Endo Flashcards
most common cause of primary hypothyroidism in the US
Hashimoto disease
MC cause of primary hypothyroidism in the world
iodine deficiency
subclinical hypothyroidism
normal T4 level and high TSH
how often should pts have TSH checked when initiating therapy for hypothyroidism
every 6 weeks after initiating treatment or changing levothyroxine doses
tx for pts who have impaired conversion of T4 to T3 in hypothyroidism
liothyronine therapy in addition to levothyroxine
primary adrenal insufficiency is also called
Addison disease
what is Addison disease
rare condition in which the adrenal cortex is unable to produce enough glucocorticoids and mineralocorticoids
what is Addison disease caused by
dysfunction or destruction of the adrenal cortex, which is located superior to the kidneys
MC cause of Addison disease
autoimmune adrenalitis
sx chronic Addison disease
weakness, fatigue, loss of appetite, a variety of gastrointestinal symptoms, weight loss, dizziness, and hypotension. Hyperpigmentation of the skin is the most characteristic physical finding of the disease and is typically generalized over the whole body.
sx acute Addison disease (crisis)
result of trauma, infection, surgery, fluid depletion, or noncompliance with medications. Patients in crisis present with severe symptoms, including high fever, nausea, vomiting, and altered mental status, and with abdominal symptoms characteristic of an acute abdomen
dx Addison disease
morning serum cortisol level and rapid adrenocorticotropic hormone stimulation test
High levels of ACTH and low levels of cortisol indicate primary adrenal insufficiency, while low levels of both ACTH and cortisol indicate secondary adrenal insufficiency
electrolyte issues in Addison disease
Hyponatremia in primary adrenal insufficiency is caused by mineralocorticoid and cortisol deficiencies and hyperkalemia is due to decreased mineralocorticoids
hypoglycemia
hypercalcemia
tx Addison disease
lifelong with a combination of glucocorticoids and mineralocorticoids.
Glucocorticoids include prednisone, hydrocortisone, and dexamethasone. Mineralocorticoid replacement is typically with fludrocortisone.
tx acute adrenal crisis
immediate hydrocortisone, intravenous fluids, vasopressors, broad-spectrum antibiotics, and correction of electrolyte abnormalities and hypoglycemia
MC cause of hyperthyroidism
Graves disease
other causes of hyperthyroidism
toxic multinodular goiters, toxic adenomas, amiodarone-induced thyrotoxicosis, and iodine-induced hyperthyroidism
eye stuff seen in graves dz
exophthalmos
tests besides T3, T4, TSH for hyperthyroidism
anti-thyrotropin receptor antibody and a thyroid-stimulating immunoglobulin test
If both are positive, it would be significant for Graves disease
tx hyperthyroidism
methimazole or propylthiouracil
preferred tx hyperthyroidism in pregnancy
propylthiouracil
Cushing disease is caused by
adrenocorticotropic hormone (ACTH)-secreting tumors found in the pituitary gland (most commonly an adenoma and rarely a carcinoma), causing an excess of corticosteroids in the body
sx Cushing syndrome
central obesity, moon face, buffalo hump, supraclavicular fat pads, protuberant abdomen, purple striae (around the thighs, breasts, and abdomen), and thin extremities due to muscle atrophy. Other symptoms include hypertension, osteoporosis
Opportunistic bacterial or fungal infections are common, as well as impaired wound healing and easy bruising
dx cushing syndrome
The diagnosis of Cushing syndrome requires the establishment of hypercortisolism in the serum or urine.
Typically, cortisol levels are lower in the evening, so a late-night salivary cortisol test that shows consistently high levels is sensitive and specific for Cushing syndrome.
An overnight (low-dose) dexamethasone suppression test uses the functionality of the hypothalamic-pituitary-adrenal (HPA) axis. When dexamethasone is given, a persistently elevated cortisol level in the morning points to Cushing syndrome (normally the HPA axis would be suppressed)
A 24-hour urinary free cortisol that is three times the upper limit of normal is suggestive of Cushing syndrome
when you confirm hypercortisolism (those initial few tests) for Cushing, what should be next
a plasma ACTH
plasma ACTH Cushing syndrome
A high ACTH level suggests a pituitary or other ectopic ACTH-secreting tumor. A low level indicates an adrenal tumor (because a glucocorticoid-producing tumor is suppressing the HPA axis). Patients with elevated ACTH levels should undergo further testing to delineate whether the source is the pituitary or an ectopic ACTH-secreting tumor. A high-dose dexamethasone suppression test can be performed. In Cushing disease, over 50% suppression will occur since pituitary adenomas are only partially resistant to negative feedback by glucocorticoids. In ectopic ACTH-secreting tumors, cortisol suppression does not occur with high doses of dexamethasone.
tx Cushing syndrome
taper of corticosteroids
Pituitary Cushing disease is treated by transsphenoidal selective resection of the pituitary adenoma
Cabergoline, ketoconazole, and metyrapone can be used to reduce levels of cortisol - if not surgical candidates
dx DM
random plasma glucose ≥ 200 mg/dL in a patient who is symptomatic, fasting plasma glucose ≥ 126 mg/dL on two separate occasions, glucose level ≥ 200 mg/dL 2 hours after oral glucose tolerance test in the serum or plasma, or hemoglobin A1C (HbA1C) > 6.5%.
Metformin should not be prescribed if pt has what GFR
under 30 mL/min/1.73 m2
vaccinations DM
yearly influenza vaccination, the pneumococcal vaccine, and the hepatitis B vaccine if previously unvaccinated. The pneumococcal vaccine should be given to patients under 65 years of age, either pneumococcal conjugate vaccine 15 or 20 may be used. If pneumococcal conjugate vaccine 15 (PCV 15) is used, then pneumococcal polysaccharide vaccine 23 (PPSV 23) should be given, where an interval ≥ 8 weeks from vaccination with PCV 15 can be considered. Current guidelines for the tetanus and diphtheria vaccinations and the herpes zoster vaccine should also be followed.
A1C goal DM
A1C goal of ≤ 7.0%
