Endo Flashcards
Dx for DM2
Symptomatic →
-Random Glu ≥ 200
Asymptomatic →
-Fasting Glu ≥ 126, two separate occasions
-A1C ≥ 6.5%
-Plasma Glu ≥ 200, 2 hrs p 75g Glu load during oral tolerance test
Diabetes Insipidus (DI): Dx for nephrogenic and Hx of taking what med?
Hx: Lithium
Dx: H2O deprivation test → NO change in urine osmolality
Low TSH, High T4, Normal T3. Dx?
Thyroiditis
Sxs: Hyperreflexia, goiter, exophthalmos, Pre-Tibial myxedema. Dx?
Hyperthyroid (Grave’s)
Tx 1ry Adrenal Insufficiency
Hydrocortisone
Structure commonly compressed and affects vision with pituitary adenoma
Optic chiasm
Tx for pituitary adenomas >1 cm
Surgery
Tx for thyroid storm D/T endogenous TH
1) BB
2) Dexamethasone
3) PTU
4) Potassium iodide
Hyperthyroidism Tx
- Methimazole or Propylthiouracil PTU
- Pregnant: PTU
Tx (Rx and Mgmt) for Acromegaly
- Octreotide
- Transsphenoidal resection
Low TSH, T4/T3. Dx?
Euthyroid Sick Syndrome
Elevated thyroid peroxidase antibody (TPO). Dx?
Hashimoto’s thyroiditis
Metformin MOA
Decreasing hepatic glucose production (gluconeogenesis)
MC precipitating factor Of Thyroid Storm
Infection
Which thyroid D/O presents post viral URI?
De Quervain thyroiditis (Subacute)
Tx for De Quervain thyroiditis (Subacute)
ASA, BB, NSAIDs
Childhood radiation exposure can lead to ____ and it is most commonly associated with what type?
- Thyroid CA
- Papillary (MCC in general)
Tx for Thyroid Storm D/T Levothyroxine abuse
1) BB
2) Dexamethasone
Tx for Central Diabetes Insipidus (DI)
Intranasal DDAVP
Curative Tx for Hyperparathyroidism
Parathyroidectomy
What labs must be checked in Hypogonadism? Why?
- FSH and LH
- Distinguishes between 1ry and 2ry
MOA thiazolidinediones (“-one”)
Increase insulin sensitivity in muscle and fat.
MCC infectious 1ry adrenal insufficiency worldwide
- TB
- Generally, MCC = autoimmune
Classic finding Hyperaldosteronism
↓ K + HTN + (↑ Na)
MCC metabolic problem in neonates
Hypoglycemia
How much Dextrose 10 should be given for <1 yo to Tx Hypoglycemia?
5-10 mL/kg
When is DM2 screening warranted?
- Age 45
- Any age adult BMI ≥ 25 + 1 RF
BEST Dx tool for adrenal insufficiency
Serum cortisol level
In Tx for DKA, when blood glucose is < 200, what is the next step in mgmt?
Add Dextrose to IVF
Glc > 600 and negative ketones. Dx? Tx?
- Hyperosmolar Hyperglycemic State
- IVF
Stones, bones, (GI) groans, psychiatric overtones. Dx?
Hypercalcemia (~Hyperparathyroidism)
Med that blocks release of stored thyroid hormone
Iodine
Most likely neuro symptom from a pituitary adenoma
Peripheral vision loss
↓ Bone density, muscle mass, memory. Dx? Lab?
- Growth Hormone Deficiency
- ↓ IGF-1
MCC Hyperthyroidism
Grave’s (autoimmune)
1st line Tx Hyperprolactinemia. What is 2nd line and done when?
- Dopamine agonists: Cabergoline, Bromocriptine
- Surgery. Only if Rx no help or with compressive effects (VL)
What labs are seen in Diabetes Insipidus?
↓ urine osmolality, ↑ serum osmolality
Values of RFs for DM2 screening
- HDL <35
- TG >250
PE: Fruity smelling breath, dehydration, AMS
Diabetic Ketoacidosis (DKA)
MCC amenorrhea and galactorrhea in premenopausal woman
Pregnancy
What DM2 med is CI in renal insufficiency?
Metformin
What presents with Chvostek’s and Trousseau’s sign? Cause?
- Hypocalcemia
- Post thyroidectomy
Hyperglycemia, ketonemia, anion gap metabolic acidosis. Dx?
Diabetic Ketoacidosis (DKA)
Diabetes Insipidus (DI): Which is MCC for decrease in ADH production, central or nephrogenic?
Central
Palpitations, HAs, Excessive sweating. HTN*. Dx?
Pheochromocytoma (α-blocker)
-“PHE” for symptoms
How do we Dx Metabolic Syndrome?
3 out of 5:
- ↑ Abdominal obesity
- ↑ BP
- ↓ HDL <40
- ↑ TG >150
- ↑Fasting Glu. >100
In hyperthyroid, what might be heard on auscultation?
Neck bruit
Infertility, galactorrhea, and amenorrhea. ~Bitemporal hemianopsia. Dx?
Hyperprolactinemia
MCC Acromegaly
Pituitary adenoma
Tx for Nephrogenic Diabetes Insipidus (DI)
- HCTZ* > Indomethacin
- Amiloride (if D/T Lithium)
What DM2 med is CI with Hx Pancreatitis? Med name?
- Glucagon-like peptide-1 agonists (GLP-1)
- “-tide”
High TSH, Normal T3/4
Subclinical hypothyroid
Hypercalcemia Tx
IVF
When giving Levothyroxine to elderly pt., how does the dosing differ than with younger?
Lower dose in elderly
Hypoparathyroidism electrolyte abnormalities
↑ Phos
↓ Ca+
What lab marker helps to distinguish 1ry from 2ry adrenal insufficiency?
1ry: ↑ ACTH
2ry: ↓ ACTH
When adding insulin to Metformin, is S/A or L/A used initially?
Long-acting
In Tx for DKA, after NS and insulin have been given, what should be given next?
Potassium (if it’s <5)
What diabetic med reduces filtered Glu in proximal renal tubules which ↑ urinary excretion of Glu and ↓ plasma Glu?
SGLT2 inhibitors (Gliflozins)
Diabetes Insipidus Dx between Central and Nephrogenic
Desmopressin stimulation test
Pt. presents with morning hyperglycemia even with routine insulin given. Mom reports nightmares and night sweats. Dx?
Somogyi Effect
What glucose-lowering agents act by delaying glucose absorption?
Alpha-Glucosidase Inhibitors (Acarbose, Miglitol)
1st, 2nd, 3rd Tx for Grave’s
1st: antithyroid meds (70% failure)
2nd: Radioactive Iodine
3rd: Thyroidectomy → lifelong hormone replacement
How do we test between DM and DI?
Check fasting Glu. Normal in DI.
Thyroid nodule workup. What comes 1st, 2nd?
1st: US
2nd: FN Bx
