Endo JB Flashcards
Acromegaly dx
Screening: ILGF-1
confirm: oral glucose suppression test increase GH levels in acromegaly
MRI of pituitary
Acromegaly sx
DM, glucose tolerance
enlarge feet, hands, skull, jaw
coarse facial features
doughy skin
acromegaly tx
transsphenoidal surgery + bromocriptine
rad therapy if GH levels high after surgery
octreotide
pegvisomant can be added to octreotide
MCC adrenal crisis
abrupt withdrawal of GCS
Adrenal crisis presentation
shock: hypoTN, hypovolemia
adrenal crisis tx
IV fluids
GCS: hydrocortisone if known Addison, dexamethasone if unknown
reverse electrolyte disorders
fludricortisone- synthetic mineralocorticoid
Adrenal insufficiency dx
Baseline 8am cortisol and renin
high dose cosynotropin test- screening
CRH stimulation differentiates causes of adrenal insufficiency
Adrenal insufficiency tx
primary: GCS + mineralocorticoids
secondary: GCS
GCS: dexamethasone, hydrocortisone
mineralocorticoids: fludricortisone
adrenocortical insufficiency sx
trunk pain w/ anorexia, N/V hypotension, F ,confusion hyper pigmented, salt cravings hypoglycemia loss of axillary/pubic hair
Charcot arthropathy
diabetic foot
Cushing syndrome sx
central obesity moon facies buffalo hump supraclavicular fat pads thin extremities, skin atrophy hyperpigmentation, acanthuses nigricans hirsutism, acne
Cushings Dx
screening: low dose dexamethasone suppression test, 24h urinary free cortisol, salivary cortisol levels
Differentiation: high dose dexamethasone suppression test, ACTH levels
Cushings tx
pituitary: transphenoidal surgery, radiation
Ectopic tumors: tumor removal, ketoconazole or metyrapone (if inoperable)
iatrogenic steroid therapy: steroid taper
Diabetes insipidus sx
sx with decreased oral water intake
polyuria, polydipsia, nocturia
dehydration, hypoTN
Diabetes insipidus dx
fluid deprivation test
desmopressin (ADH) stimulation test: central vs nephrogenic DI (central=dec urine output w/ ADH, nephrogenic= no response to ADH)
diabetes insipidus tx
central: DDAVP, carbamazepine
nephrogenic: Na/protein restriction –> HCTZ, indomethacin, amiloride if due to lithium
sx: hypotonic fluid
DKA labs
high anion gap metabolic acidosis: low pH/bicarb/CO2 increased RR (kussmaul) \+ ketones
DKA tx
IV fluids regular insulin potassium bicarb Goal= close anion gap
Graves dz tx
radioactive iodine MC levothyroxine methimazole/PTU (PTU safe in pregnancy) BB (propranolol) for tremors thyroidectomy
hyperaldosteronism sx
refractory HTN low K, low Mg proximal muscle weakness, decreased DTR polyuria, constipation fatigue
Hyperaldosteronism dx
aldosterone renin ratio screening: primary vs secondary
definitive: saline infusion test, sodium loading
hyperaldosteronism tx
conns: excision + spironolactone
hyperplasia: spironolactone, ACE, BB, correct electrolyte
secondary (renovascular HTN): angioplasty definitive, ACE
Cushing syndrome vs Cushing dz
syndrome: from steroids
disease: from pituitary adenoma
Hyperosmolar coma
from hyperosmoler hyperglycemic syndrome (HHS)
Mental status change
Goal of tx is normal mental status
Hyperparathyroidism sx
stones bones groans psychiatric overtones decreased DTR
hypoparathyroidism PE
triad: hypocalcemia, decreased PTH, increased P
carpopedal spasms
trousseau sign
chvostek sign
hypothyroidism labs
high TSH, low T4
decreased RIU
check for iodine deficiency
hashimotos thyroiditis labs
+ thyroid ab
thyroglobulin ab
antimicrosomial
thyroid peroxidase ab
Hypothyroidism (myxedema) sx
cold tolerance, goiter, bradycardia, delayed relaxation to DTR
hypothyroidism (myxedema) labs
decreased T3/T4
increased TSH
klinefelter syndrome sx
hypogonadism
small testes/infertility
tall stature, gynecomastia
scarce pubic hair
Klinefelter labs
low serum testosterone
47XXY karyotype
klinefelter syndrome tx
testosterone supplementation
pheochromocytoma sx
secondary HTN
palpitations, HA
excessive sweating, weight loss, increased appetite
pheochromocytoma dx
increase in 24h urinary catecholamines (increased metanephrine and vanillylmandelic acid)
MRI/CT abdomen
pheochromocytoma tx
complete adrenalectomy
pre-op non selective alpha blocker (phenoxybenzamine or phentolamine) –> BB/CCB
pituitary adenoma dx
MRI
prolactin, GH, ACTH, TSH, FSH, LH
Primary hyperaldosteronism labs
hypoK w/ metabolic alkalosis
aldosterone renin ratio screening
DefinitiveL saline infusion
primary hyperparathyroidism tx
surgery
vitD/Ca supplement if secondary
tx hypercalcemia if sx (IV fluids, furosemide)
SIADH dx
isovolemic hypotonic hyponatremia. dec serum osmo, decreased Na, decreased BUN
increase urine Cosmo
Dx of exclusion
SIADH tx
fluid restriction
subacute thyroiditis sx
painful thyroiditis
MC after viral infx
associated w/ HLA-B35
subacute thyroiditis dx
clinical. hyperthyroidism in acute –> hypothyroid
increased ESR hallmark
no thyroid ab
decreased RAIU
subacute thyroiditis tx
aspirin
thyrotoxicosis labs
increased T3 and T4
decrease TSH
usually a precipitating event
thyrotoxicosis tx
antithyroid: IV PTU/methimazole, RAIU, surgery
BB ASAP
supportive: IV glucocorticoid, avoid aspirin, cooling blankets
DMT2 tx
neuropathy: gabapentin
retinopathy: bevacizumab
nephaopathy: ACE
Glucose: anti hyperglycemic meds/insulin
