endo Flashcards
how often do we screen for t2dm
ADA recommends fasting BGL q3yrs in adults regardless of risk
R: T2DM is unlikely to develop in 3 yr time frame if initial BGL WNL
when to begin screening for t2dm
age 45 if w/o high risk
testing recommendations for high risk t2dm
Physical inactivity FH and H/O high birthweight babies or gestational DM High risk ethnicity HTN 140/90 and above, or treated HDL < 35 or TG > 250 PCOS- polycystic ovary disease CVD
what can affect glucose levels
what we ate, exercise, sickness
what is diagnostic of t2dm
- FBS no intake for >8 hrs ./=126 diagnostic of risk (98% spec, 88% sens)
- random bgl >/= 200 with symptoms- polys, wt loss, hyperglycemic crisis
criteria for pre dm
a1c 5.7-6.4
fasting bgl 100-125
glucose post standardized glucose lose 140-199
testing for complications with diabetes
Renal function: Creatinine, microalbuminuria(MRU) at least yearly
neuropathy - usually done yearly; vibration, monofilament, temp, pulses
fasting lipid panel-
every 5 years starting at age 10 unless there is a strong family history when screening begins at age 2
Q6 mo-1 yr in a diabetic
DM goal is LDL < 100 mg/dl (cardiac <80), HDL > 50 mg/dl (men), >45 (female) and triglycerides < 150 mg/dl
Opthalmalogy & dentist: at least yearly
what is the main fx of parathyroid glands
regulate calcium through parathyroid hormone release
/raises serum calcium through calcium sensing receptors
how does parathyroid hormones regulate serum calcium levels
- direct action on bone to release calcium into extracellular fluid
- direct action on kidney to decrease renal loss of calcium
- indirect action on GI tract by activating vit D to increase dietary calcium absorption
hyperparathyroid dysfuction is what
over-secretion of PTH
what is primary hyperparathyroid dysfx
inappropriate secretion of PTH in setting of hypercalcemia
80% dt parathyroid adenoma
secondary hyperparathyroid dysfx
appropriately increased secretion of PTH in setting of low or normal serum calcium usually d/t vit D deficiency or renal failure
tertiary hyperparathyroid dysfx
prolonged secondary that leads to hypercalcemia
what is hypoparathryoid dysfx
under secretion of PTH
inappropriately low secretion of PTH in setting of hypocalcemia
result of destruction of parathyroid gland dt surgery, radiation, infiltration- amyloidosis, hemochromotasis
what does hyperparathyroidism present as
asymptomatic hypercalcemia
nonspecific neurocongnitive symptoms based on degree of hypercalcemia
weakness, fatigue, depression, loss of initiative
anxiety, irritability, insomnia
HTN, CAD
kidney stones, hematuria, nocturia, polyuria, osteoporosis
diagnostics for hyperparathyroidism and hypo
- PTH
- Serum ca
- albumin
- fasting phosphorus
- serum 1,25-dihydroxyvitamin D
- serum 25-hydroxyvitamin D
24 hr urine calcium for hyper
mag for hypo
high PTH and high calcium
primary hyperparathyroidism or secondary hyperparathyroidism from vit d def
low PTH and high ca
PTH production is suppressed dt high calcium
possibly from metastic disease to bone, sarcoidosis, vit d intoxication
low PTH and low calcium
dt surgical excision of parathyroid
high PTH and low calcium
pts witch chronic refnal failure do not excrete phosphates normally
when to test for hyperthryoidism
New onset of tachycardia, afib, arrhythmias, unexplained weight loss, exophthalmos, elevated temp (mild), thyroid nodule, heat intolerance, change in hair
when to test for hypothyroidism
Fatigue, dyslipidemia that is hard to control, hypotension that is unexplained, bradycardia, weight gain, depression, sexual dysfunction, puffy eyes, cold intolerance, aching joints, hair thinning
anti-TPO antibodies
In autoimmune thyroid disease, proteins mistakenly attack the thyroid peroxidase enzyme, which is used by the thyroid to make thyroid hormones. Used for diagnosing Hashimotos Disease
thyroid US
probe is placed on the skin of the neck, and reflected sound waves can detect abnormal areas of thyroid tissue. Used to detect nodules and during needle biopsy of nodules
thyroid scan
small amount of radioactive iodine is given by mouth to get images of the thyroid gland. Radioactive iodine is concentrated within the thyroid gland (GRAVES)
thyroglobulins
substance secreted by the thyroid gland that can be used as a marker of thyroid cancer. It is often measured during follow-up in patients that have undergone treatment for thyroid cancer. High levels indicate recurrence of the cancer.
other imaging for thyroid disease
If thyroid cancer has spread (metastasized), tests such as Thyroid scan, CT scans, MRI scans, or PET scans can help identify the extent of spread
what to do when TSH is abnormal
FT3, FT4 are needed for establishing a diagnosis
FT3 assists when you suspect hyperthyroidism
Graves disease along with thyroid antibodies
FT4 directly measures unbound thyroxine, NL 1.1-4.3
diagnostics for thyroid
- TSH
- Free T3
- free T4
- Thyroglobulin
- Anti-thyroid antibody
- Thyroid scan
- ultrasound
diagnostics for parathyroid
- PTH
- Calcium phosphate
- vitamin D-25
