Endicrinology Flashcards
Prolactinoma Presentation
Female- Amenorrhea, Galctorrhea, Microadenoma
Male-Decreased libido, Macroadenoma visual field changes
Pralctinoma Dx
Medications
TSH
Prolactin
MRI to find tumor
Prolactinoma Treatment
Dopamine Agonists
Carbegoline>Bromocriptine
Acromegaly Presenation
kids-gigantism Adults-Hands, Feet, Face]visceral organs diabetes, Diastolic HF Dx: ILGF-1 Glucose Supression Test Tx: Surgery Octreotide
Hypopituitarism Acute Causes
Infection, Infarction, Iatrogenic
Hypopituitarism Acute Presentation
Cortisol-Hypotensive, Tachycardia TSH-Lethargy, Coma Dx: Cortisol T4 Tx: Replace hormones
Diabetes Insipidus Presentation
Polydipsia, Polyuria, Normal glucose, no glucose in the urine
Dx: H2O Deprivation test
Tx: PP- stop drinking water
Central- DDAVP
Nephrogenic-Gentle Diuresis, HCTZ, Amiloride
H20 Deprivation Results
increase uOSM=PP
Give ADH-uOSM and it corrects means central
Give ADH with no change means nephrogenic
SIADH Presentation
Pt: Hyponatremia Dx: U/A- uNa increased increase uOsm sOsm decreased Tx: Water Restriction Demeclocycline
Hyperthyroidism Presentation
Tachycardia, Diarrhea, Heat intolerance, increased DTR, Weight loss, A-Fib
Dx: TSH decreased
Free T4 increased
Tx: Surgery
Radioactive iodine ablation for everything else
Hypothyroidism Presentation
Bradycardia Constipation decreased DTR Weight gain Dx: TSH increased T4 Decreased RAIU Tx: Levothyroxine
Treatment for thyroid storm
- Propanolol
- PTU/methimazole
- Steroids
Thyroid Nodule history risk of cancer
Hx of radiation to the head and neck
H/O of cancer or cancer in the family
Hoarseness
Age, <20, >60
Thyroid nodule Physical exam for risk of cancer
Fixed, Firm, Hard, Non-tender Lymph nodes
U/S: Solid, Hypoechoic, Size >2cm
Microcalcifications, irregular borders
Thyroid nodule <1 cm
Repeat U/S in 6-12 months
Thyroid Nodule >1 cm
FNA
FNA findings thyroid
CA- Resection
Not CA- Repeat U/S 6-12 months
Inconclusive-repeat FNA
Paipillary CA description
Most common
Orphan Annie Nuclei
Ts: Resection
Follicular CA description
FNA shows normal thyroid
hematogenous spread
Tx: Radioactive iodine ablation
Medullary CA description
C-cells, Calcitonin
Associated with MEN 2A 2B
RET oncogene and pheochromocytoma
Anaplastic CA description
affects the elderly
Locally invasive usually fatal
Cushing Syndrome Presentation
HTN, Diabetes, Obesity,
Acne (Moon Facies), Truncal obesity, Buffalo Hump, Purple Striae
Cushing Sydrome Diagnostic tests
Low dose dexamethasone suppression-if cushings should fail to suppress cortisol THEN
check ACTH level
if low then do high dose dexa suppression
Cushing Syndrome ACTH normal
primary adrenal tumor
MRI Resection
Cushing Syndrome ACTH elevated
ACTH dependent THEN
High dose dexamethasone
Fails-Ectopic tumor
Suppressed-Cushing disease from pituitary tumor -resection
if you get the low dose dexamethsone test what other tests should you get?
24 hour urine cortisol or
late night salivary cortisol
you need two tests to says cushing syndrome
Addisons disease Acute Presentation
Nausea, Vomiting, Hypotension, Coma - At deaths door
Addisons disease Chronic presentation
Orthostatic, Hyperpigmentation, decreased Na and increased potassium
Addisons disease Diagnostic tests
- Early AM cortisol
- Cosyntropin Stimulation
(Give ACTH)
Consyntropin Stim Test increases Cortisol, Addisons disease
Anterior Pituitary problem
MRI
Replace Cortisol
Cosyntropin Stim Test No change in cortisol, addisons
Adrenal Gland
CT/MRI
Cortisol & Fludrocortisone
Conn Syndrome Presentation
HTN, Hypokalemia
secondary hypertension-to 3 or more medications
Conn Syndrome aldosterone:renin=>30
Aldosterone increased
Renin Decreased
Conns
do salt suppression test
doesnt suppress perfomr MRI
perform adrenal vein sampling
Conn syndrome
Increased aldosterone
Increased Renin
Ratio <10
Renal vascular disease
FMD-Stent
AS-no stent
Pheochromocytoma Presentation
Paroxysmal pain-HA
Pressure-HTN
Palpitations-HTN
Perspiration
Pheochromocytoma diagnostic tests
Plasma free catecholamines
24 hr urine metanephrines, VMA
CT/MRI Abd
Adrenal vein sampling
Pheochromocytoma Treatment
first Alpha blockade
then Beta blockade
Then resect
Diabetes screening Random BG
one time plus symptoms
>200
Diabetes screening Fasting BG
two times
>125=DM
100-125=pre diabetes
<100= normal
Diabetes screening HbA1c
> 6.5=DM
5.7-6.5=Pred diabetes
<5.7=Normal
Contraindications for metformin
CKD, CHF, Liver disease
Biguanides-Metformin AE
Diarrhea
Sulfonylureas-glipizides/glyburide AE
Hypoglycemia
TZD-glitazone AE
CHF, weight gain
DDP4i-gliptins
Weight neutral
glp1-utides
weight loss
a-glucosidase-acarbose
diarrhea, flatulence
SGLT2i-gliflozins
euglycemia, DKA
hypoglycemia in non-diabetic
check C-peptide
decreased=injecting-factitous
increased C-peptide in non-diabetic, hypoglycemia
secretagogue screen positive-ingesting negative-insulinoma 72 hr fast CT/MRI/Abd
Diabetic with hypoglycemia Treatment
Awake-PO Glucose
Come- IV D50
DKA presentation
too much sugar Diabetes, Coma, Ketones, Acidosis Dx: BG>300-500 U/A-Ketones ABG:Acidosis BMP: GAP,K
DKA Treatment
Glucose: 10u IV insulin
GAP: NS/LR BMP -When BG normalizes gap is open give D5 1/2 normal
Potassium: check potassium is >4 before insulin and replace when is low
