Endo Flashcards
Dx of SIADH
-euvolemia
- no diuretics in 24-48 hours
- urine osm high + low serum Na and osm
SIADH treatment
- fluid restriction <800 cc/24 hours over severe days to correct hypoosmolality
- treat underlying cause
- For servere hypoNa w/ seizures/obtunded –> 3% saline
Oral diabetes medications that have been FDA approved for secondary prevention of CVD
liraglutide (GLP1)
Empagliflozin (SGLT2)
monitoring DM in patients with hemoglobinopathies (falsely lower A1c)
Fructosamine
Dx in graves
RAIU: diffuse
+Thyrotropin receptor abx
(no uptake in thyroiditis, post partum thyroiditis, subacute thyroioditis)
Postpartum thyroiditis
Transient or persistent thyroid dysfunction within 1 year childbirth
-MOA: release of preformed thyroid hormone
- Dx: RAIU is LOW during hyperthyroid phase
- preg/breast feeding are CI to RAIU
When is thyroid US indicated?
only if palpable abrnomality of thyroid gland
Hashimotos (autoimmune thyroiditis)
+ TPO ab, sx of HYPOthyroidism
BMI with most benefit for bariatric surgery
> 40
Rotterdam criteria
Need 2/3:
1. hyperandrogenism
2. annovulatory cycles
3. at least one polycystic ovary
meds/conditions that alter metabolism of levothyroxine
gastritis
h pylori
chronic PPI
inc by 30%
Contraindications for GLP1
medullary thyroid CA or MEN
impaired fasting glucose
100-125
DM meds that cause weight gain
sulfonylureas, thiazolidinediones, insulins
GFR cut off for prescribing metformin
men 1.5
women 1.4
A1c to start insulin
> 9
Metformin should be first line regardless
Absolute contraindications to testosterone replacement
Hct >54%, PSA >4, breast/prostate CA, nodules on DRE
Hct >50% is relative CI
first line tx of RA
methotrexate (DMARD)
- starting within 3 mo leads to sustained remission
- underlying liver disease is a contraindication to MTX
First dx test in thyroid concern always? W/u if nodule on exam?
TSH, than US if nodule
If nodule?
Low »_space; RAUI
High»_space; FNA
impacts of over treating hypothyroidism
afib
osteoporosis
tx of Graves
1= radioactive idoine ablation
2= Methimazole (1st line), PTU (2nd line)
when is PTU considered first line
1st tri pregnancy and lactation
thyroid nodules epidemiology
95%= benign adenoma
5%= malignant
Of malignant lesions, 60% papillary,12% follicular
goal TSH in pregnancy
how to adjust levothyroxin
<3
Inc by 25-50%
survival outcomes after weight loss surgery:
-all cause mortality
-DM
Mortality benefit over non-surgical methods; all cause mortality dec 30-50% at 7-15 years
DM remission in large proportion of patients at 2 years
lab monitoring for nutritional deficiency after bariatric surgery
q3 mo for one year then annually
1st line tx of DM if presenting with weight loss
Insulin! patient is in a catabolic state
female athlete triad
low energy relative to needs
ex: exercising beyond caloric store
irregular periods from hypothalamic shut down, impaired bone mineral density
t/f breastfeeding decreases risk f DM
true
also HTN, CVD
Test after adrenal incidentaloma
dexamethasone suppression test
Factors associated with an increased risk of osteoporosis
include smoking, excessive alcohol consumption, low body weight, and a parental history of hip fracture.
Elevated ALP, nrmal GTT
Think Pagets»_space; order xray pelvis, tibia, skull»_space; if pagets, order radionucleotide bne scan
