EM - Endocrine Flashcards by Kienan W

etiology of addisons disease

autoimmune

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MC autoantigen in addisons disease

21-hydroxylase

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result of different deficiencies in addison’s disease

-21 hydroxylase: decreased cortisol and aldosterone and increased androgen
-CYP11A1: decreased cortisol and testosterone and increased aldosterone
-12-alpha-hydroxylase: decreased aldosterone and testosterone and increased cortisol

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s/s of addisons disease

-hyperpigmentation
-anorexia
-weight loss
-fatigue
-abdominal pain
-hypotension
-change in body hair

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s/s of adrenal crisis

-severe fever
-abdominal pain with n/v
-hypotensive shock

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diagnosis of addison’s disease

-ACTH stimulation test
-8am plasma cortisol <3

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treatment of addison’s disease

hydrocortisone

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etiology of cushing’s syndrome

-exogenous cortisol
-ectopic secretion of ACTH or CRH

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s/s of cushing’s syndrome

-weight gain
-buffalo hump
-striae
-menstrual irregularities

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Diagnosis of Cushing’s Syndrome

-24 hour urine free cortisol
-dexamethasone suppression
-late night salivary cortisol

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treatment of cushing’s syndrome

-titrate down dose
-surgical removal of tumor

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etiology of diabetes insipidus

-primary: increased secretion of ADH (I thought it was Lack of ADH??)
-secondary: damage to the hypothalamus or pituitary stalk
-nephrogenic: defect in kidneys

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s/s of diabetes insipidus

-thirst
-polyuria

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diagnosis of diabetes insipidus

-24 hour urine collection
-water deprivation followed by vasopressin challenge test

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interpretation of vasopressin challenge test

-central: decrease in thirst and polyuria
-psychogenic: improves after patient stops drinking water
-nephrogenic: thirst and polyuria doesn’t improve

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treatment of diabetes insipidus

Desmopressin

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Diagnosis of Diabetes

FPG >126
2h PPG >200
A1c >6.5% (7?)

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etiology of diabetic ketoacidosis

-insulin deficiency
-triggered by illness, trauma, pregnancy etc.

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s/s of diabetic ketoacidosis

-n/v
-abdominal pain
-fruity breath
-kussmaul respirations

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diagnosis of DKA

-elevated glucose (>250?or is it 5 hundo)
-low bicarb (<7.3, <15bicarb?)
-B-hydroxybutyrate
(Anion Gap?)

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management of DKA

-fluid repletion
-insulin
-potassium

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etiology of primary hyperparathyroidism

-adenoma

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s/s of primary hyperparathyroidism

-hypercalcemia
-often asymptomatic
-“getting old” sx

diagnosis of primary hyperparathyroidism

-elevation of PTH
-24 hour urine calcium
-low phosphate

treatment of primary hyperparathyroidism

-parathyroidectomy -sensispar

etiology of secondary hyperparathyroidism

CKD

s/s of secondary hyperparathyroidism

-hypocalcemia -elevated phosphorus

treatment of secondary hyperparathyroidism

Tx CKD

etiology of hypothyroidism

-US: hoshimotos -worldwide: iodine deficiency

s/s of hypothyroidism

-dry skin -weight gain -cold intolerance -constipation

diagnosis of hypothyroidism

-low T4, high TSH -anti-TPO

s/s of myxedema crisis

-hypothermia -hypoventilation -hyponatremia -hypoglycemia -hypotension From sever hypothyroidism :(

treatment of hypothyroidism

levothyroxine

etiology of hyperthyroidism

-graves disease -excess iodine

s/s of hyperthyroidism

-tachycardia -weight loss -heat intolerance -bulging eyes

diagnosis of hyperthyroidism

-Low TSH, high T3 and T4 -anti-TSI -radioactive iodine uptake scan

treatment of hyperthyroidism

-methimazole -PTU -radioactive iodine destruction -surgery

etiology of hyperglycemic hyperosmolar state (HHS)

-relative insulin deficiency

s/s of HHS

-extreme dehydration -thirst -lethargy -mental confusion -hypotension

diagnosis of HHS

-BS 600-1200 -pre-renal azotemia

treatment of HHS

-fluid repletion -insulin -potassium

etiology of subacute thyroiditis

-viral URI

etiology of suppurative thyroiditis

nonviral thyroid gland infection

etiology of riedel thyroiditis

-systemic fibrosis

treatment of subacute thyroiditis

ASA or NSAIDs

treatment of suppurative thyroiditis

ABX ( I think a PEN)

treatment of riedel thyroiditis

tamoxifen

Ah geez typo uhhhh sawy

occurs in an attempt to maintain a specific posture or position against the force of gravity

simple kinetic tremor

during voluntary movements that are not target directed

action postural tremor

occurs in an attempt to maintain a specific posture or position against the force of gravity

intentional tremor

worsens as the body part approaches its target

task specific tremor

-occurs during a specific task (derrr)

action isometric tremor

-occurs during a muscle contraction against a rigid stationary object

s/s of essential tremor

-bilateral -hands and arms -goal oriented movements -resolves with rest -exacerbated by emotion, hunger, fatigue -improves with alcohol -progressive overtime

diagnostic criteria of essential tremor

-isolated tremor consisting of bilateral upper limb action -at least 3 years in duration -with or without tremor in other locations -absence of other neurologic signs

management of essential tremor

Propranolol and primidone