Endocrine Flashcards
primary function of parathyroid hormone
regulate homeostasis of calcium, phosphate and 1,25 dihydroxyvitamin D (calcitriol)
what happens when Calcium receptors on Parathyroid gland sense lower calcium levels
PTH is released which causes:
1- within minutes bone resorption begins
2- within minutes calcium reabsorption in the kidney
3- Calcitriol increases the absorption of calcium in the GI tract
Will DPP4 inhibitors cause hypoglycemia
No
What is unique about SGLT-2 Inhibitors
Reduce CV risk
increase risk of amputations
What can microalbuminuria mean
progressive nephropathy
What do GLP-1 meds do
enhanced insulin secretion
suppress glucogon secretion
slows gastric emptying
early satiety
never mix which insulin with any other type
Insulin Glargine
which vitmain will be depleted with long term metformin use
B12
Minimum weight loss goal for pre DM to avoid DM dx.
5-10%
Fasting BS level to dx pre diabetes
100-125
Pros and cons of ACTOS
Pro: 24% reduction of heart attack and stroke, 52% reduction risk of developing DM
Con: Wt gain, Edema, Bone fxr, bladder cancer
Tx options for dm neuropathy
Lyrica and Cymbalta FDA approved
TCAs, Tegretol, Venlafaxine
What are the levels of Hypoglycemia
Level 1: 54-70
Level 2: <54
Level 3: <54 and requiring assistance
Triad of Hemochromotosis
Cirrhosis, DM, Skin Hyperpigmentation
what may slow progression of DM retinopathy
Adding fenofibrate to statin tx (Accord trial)
When should you be concerned about kidney fxn after starting ACEI?
Rise of Cr to 30% above baseline after two months.
Clear indication for ASA 75-162 mg daily
DM with CAD or PVD
difference between Adding metformin or 30 min of daily moderate exercise to lose 5-10% wt. on Developing DM
Metformin 31% reduction risk
Wt loss and exercise 58% reduction risk
Do statins increase risk of DM
Yes, 9% increased risk
Statins will cause 1 case of new DM for 500 pt treated x one yr
Lack of statins will cause one CV event for 200 pt treated x one yr.
Who should have brain MRI in Low T workup
Men <40yrs with T <250, Men >60 yrs with T <150
Risk for pts with subclinical hypothyroidism?
Elevated Lipids and progression to hypothyroidism,
Next test to check with Subclinical hypothroidism?
anti TPO antibodies
If positive pt WILL become hypothyroid
What is thyroid risk in pts taking amiodarone?
3% get hyperthyroidism
Test to order if TSH low and T4 high
Radioactive Iodine Uptake scan
Starting dose of thyroid med
1.6 mcg / kg recheck in 6 wks.
MC thyroid cancer
Papillary (10 yr survival is 90%)
Define thyrotoxicosis
Excess thyroid hormone
What is the first thing you need to do when you identify thyrotoxicosis?
Determine if it is due to hyperthyroidism or thyroiditis
What are some examples of hyper thyroidism?
Graves’ disease, toxic, multinodular, goiter, toxic adenoma
What are some examples of thyroiditis?
This is release of preformed, thyroid hormone, such as after a viral infection,
Treatment of thyrotoxicosis
It depends on what is causing the thyroid hormone to be elevated. Perhaps just treating symptoms with beta blockers with thyroiditis. Perhaps needs anti-thyroid drugs, such as Graves’ disease
who should be screened for DM?
all pts over the age of 45 every 3 yrs. any female with hx of GDM every 3 yrs. Anyone younger with risk factors: obesity, 1st degree relative with DM, pt on BP meds. high risk ethnicity
How can hypothyroidism cause Hyperprolactinemia?
Increased TRH causes release of prolactin as well.
Why does risperidone cause prolactin secretion?
Dopamine can inhibit the release of prolactin, so dopamine antagonists will contribute to elevated prolactin. Risperidone one of the worse, Abilify resolves this in 80% of trial pts.
how to recognize and work up pathologic galactorrhea?
Pathologic nipple discharge, characterized by a spontaneous unilateral, uniductal discharge with bloody features, should also be ruled out. Ultrasonography is the first-line modality in women <30 years of age and mammography is the first-line modality in women ≥30 years of age
