Clinical questions - Endocrinology Flashcards
Subacute (de Quervain) thyroiditis
Painful goiter
mechanism: granulomatous inflammation of the thyroid presents initially with thyroid pain and hyperthyroidism with release of preformed hormone then becomes transiently hypothyroid before return to euthyroid.
Radioactive iodine uptake scan shows decreased uptake
Initial labs decreased TSH, elevated T4. At 6 months out will be elevated TSH or normal.
Tx with NSAIDs for acute inflammation Hyperthyroid sis (palpitations, fine tremor in hands): b-blocker (propranolol, atenolol) for a few weeks
No indication for methimazole or propylthiouracil as this is preformed hormone and these block synthesis.
Treatment for Cushing syndrome secondary to exogenous glucocorticoid administration
Most common cause
Taper off glucocorticoids
Treatment for Cushing syndrome secondary to Corticotroph pituitary adenoma
Elevated ACTH - True Cushings
Transsphenoidal resection +/- irradiation of pituitary
Treatment for Cushing syndrome secondary to hyperfunctioning adrenal adenoma
Primary hypercortisolism
Unilateral adrenalectomy
Treatment for Cushing syndrome secondary to ectopic ACTH production from a non-pituitary site
i.e. small cell lung cancer
Surgical resection and treatment of underlying tumor
Ketoconazole - suppresses adrenal steroid synthesis
Mitotane - kills adrenal glands
B/l adrenalectomy
followed by hormone replacement if resecting adrenal glands
Management of lactotroph adenoma aka prolactinoma
Medical management:
-Dopamine agonist to inhibit secretion of prolactin - can shrink the tumor
>Capergoline, bromocriptine
Surgical management:
- Transphenoidal resection
- Indicated if failed medical management or if female with adenoma >3 cm who desires pregnancy
Most appropriate first line treatment for newly diagnosed type 2 diabetes
metformin - always give at diagnosis
Risks of supratherapeutic doses of levothyroxine, and management of
accelerated bone loss
Arrhythmias - a fib
Mgmt:
Decrease dose
Re-evaluate labs in 6 weeks with appointment
Levothyroxine role in thyroid cancer
given after resection for replacement as well as to suppress TSH to keep cancer from growing
Most common cause of hypothyroid
Hashimoto thyroiditis - gradual decrease in thyroid hormone levels
Osteoporosis - at risk population and treatment
Increased risk: thin, post-menopausal women, whites > asians
Tx: Bisphosphonates - need to take first thing in the morning with 8 oz of water, no laying down d/t risk of pill esophagitis Ca + Vit D Wt bearing exercise at least 3x/wk fall prevention avoid smoking and heavy alcohol use
Adrenal crisis - presentation and treatment
patient with primary adrenal insufficiency with acute illness, presents with hyponatremia, hyperkalemia (both 2/2 mineralocorticoid deficiency) and hypoglycemia (2/2 glucocorticoid deficiency), can present in shock
Tx: ICU admission for hemodynamic monitoring IV dexamethasone IVF IV glucose elytes prn Tx underling cause
Counsel about stress dose PO steroids during illness and have a vial of hydrocortisone on hand if acutely ill or unresponsive
Work up for a solitary, nontender thyroid nodule
1st: labs - TSH/Free T4, Thyroid U/S
If TSH low, T4 high = hyperthyroid
> radioactive iodine uptake scan
» If HOT it’s NOT cancer - treat hyperthyroid
» If Cold get FNA - 10% are cancer
If TSH is normal with T4 normal or TSH elevated with low T4 proceed with FNA
- It is not a hot nodule if the T4 is not high
Pheochromocytoma - preoperative treatment
alpha blockade - phenoxybenzamine or phentolamine
Can use labetalol
Diagnoses that should be considered with bilateral phenochromocytoma
MEN 2 or VHL disease (Von Hippel Lindau)
