ENDO 1 Flashcards
On abrupt discontinuation of exogenous glucocorticoids, the pituitary gland may be unable to increase ACTH secretion to meet metabolic demands for up to _____, resulting in _________
6-12 months
secondary AI.
Any patient who receives chronic glucocorticoids for _________ is at risk for developing secondary AI
≥3 weeks
Recommended add-on therapy for patients with established cardiovascular disease (eg, heart failure, myocardial infarction, coronary artery disease) includes
- Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (eg, canagliflozin, empagliflozin)
- Glucagon-like peptide-1 (GLP-1) receptor agonists (eg, semaglutide, liraglutide)
(both induces weight loss)
• Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (eg, canagliflozin, empagliflozin)
Adverse effects
Euglycemic ketoacidosis
Increased risk of genitourinary infections
• Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (eg, canagliflozin, empagliflozin)
Contraindications
Type 1 DM
History of DKA
Impaired renal function (eGFR <30 mL/min/1.73 m2)
• Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (eg, canagliflozin, empagliflozin)
Possible benefits
Reduced progression of nephropathy & albuminuria
Reduced cardiovascular morbidity & mortality
Reduced hospitalizations for heart failure
Weight loss
Thyroid hormones undergo significant enterohepatic circulation, with reabsorption in the ______
jejunum and upper ileum.
_____ is indicated for the primary prevention of atherosclerotic cardiovascular disease in all patients age ≥40 with diabetes mellitus, regardless of _________.
Statin therapy
LDL level
______ are indicated in patients with severe hypertriglyceridemia (ie, >1000 mg/dL) to reduce the risk of_______
Fibrates
acute pancreatitis
Nodium levels in plasma, Why?
Central DI
Nephrogenic DI
Central DI usually has significant hypernatremia (>150 mEq/L, due to an impaired thirst mechanism.
Nephrogenic DI usually have an intact thirst mechanism and adequate water intake; they usually compensate for renal water loss and may have a normal sodium level.
The 3 major treatment options for Graves’ disease are:
Radioactive iodine ablation (preferred in the United States)
Antithyroid drug (ATD) therapy
Thyroidectomy
Out of raloxefine and bisphosphonates, which is more effective
Raloxifene is Less effective than bisphosphonates
Effect of hyperthyroidism on bone:
hypercalcemia and hypercalciuria due to increased bone turnover.
The magnitude of prolactin elevation correlates with the _________ of the prolactinoma, and a level _____ is virtually diagnostic of prolactinoma.
size
> 200 ng/mL
RAI (131I) uptake leads to clinical and biochemical resolution of hyperthyroidism over the subsequent
6-18 weeks (not rapidly)
RAI in Graves disease leads to __________.
RAI used to treat toxic nodular goiter and toxic adenoma ______________
permanent hypothyroidism within months in >90% of patients
the radioisotope is taken up only by the autonomous thyroid tissue, and the function of the remaining normal tissue is usually adequate to prevent permanent hypothyroidism.
The dose of iodine used in RAI, although sufficient to induce radiation necrosis, is much lower than that required to
biochemically inhibit thyroid hormone synthesis.
___________ ratio suggests primary hyperaldosteronism
A PAC/PRA ratio >20 with plasma aldosterone >15 ng/dL .
primary lateral sclerosis is caused due to:
Examination findings
Upper motor neuron disease causes slowness, stiffness, and clumsiness of movement rather than proximal muscle weakness and atrophy.
Examination typically shows long tract signs (eg, hyper-reflexia, spasticity).
Postpartum endometritis occurs during the ________, most commonly in patients with __________
first 10 days after delivery
prolonged rupture of membranes or cesarian delivery.
Hypomagnesemia is an important cause of ________, particularly in alcoholics.
Mechanism:
hypocalcemia
Hypomagnesemia causes decreased release of parathyroid hormone (PTH) and PTH resistance.
Hypoparathyroidism induced by low magnesium is not associated with _____________
elevated phosphorus levels
Despite PTH deficiency, phosphorus levels are normal or low in magnesium deficiency; this is possibly due to ____________
intracellular phosphorus depletion.
treatment with __________ can worsen the ophthalmopathy in graves disease.
RAI
The most common drugs associated with myopathy are
corticosteroids, statins, and colchicine.
Alcohol, cocaine, heroin
the preferred initial test in suspected acromegaly
Insulin-like growth factor-1
the preferred initial test in suspected acromegaly
Insulin-like growth factor-1
Milk-alkali syndrome can be seen in patients taking __________ for osteoporosis.
calcium bicarbonate
Muscle weakness + hirsutism =
Cushing syndrome
Muscle weakness + hypertension, hirsutism, or demineralization of bone. =
Cushing syndrome
Changes in TFTs in cirrhosis:
↓serum binding proteins for thyroid hormones
↓total triiodothyronine (T3) and thyroxine (T4) in circulation;
free T3 and T4 levels are unchanged,
TSH will be normal, reflecting a euthyroid status.
Elevated testosterone with normal DHEAS suggests an________ , whereas elevated DHEAS suggests an _______ source.
ovarian source
adrenal
Management of diabetic ketoacidosis
Start continuous IV insulin infusion; hold if
K <3.3 mEq/L
Management of diabetic ketoacidosis
Switch to SQ (basal bolus) insulin for the following:
able to eat,
glucose <200 mg/dL,
anion gap <12 mEq/L
serum HCO3− ≥15 mEq/L
Management of diabetic ketoacidosis
Phosphate replacement
Consider for serum phosphate <1.0 mg/dL,
cardiac dysfunction,
or
respiratory depression
Management of diabetic ketoacidosis
Frequent clinical and laboratory monitoring is indicated:
♣ the anion gap, electrolytes, and venous pH are measured every 2-4 hours,
♣ serum glucose is measured hourly.
