor autoantibdoies
Type 1 multiple endocrine neoplasia
- primary hyperparathyroidsim
- pituitary tumors
- GI/pancreatic endocrime tumors
glucagonoma
hyperglycemia
necrolyic migratory erythema
weight loss
anemia
cause of hypocalcemia in alcoholics ? explain phosphorus levels
hypomagnesemia
- decreases PTH release, but Phosphorus levels are not elevated
what causes graves Ophthalmopathy
activated t cells and thyrotropin receptor antibodies on TSH receptors
what treatment can worsen graves ophthalmopathy
radioactive treatment
- raise thyrotropin receptor antibodies
treatment for macroprolactinoma ( 1cm greater) or symptomatic prolactinoma
Dopaminergic agonists
Cabergoline, bromocriptine
presenting signs of glucagonoma
- mild diabetes or hyperglycemia
- necrotic migratory erythema
most beneficial therapy to reduce progression of diabetic nephropathy is
blood pressure control
130/80 goal
what percent is normal saline
.9%
oral estrogen preparations increase levels of what? what happens when you are on thyroid replacement
thyroxine-binding globulin
- higher dose of thyroid
acute thyrotoxicosis with mild thyroid gland enlargement and suppressed TSH
painless thyroiditis
thyroid scintigraphy for painless thyroiditis shows
decreased radioiodine uptake
Is thyroid enlarged in struma ovarii
no
is thyroid enlarged in painless thyroiditis
yes
pseudodemantia
major depression in elderly
hoarsness if throat is a sign of
hypothyroidism
hypothyroidism can cause reversible changes in
memory and mentation
high volume blood transfusion can cause what
symptomatic hypocalcemia due to chelation of ionized calcium by citrate in transfused blood
- increase risk with hepatic function impaired due to decrease clearance of citrate by liver
what is and when does carpal spasm ( trousseau sign)
hypocalcemia
- flexed wrist with abduction of thumb
next step in determining hypocalcemia
check PTH then vitamin D
easy bruisability, hyperpigmentation, hyperandrogenism
cushing
Potassium level for mild primary hyperaldosteronism, especially if on diuretic
hypoK
when do you not give metformin for type 2 initially
renal insufficiency
side effect of GLP-1
weight loss and lower hypoglycemia risk
hypocalcemia, hyperphosphatemia, and increased PTH characteristic of
secondary hyperPTH in chronic renal failure
somes symptoms of hyperosmolar hyperglycemic state
neurologic symptoms ( blurry vision, lethargy)
what trigger thyroid storm
non-thyroid surgery trauma infection iodine contrast childbrith
tachycardia, hypertension, cardiac arrhthmias, high fever, tremor , altered mentation, lid lag
thyroid storm
estrogen increases the levels of what for thyroid
T4- binding globulin
Euthroid state for normal people, b/c thyroid increases production to keep up with globulin
when do you screen for diabetes
- blood pressure 135/ 80 and greater
- 45 and over
what tests do you use to screen for diabets
- fasting plasma glucose
- 2-hour oral glucose tolerane test
- Hemoglobin A1c
Name aldosterone antagonists
Spironolactone
Elperenone
What is typical for patients with central-type obesity and is the key to devleopment of type 2, hypertension, dyslipidiemia
insulin resistance
initial step in hyperosmolar hyperglycemic state
normal saline
how does hypoalbuminemia change electorlytes
decrease total serum calcium
ionized calcium remains stable
who makes vasoactive intestinal peptide (VIP)
pancreatic cells
Biggest symtpoms for VIPoma
watery diarrhea
hypokalemia
fever and sore throat is any patient taking antithyroid drug suggests
agranulocytosis
Methimazole
anti- thyroid drug
