Endo 2 Flashcards
Dawn phenomenon
high FBG concentrations due to diurnal secretion patterns of hormones, particularly GH at 12-2am
how to determine if insulin dosing needs to be adjusted - dawn phenomenon
examine glucose patterns at least 3-4 hours after the last meal or snack and insulin bolus, as well as at 3 am
diabetic retinopathy - type 1, screen when
after age 10 years
diabetic retinopathy - type 2 screen when
refer to ophthalmologist shortly after dx; then eye exam needed every 6-12 months
insulin that lasts from meal to meal
regular insulin
insulin that lasts from breakfast to dinner
NPH
graves disease is to
hyperthyroidism
classic finding for hyperthyroidism
very low TSH w/ elevations in both serum free T4 and T3 levels
pretibial myxedema
thickening of the skin usually located in the shins and gives an orange peel appearance
pretibial myxedema is to
hyperthyroid/Grave’s disease
what antibody is positive in grave’s disease
thyrotropin receptor antibodies TRAb
thyroid peroxidase antibody TPO is positive in what
graves disease and hashimoto’s disease
preferred tx for mod to severe hyperthyroidism
PTU
med options for hyperthyroid
2
methimazole
PTU
PTU can cause what issue
liver failure
for hyperthyroidism, what med is preferred tx during the first trimester
PTU
hyperthyroidism adjunctive tx - given to alleviate the symptoms of hyperstimulation
BB
normal TSH range
0.5-5
high TSH and low free T4
hypothyroid
hashimoto’s is to
hypothyroid
gold standard test to confirm hashimoto’s thyroiditis
TPOs
classic triad of symptoms for pheochromocytoma
episodic HA
sweating
tachycardia
initial test for pheochromocytoma
24 hour urine fractionated metanephrines and catecholamines
elevated TSH and decreased serum T4 or T3
hypothyroid
overt thyrotoxicosis is defined as the syndrome of
hyperthyroidism associated with suppressed TSH and elevated serum levels of T4 or T3
diabetic retinopathy findings
6
cotton wool spots
intraretinal hemorrhages
hard exudates
microanuerysms
occluded vessels
dilated or tortuous vessels
ocular effects more specific to HTN
3
AV nicking
retinal arterial narrrowing
papilledema
myxedema coma
severe hypothyroidism leading to slowing of function in multiple organs
hallmark presentation for myxedema coma (severe hypothyroidism)
decreased mental status
hypothermia
hypotension
bradycardia
hyponatremia
hypoglycemia
hypoventilation
primary hypothyroidism lab values
high serum TSH concentration
low serum free T4 concentration
subclinical hypothyroidism labs
high TSH concentration
normal free T4 concentration
which hormones stimulates testosterone release from the testes
luteinizing hormone LH
which lab value can differentiate primary from secondary adrenal insufficiency
adrenocorticotropic hormone ACTH
primary adrenal insufficiency - clinical manifestations often include
6
fatigue
weight loss
nausea
vomiting
muscle and joint pain
hyperpigmentation
lab values for primary adrenal insuffiency
hyponatremia
hyperkalemia
anemia
low serum cortisol levels
high ACTH concentration
both serum cortisol and plasma ACTH concentrations are low - think
secondary (pituitary disease) or tertiary (hypothalamic disease) adrenal insufficiency
adrenal crisis presents as
4
tachycardia
hypotension
cool extremities
dehydration
Cushing’s syndrome features
8
striae
decreased libido
central obesity/weight gain
menstrual changes
round face
hirsutism
HTN
lethargy
initial testing for cushing’s syndrome can include
late night salivary cortisol (two measurements)
24 hour urinary free cortisol excretion (two measurements)
overnight 1 mg dexamethasone suppression test
which DM med can cause weight gain
sulfonylurea like glipizide
how does dawn phenomenon happen
there is diurnal secretion patterns of hormones at night with GH being released at midnight to 2 am which inhibits the action of insulin, causing an increase in BG In the morning
