Endo #2 Flashcards
Thyroid Scanning (Thyroid Scintiscan) what is it ?
Radioactive substance is given to patient and the thyroid uptakes the isotope
Camera is passed over the neck and thyroid can be visualized
**the T uptakes the isotope and it makes it glow when u take images and you are looking for thyroid nodules **
Thyroid Scanning (Thyroid Scintiscan) when is it used ?
Evaluate for thyroid nodules
Thyroid Scan Classifies the nodule or mass: nonfunctioning ?
Cold
- *nonfucniton or inactive - cold
- *
Thyroid Scan Classifies the nodule or mass functioning ?
Hot
** active - hot
functioning like T NL functions - HOT
not function NL like T then it will not pick up the Isotope
HOT - lighting up even after the rest of the T is done with the isotope **
Thyroid Scan: Hot result ?
Graves disease
Ig attacking TSH receptors making the area more active
Toxic goiter
is it functioning or not, G enlarged cause T was over active = toxic, or is it there from inflammation or destruction - differenacite between the two
Functional adenoma
Thyroid Scan: Cold result ?
Thyroiditis
Non-toxic Goiter
Carcinoma - not normal functioning tha T normally does
Cyst
Nonfunctional Adenoma
Thyroid Scan own notes ?
Iodine deficiency - non toxic - over worked over time
US = FNA - feel a mass do this test to see if it is H or C and, a US to see if it is a cysts or not and put a needle in the area and get a bx sample
Glucose Testing own notes ?
L - gametogenesis
H blood glucose levels makes insulin releases from the P which drive G into the cell and it makes the L take G out of the blood and store it as glycogen
L blood glucose it acts on the P to cause glycogen release and release G into the blood
frequency I use and no eating - hypo
Dm is actually a high blood sugar problem
to high G they can go into ketoacidosis and electrolyte distrunabces
Glucose Testing types ?
Random Blood Glucose
2 hour post-prandial glucose
Fasting Blood Glucose
Hemoglobin A1C
Who should get tested: Testing for TII Diabetes and Prediabetes in asxs. adults ?
TII Diabetes testing should be done in all adults who are overweight or obese
BMI > equal to 25 or 23 in sia americans, who have > or equal to 1 diabetes risk factor.
Diabetes risk factors ?
Physical inactivity
first degree relative with D
high risk ethnicity
Women who delivered a baby > 9 lbs or dx with GDM
HDL-C <35 +- TG >250
HTN (>140/90)
A1C > or equal to 5.7%, IGT or IFG
condition associated with insulin resistance: obesity, acanthuses nigerians, PCOS
CVD hx.
**impaired glucose tolerance - IGT
PCOS - polycystic ovarian syncrome **
Who should get tested? Age ?
Testing should begin at age 45, especially if individual is overweight or obese
Who should get tested? If NL results ?
repeat testing in > or equal to 3 yr intervals
Hgb A1C what is it ?
About 7% of Hgb A can combine with glucose in a process called glycosylation (not easily reversed)
Hgb A1C when is it used ?
Diagnose and/or monitor diabetes
Takes 3 weeks to rise and 4 weeks to decrease
Hgb A1C what does it mean ?
Gives a percentage (glucolyciyaed in the serum) that corresponds to an average blood glucose range
Average daily blood sugar - 135 = what A1C level ?
6%
Average daily blood sugar - 170 = what A1C level ?
7%
Average daily blood sugar - 205 = what A1C level ?
8%
Average daily blood sugar - 240 = what A1C level ?
9%
Average daily blood sugar - 275 = what A1C level ?
10%
Average daily blood sugar - 310 = what A1C level ?
11%
Average daily blood sugar - 345 = what A1C level ?
12%
Hgb A1C own notes ?
typically it is quarterly - every three months
great patients and young and health - 6 months
lover than 7 for non preg.
anything about 6.5% is Diabete and we want to keep out D around 7% ( more stringent = <6.5%)
5.7-6.4% pre DM - they are become insulin resistance - body is need more I to do the job it used to do
Need I to open the door for G to get into the cell
No Insulin then TI DM
TII - rusty dorr hinges - I used to be able to open door , now there need two big men to open door cause the door is resistant ( adipose, fat cell - reduce insulin = obese patients, diet - attack P with high glucose over and over build resistance)
drugs to increase I from the P or used the I they have in a more effective way
Impaired fasting glucose - pre DM
2 hr post-prandial glucose (PPG) what is it ?
Measurement of the amount of glucose in the blood 2 hrs after a meal is ingested.
Meal acts as a glucose challenge.
Usually glucose levels return to “pre-meal” range after 2 hours
2 hr post-prandial glucose (PPG) when is it used ?
Evaluate for diabetes
2 hr post-prandial glucose (PPG) NL ?
≤ 140 mg/dL
2 hr post-prandial glucose (PPG) Diabetes value ?
≥ 200 mg/dL
2 hr post-prandial glucose (PPG): Values between ___-___ should be rechecked with another test ( this is the impariened fasting glucose level )
140-200
2 hr post-prandial glucose (PPG) own notes ?
2 hours after a meal is ingested
used they will retrun to pr meal levels around 2 hours - NL = less then 140 in 2 hours normally
Oral Glucose Tolerance Test (OGTT) ?
Similar to the post-prandial glucose although in this test a glucose “load” is administered.
Usually 75 g of anhydrous glucose given PO
Same values as 2 hr PPG
**75 G is the 2 hours test - after 2 hours it should be less then 140 - over 200 is DM **
OGTT Gestational DM Testing own notes ?
for pregos we give 50 g load for 1 hour ( need to be 8 hours fasting)
if failed then need to come back in another day with a 100 g test ( test at 1 hr, 2 hr, and 3 hr)
stick with the NDDG #’s ( anything over the numbers is DM)
OGTT Gestational DM Testing: fasting NDDG # ?
105
OGTT Gestational DM Testing: 1 hour NDDG # ?
190
OGTT Gestational DM Testing: 2 hour NDDG # ?
165
OGTT Gestational DM Testing: 3 hour NDDG # ?
145
Fasting Plasma Glucose (FPG) NL ?
70-100(99) mg/dL
Fasting Plasma Glucose (FPG) pre-diabetic ?
100-126
Fasting Plasma Glucose (FPG) diabetes ?
> or equal to 126
** THIS IS FASTING!!!**
have them come in i the morning w/o eating or drinking anything
Fasting is defined as ?
no caloric intake for more than or equal to 8 hours
Random Plasma Glucose (RPG) diabetes number ?
Any value ≥200 mg/dL = diabetes
DM Autoantibody Panel what is it ?
Panel used to discover autoantibodies
Useful in diagnosing Type I DM
DM Autoantibody Panel when is it used ?
Diagnosing juvenile diabetes or Late onset Autoimmune Diabetes of the Adult
Correlate with progression to Type I DM
Increased risk of developing DM in 1st degree relatives in TI DM
Insulin Autoantibody (IAA) ?
Antibodies to insulin
Islet Cell Antibody (ICA) ?
Antibodies attacking islet cells
Glutamic Acid Decarboxylase Antibody (GAD Ab) presence ?
Type I DM
Gestational DM may need insulin for life.
( highly likely )
**TII DM have lower Neg. titers
get all three with the panel
Insulin what is it ?
Measures serum levels of insulin
Insulin when is it used ?
Used to diagnose insulinoma
Used to evaluate patients with fasting hypoglycemia
**more insulin then it should ( opposite prob then DM) and they are constant dropping BS, hypoglycemia when fasting always **
Insulin increased ?
Insulinoma
Cushing syndrome:
-Overproduction of cortisol
Obesity:
-Insulin resistance causes persistent highs
Acromegaly:
- Overproduction of growth hormons
- somatmetings
Insulin decreased ?
IDDM
-insulin dependent DM
Hypopituitarism:
-Reduced thyroid and adrenal functions
C-Peptide what is it ?
Cleaved off of proinsulin molecule to create insulin
Measurement of endogenous insulin production
**measure meant out endogenous Insulin - insulin being made in the body
CP is discarded remnant with I is made and it is cleave off when making I - good indicator of how much I is being produced **
C-peptide increased ?
Insulinoma
Pancreas transplant
Renal failure
Oral hypoglycemic agents
C-peptide decreased ?
Factitious hypoglycemia
IDDM
Pancreatectomy
Adrenal Hormones: Zona glomerulosa , examples?
Mineralcorticoids (regulate mineral balance)
Aldosterone
Adrenal Hormones: Zona fasciculata, examples?
Glucocorticoids (regulate glucose metabolism)
Cortisol, Corticosterone, Cortisone
**C - stress, increase glucose , decrease inflammation , **
Adrenal Hormones: Zona reticularis , examples?
Androgens (stimulate masculinization)
Dehydroepiandrosterone
Adrenal Hormones: Adrenal medulla , examples?
Stress hormones (stimulate sympathetic ANS)
Epinephrine, Norepinephrine
Cortisol is a ?
Potent glucocorticoid
**excess cortison - cushing
decrease - addisons **
↑ Cortisol from what ?
prolonged stress
Surgery Trauma Chronic infection or disease Hypo- or hyperthermia Restraint
↑ Cortisol effects on the body ?
↑ Plasma glucose
↑ Plasma fatty acids
↑ Plasma amino acids
↓ Inflammatory response
↑ Cortisol own notes ?
body is trying to cope with increase Inflamma response in the body
prolong period of stress = inflammation - body thinks it is under attack and raise G levels and give u things to fight stress off by lower inflammation levels and battle the stress off
Cortisol Testing ?
Serum cortisol
Saliva for cortisol
24 Urine free cortisol
Dexamethasone suppression test
ACTH stimulation test
**8am = highest ( peak)
lowest at 4 pm ( tough) **
Primary adrenal insufficiency ?
due to impairment of the adrenal glands
Addisons Disease q
Secondary adrenal insufficiency ?
Is caused by impairment of the pituitary gland or hypothalamus
- *secondary - pituitary level
- *
Tertiary adrenal insufficiency ?
is due to hypothalamic disease and decrease run corticotropin releasing factor (CRF)
Laboratory Testing for Adrenal Insufficiency
initial testing ?
Measure early morning serum cortisol
- *initial tets is morning C level at 8 am - if higher then 5 then it is less likes for Adrenal insufficiency
- *
Measure early morning serum cortisol: __________ µg/dL makes primary adrenal insufficiency less likely
Cortisol ≥5
If serious consideration is given to this diagnosis, perform stimulation testing
Follow abnormal cortisol results with ?
adrenocorticotropic hormone (ACTH) testing
If ACTH _____ pg/dL – adrenal failure likely
> 300
Pituitary is making it but Adrenal Gland is not working ( adrenal failure primary)
If ACTH ____ pg/dL – pituitary failure likely.
<10
**- ACTH is not being produce - prob. a pituitary problem **
If ACTH _____ pg/dL – administer ACTH (cosyntropin) stimulation test
<300
Testing based on ACTH result ?
ACTH stimulation test (cosyntropin)
ACTH stimulation test (cosyntropin) measures ?
Measures cortisol response to cosyntropin (250 µg using serial cortisol measures )
ACTH stimulation test (cosyntropin): _______ µg/dL ( with synthetic ACTH) – primary severe adrenal failure
Cortisol <5
ACTH stimulation test (cosyntropin):_______ µg/dL – normal; primary adrenal insufficiency unlikely ( cause it is responding to ACTH being put into the system)
Cortisol >20
Abnormal cortisol testing ?
abnormal Cortisol results and think adrenal INsufficencit, then follow initiall test with ACH level = is it pituitary fault or hypothalamus fault
ACTH Stimulation Test:
ACTH = decreased (negative feedback)
Cortisol = increased
condition ?
NL response
ACTH Stimulation Test:
ACTH = decreased (negative feedback)
Cortisol = decreased
condition ?
Primary Adrenal insufficiency
ACTH = ↑
Cortisone = ↓
Aldosterone = ↓
Basal secretion ?
Primary
the adrenal gland is the problem
ACTH = ↓
Cortisone = ↓
Aldosterone = NL
Basal secretion ?
Secondary
pituitary problem , it is not making it
ACTH = ↓
Cortisone = ↓
Aldosterone = NL
Basal secretion ?
Tertiary
Hypothalamus problem ,
24 hour urine for free cortisol ?
Collect 24-hour urine specimen
Measure cortisol excreted in the urine
If high, suggests Cushings
24 hour urine for free cortisol ? dont to dx ?
cushings
Evaluating for Cushings Serum Cortisol and ACTH: Endogenous examples ?
Pituitary adenoma
Tumors producing ACTH (carcinoid)
Adrenal tumors
Evaluating for Cushings Serum Cortisol and ACTH: Exogenous examples?
Exogenous steroids
prednisone, glucocrticoids
Evaluating for Cushings : endogenous ACTH ?
↑ elevated
↑ elevated
↓ decreased ( ACTH trying to shut off)
Evaluating for Cushings : endogenous basal cortisol ?
8am: elevated
4pm: elevated
Evaluating for Cushings : exogenous ACTH ?
↓ decreased
because no fluctuation, constant High C levels cause we are giving it to them
Evaluating for Cushings : exogenous basal cortisol ?
Loss of diurnal variation
Evaluating for Cushings: Dexamethasone Suppression Test ?
Synthetic steroid similar to cortisol
Suppresses ACTH secretion
Results in drop of 50% or more of plasma cortisol
**give them a steroid and see what C levels do , it should suppress ACTh and drop plasma cortisol levels **
ACTH = decreased
Cortisol = decreased
condition ?
Normal Response
ACTH = elevated
Cortisol = elevated
condition ?
Pituitary Tumor ( no response to Dx)
ACTH = decreased
Cortisol = elevated
condition ?
Adrenal Tumor
ACTH = decreased
Cortisol = increase
condition ?
Steroid treatment
