Encocrinology Flashcards
22 year old with a basic metabolic panel is notable for a sodium level of 131 mEq/L (N 135–145) and a potassium level of 5.1 mEq/L (N 3.5–5.0). He is having nausea, poor appetite, fatigue and dizziness
Addison’s disease. Autoimmune destruction of adrenal cortex. This results in the loss of mineralocorticoid, glucocorticoid, and adrenal androgen hormone production.
What medication treatment does an Addison’s pt need
People with Addison’s disease require lifelong hormone therapy with glucocorticoids and mineralocorticoids. They also require stress-dose glucocorticoids for illnesses and before surgical procedures because they are unable to mount an adequate response to stress. Generally, the treatment will be prednisone or hydrocortisone along with fludrocortisone.
What are the two types of primary hyperaldosteronism
One is aldosteronoma in the adrenal gland that needs to be surgically fixed.
Second is idiopathicadrenal hyperplasia Which may account for up to 75% of cases
True or false, up to 5 to 15% of secondary hypertension’s are due to hyper aldosteronism
True
Signs and symptoms of hyperaldosteronism
HTN - Hypokalemia Hypernatremia Weakness Abdominal distention Ileus from hypokalemia
What are the 2 main hormones that influence the kidney and change blood volume
two main hormones that act on the kidneys to change blood volume—antidiuretic hormone and aldosterone. Both effectively increase blood volume
aldosterone- nc. Na reabsorption (inc water by osmosis
ADH - increase water reabsorption, decrease Na
concentration
What are the 4 end organs that Angiotensin II acts on
Blood vessels- vasoconstriction
Adrenals- release aldosterone
Brain- release ADH and increase thirst
Kidney- Increase Na reabsorption
Causes of Cushing’s syndrome
Causes of Cushing syndrome include administration of exogenous corticosteroids such as prednisolone, pituitary adenoma, adrenal adenoma or carcinoma, and exogenous production of ACTH (such as oat cell tumor of lung).
Cushing’s dx vs Cushing’s syndrome
Both are from excess cortisol. Cushing dx is from a pituitary tumor secreting excess ACTH
Cushing’s syndrome is diagnosed with
urinary free cortisol levels - 24hr urine collection
also dexamethasone suppression test
in addition to moon facies, buffalo hump, abd. skin purple striae, other symptoms findings include…
Hypertension, impaired glucose tolerance, and osteopenia may be seen.
What is the confirmatory test for CF
Sweat test
What is the most common cause of hyperaldosteronism?
Are all hypokalemic?
Adrenal adenoma
second is idiopathic
No
treatment for hyperaldosterone from adenoma
surgery,
potassium sparring diuretic like amiloride + HCTZ or spironolactone
longest acting injected insulin
Degludec (Tresiba) up to 42 hrs
What are the 3 releasing hormones that are released by the hypothalamus
CRH (corticotrophin releasing H) TRH (Thydrotrophic)
GHRH (Growth Hormone Releasing H)
What are the 6 Trophic hormones
TSH, ACTH, GH, Prolactin and the two gonadotrophins LH and FSH
Best test to R/O Addison’s disease
ACTH stimulation test
Graves’ disease
Autoimmune. Unclear trigger. .Antibodies attach to follicular cells. Both hypertrophy and hyperplasia occur.
What causes the proptosis in Graves’ dx
glycosaminoglycans
Best test for Addison’s disease
ACTH stimulation test (Cosyntropin)
STOP bang questionnaire for sleep apnea
snore, tierd, observe you stop breathing during sleep, pressure, BMI, age, neck size, gender
What antibiotics are most likely to increase INR
TMP/SMX, ciprofloxacin, levofloxacin, metronidazole, fluconazole, azithromycin, and clarithromycin (TABLE 2).
Low-risk agents include clindamycin, cephalexin, and penicillin G.
what happens in the esophagus with esophageal achalasia
Esophageal manometry to reveal incomplete lower esophageal sphincter relaxation in response to swallowing, high resting lower esophageal sphincter pressure, and the absence of esophageal peristalsis.
what is amblyopia
Lazy eye. USPSTF recommends screening 3-5yrs age
tapazole for hyperthyroidism takes how long to be effective
3-6 wks
What are the 3 functions of Parathyroid Hormone to increase serum Ca
- Mobilize Ca from bone (activate ostoclasts) 2.Reabsorbtion Ca in Kidney, and excrete phosphorus
- Activate Vit D for increase absorption in sm. intestine
Symptoms of hypocalcemia
mostly asymptomatic. + Chvostek’s sign (tentany) “cheek” tap + Trousseau sign (tetany) use tourniquet
What value is needed for a corrected calcium level
albumin. Low albumin, low Ca
Causes of elevated PTH
most common cause is parathyroid adenoma- primary
Secondary hyperparathyroidism is from hypocalcemia from kidney dx or vitamin D deficiency, other causes of hypocalcemia such as hypomagnesemia
Hypercalcemia symptoms
Moans, groans, stones, psych overtones – abdominal pain, constipation, decreased appetite, nausea, and vomiting, confusion
what T score on Dexa scan indicates osteopenia.
what score indicates osteoporosis?
-2.5 to -1
What is tertiary hyperparathyroidism
When secondary hyperparathyroidism leads to parathyroid hypertrophy and abnormally increased PTH from the hypertrophied gland resulting in hyperCa
what is calcitriol
Activated vitamin D- It is also known as 1,25-dihydroxycholecalciferol.
Describe calcitonin
It is secreted by the Thyroid Gland and acts to reduce Ca levels of they get too high
Besides their anatomic proximity, how is the thyroid gland endrocrinologically related to parathyroid gland
Calcitonin vs PTH in Ca regulation
Treatment of Hypercalcemia
Saline, lasix, IV Calcitonin, IV bisphosphonate (e.g Mithramycin), dialysis
When is surgery recommended for hyperparathyroidism
<50yrs old, Ca > 11.5, Osteoporosis, low GFR
What should all postmenopausal women take daily
1200 mg elemental Ca and Vitamin D
What are vitamin D supplement recommendations?
400IU infants then 600IU up to 70yrs old then 800IU per day
Psyllium is effective for lowering…
Fish oil for lowering….
LDL and Total cholesterol
Triglycerides
Does omega 3 FA have a role in primary CVD prevention? Secondary?
Nope. Nope
