ENDO Flashcards
Diabetic neuropathy should be suspected in patients with diabetes
who have symmetric sensory changes in the feet that consist of injury to nerve fibers controlling pain, temperature, vibratory, and proprioception sense. The tuning fork test is an easy and inexpensive way to assess for the loss of vibratory sense in patients with diabetic neuropathy.
Aggressive glycemic control is the most important aspect of treatment for diabetic
neuropathy. However, for patients with severe associated pain, treatment with medications like tricyclic antidepressants, duloxetine, or certain anticonvulsant medications (gabapentin, pregabalin) can alter neuronal transmission and decrease pain. While tricyclic antidepressants are effective pain control agents for diabetic neuropathy, SSRIs are not.
Young patients with diabetes, osteoporosis, hypertension, and hypokalemia
should be screened for Cushing syndrome. Screening for Cushing syndrome can be performed by an overnight dexamethasone suppression test or measurement of 24-hour urinary free cortisol level.
Aggressive volume resuscitation is necessary in patients with a
hyperosmolar hyperglycemic state (HHS), since they are generally severely volume depleted. Intravenous insulin should be started after the patient has been partially resuscitated. Aggressive management of hyperkalemia should be avoided in these patients since these patients generally have a total body potassium deficit.
Medullary thyroid cancer (MTC) is usually sporadic
but may occur as part of multiple endocrine neoplasia type 2 (MEN2). MEN2 is also associated with pheochromocytoma in approximately 40% of cases, which can lead to life-threatening hemodynamic complications during surgery. Therefore, patients with MTC should be screened for pheochromocytoma with a plasma free metanephrines assay prior to surgery.
The first step in the evaluation of hypercortisolism (Cushing syndrome) is measurement of plasma
ACTH. A low ACTH level indicates that cortisol secretion is ACTH independent, which should prompt a CT scan of the adrenal glands to assess for an adrenal tumor (adenoma or carcinoma).
Glucagon-like peptide-1 agonists normalize blood glucose with a low risk for hypoglycemia.
In addition, they are associated with significant weight loss due to decreased gastric motility, which causes early satiety and an increased feeling of fullness. They likely also cause a direct decrease in appetite.
GLP-1 agonists increase, not decrease, postprandial glucose-dependent insulin secretion.
Sodium-glucose cotransporter-2 inhibitors (eg, empagliflozin, dapagliflozin) reduce glucose and sodium reabsorption in the proximal renal tubule.
This causes increased urinary glucose excretion, lowering blood glucose levels. In addition, the resulting natriuresis and osmotic diuresis can lower blood pressure and lead to decreased extracellular fluid volume.
Sympathomimetic weight-loss medications (eg, phentermine) induce weight loss due to decreased appetite and increased resting energy expenditure.
GLP-1 agonists may reduce appetite but do not significantly alter resting energy expenditure.
Type 1 diabetes mellitus (T1DM) is an autoimmune disorder that is often associated with other autoimmune disorders, including endocrinopathies. Unlike type 2 diabetes and monogenic diabetes,
T1DM typically presents with symptomatic hyperglycemia, including ketoacidosis, usually in young patients without obesity and without a strong family history of diabetes mellitus.
Abuse of androgen-anabolic steroids can cause decreased production of endogenous testosterone, leading to symptomatic hypogonadism.
Testosterone levels usually recover in weeks to months after discontinuation, but chronic abuse can cause prolonged or permanent suppression of endogenous testosterone production
Bisphosphonate therapy is indicated for postmenopausal women with osteoporosis (ie, T-score ≤−2.5 or fragility fracture).
It is also indicated for those with osteopenia (ie, T-score between −1.0 and −2.5) who have increased fracture risk; the 10-year fracture risk should be calculated using a standardized tool (eg, FRAX risk calculator).
Extended immobilization can cause hypercalcemia due to release of calcium from bones.
This is most common in patients with increased bone turnover (eg, adolescents, Paget disease). Bisphosphonates can decrease bone turnover and preserve bone mass.
