Endocrine Flashcards
hyperaldosteronism is caused by increased ___ production
aldosterone
necrotizing skin and soft tissue infections are surgical ___
emergencies
primary hyperaldosteronism can be caused by (3)
- idiopathic
- adrenal adenoma
- adrenal carcinoma
lab values in hyperaldosteronism
- uncontrolled hypertension
- hypokalemia
- hypernatremia
most common presentation of hyperaldosteronism
vision impairment
2 tests to dx hyperaldosteronism
- plasma aldosterone concentration (PAC); plasma renin concentration (PRA)
- PAC/PRA ratio
pharm for hyperaldosteronism
Spironolactone
imaging for hyperaldosteronism
CT scan
in hypoaldosteronism, potassium will be
high
hypoaldosteronism causes metabolic
acidosis
pharm for hypoaldosteronism
Florinef (corticosteroid)
Adrenal Insufficiency is also called
Addison’s Disease
what hormone stimulates coritsol release
ACTH
4 symptoms of Addison’s Disease
- hyperpigmentation of the skin
- weakness
- fatigue
- hypoglycemia
Addison’s is differentiated from secondary/tertiary Adrenal Insufficiency by
- hyperpigmentation
- hyperkalemia
- dehydration
none of these are seen in secondary/tertiary
2 diagnostic tests for Adrenal Insufficiency
- simplified cosyntropin test (ACTH stimulation test)
2. 8 am plasma cortisol level + plasma ACTH
tx for Addisonian crisis
glucocorticoid: high dose 100 mg IV bolus over 24 hours
chronic tx for Adrenal Insufficiency
mineralocorticoid and glucocorticoid replacement + long acting predinosine/dexamethasone
pheochromocytoma triad
- HA
- sweating
- tachycardia
tests for pheochromocytoma
- fractionated metanphrines
- CT or MRI
- if normal –> repeat during spell
pheochromocytoma tx
in this order:
- alpha blocker
- beta blocker
- liberalize salt intake
- surgical resection
MEN 1 involves
- parathyroid
- AP
- pancreas
MEN 1 pruritis improves with __ and worsens with __
sun; stress
Men 2 - aka Sipple involves
- parathyroid
- pheochromocytoma
- medullary thyroid carcinoma
MEN 2b - aka MEN 3 involves
- marfanoid habitus
- pheochromocytoma
- medullary thyroid carcinoma
MEN 4 involves
- parathyroid adenomas
- pancreatic neuroendocrine tumors
- gonadal tumors
- adrenal tumors
- renal tumors
- thyroid tumors
Congenital Adrenal Hyperplasia is caused by
21-hydroxylase deficiency
CAH is characterized by increased __ and accumulation of __ precursors
ACTH; cortisol
3 symptoms of CAH
- skin hyperpigmentation
- ambiguous genitalia
- hyponatremia
CAH can cause a ___ crisis
salt wasting
tx for CAH
- crisis: hydrocortisone and fluids
2. chronic: cortiosteroids + mineralocorticoids for life
most common cause of Cushing’s Syndrome
iatrogenic –> prolonged steroid use
primary Cushing’s is caused by
adrenal adenoma or carcinoma
most common cause of secondary Cushing’s
SCLC
work up for Cushing’s
1. low dose dexamethasone test (DST) 2. late night salivary cortisol 3. 24 hr urinary free cortisol excretion 4. plasma ACTH
tx for secondary Cushing’s
transsphenoidal resection or irradiation
pharm for Cushing’s
Mitotane
Metyrapone
Ketoconazole
Cushing’s Disease (Secondary Cushing’s) is specifically caused by
ACTH secreting pituitary tumor
T1DM work up
OGTT
A1C
tx for hypoglycemia
15-20 g glucose or simple CHO –> recheck after 15 min
BG < 50 tx
glucagon injxn in buttocks, arm, thigh, or nasal spray
onset of hypoglycemia occur at what level
60-70
cognitive impairment is seen w. hypoglycemia at what level
50
criteria for T2DM dx
- FBG < 126
- A1C greater than or equal to 6.5
- random plasma BG 200 or higher
confirmation w. at least 2 tests
indications for insulin
- A1C > 10%
- BC 300 or higher
- complications (ex CAD)
- serum BG not met w. oral meds
- markedly symptomatic
ABCs of DM goals
- A1C
- blood pressure <140/90; CVD risk 130/80
- Cholesterol
DM insulin regimen
- stable baseline: basal insulin –> long acting OR short term via pump PLUS pre-meal short acting
- intermediate insulin at bedtime OR long acting insulin in the AM or at bedtime
testing for gestational diabetes should occur
24-48 weeks gestation –> A1C OGTT
metabolic syndrome includes (5 things)
- elevated TG
- low HDL
- HTN
- abdominal obesity
- insulin resistance
what is an insulinoma
tumor of pancreas that produces excess insulin
insulinoma presentation
healthy appearing person w. fasting hypoglycemia
DKA triad
- hyperglycemia
- ketosis
- metabolic acidosis
tx for DKA
IV insulin + glucose
Charcot Foot can be a complication of
DM ch
acne is caused by (4 things)
- androgens
- keratin and sebum plug hair follicle
- C acnes
- inflammation
tx for acne
- topical retinoid
- benzoyl peroxide
- +/- abx
acne morphologies
- comedomes
- inflammatory
- nodulocystic
Actinic keratosis can turn into
SCC
indurated lesions w. a scale are suggestive of
SCC
tx for AK
- liquid nitrogen cryotherapy
- Diclofenac
- Ingenol Mebutate
which gene is most altered tumor suppressor gene in SCC and AK
p53
SCC originates in
keratinocytes
work up for SCC
tangential shave bx
tx for SCC
mohs micrographic surgery
staging for melanoma
Breslow depth
warts are caused by what virus
HPV
molluscum contagiousum is caused by what virus
pox virus
HPV __ and __ have higher risk for malignancy
16; 18
only FDA approved tx for warts
Imiquimod
HPV prevention
Ceravix; Gardasil; Gardasil-9
endemic goiter is caused by
low iodine diet e
most endemic goiters reflect __ thyroid hormone levels
euthyroid
pharm for endemic goiter
Levothyroxine
primary cause of hypothyroidism
Hashimoto’s
TSH nl
0.5-5.0
is serum T3 used to dx hypothyroidism
no!
pharm for hypothyroid
- Levothyroxine
2. Armour thyroid: T3 and T4 from pig
most common thyroid d.o in US
Hashimoto’s
Hashimoto’s is an ___ disorder
autoimmune
tx for Hashimoto’s
- AI –> abs
- antithyroperoxidase
- antithyroglobulin
myxedema can be a complication of
untreated hypothyroidism
painful subacute thyroiditis (deQuervain’s) often a
viral URI
tx for deQuairvan’s
- ASA
- Propranolol
- Iodinated contrast agent for elevated T3
- Ipodate sodium/iopanoic acid for elevated T4
labs in hypothyroidism
TSH: high
T3/T4: normal to low
Graves Disease is a type of autoimmune
hyperthyroidism
3 PE symptoms of hyperthyroidism
- Afib
- exophthalmos
- myxedema
labs in hyperthyroidism: TSH: FT4: T4: FT3: T3:
TSH: low
FT4, T4, FT3, T3: elevated
tx for hyperthyroidism
- Propranolol
- Thiurea (Methimazole, Propylthiouracil) –> safe in pregnancy
- Iodinated contrast agents (Iopanoic acid, Ipodate sodium)
- Radioactive iodine 131 –> NOT save in pregnancy
contraindications for Radioactive iodine 131
pregnancy
exophthalmos
__% of thyroid nodules are
benign
work up for thyroid nodules
- thyroid US
2. fine needle bx
tx for thyroid nodule
- Propranolol
2. Radioactive Iodine 131
folliculitis is inflammation of the
hair follicle
folliculitis is caused by
staph>strep
tx for folliculitis
warm compress
avoid systemic abx!
furuncle (aka boil) is caused by what pathogen
staph
furuncle is an infevtion of the
hair follicle AND surrounding soft tissue furu
tx for furuncle
- warm compress
2. I&D
if abx for furuncle
- Doxycycline
- 1st gen cephalosporins
- Tetracyclines
a carbuncle is a coalescence of
furuncles
carbuncles are caused by which pathogen
staph
tx for carbuncle
systemic abx focused on MRSA:
- Tetracyclines
- Bactrim
cellulitis is caused by what pathogen
staph, strep
cellulitis is an infection of the
epidermis AND subcutaneous CT
cellulitis is especially concerning for
DM pt
cellulitis patients may appear
septic
cellulitis tx OP setting
- Penicillins
- beta lactam inhibitors
- cephalosporins
- sulfa
- tetracyclines
cellulitis tx hospital setting
- Vancomycin
2. Ancef
cellulitis tx DM
- Bactrim PLUS Keflex
what drug is contraindicated in CO for cellulitis
Azithromycin
erysipelas is caused by what pathogen
group A strep
erysipelas is an infection of the
dermis
erysipelas is characterized by
very shiny, red, well demarcated erythema
erysipelas tx
- vancomycin
2. daptomycin
necrotizing fasciitis is characterized by
bullae, crepitus of the skin
nectrotizing fascitis is caused by
group A strep (Mprotein)
___ progresses quickly, destroys subcutaneous fat, but spares ___
nectrotizing fasciitis; muscle
tx for necrotizing fasciitis
urgents surgical consultation
Fournier’s Gangrene attacks the
penis and scrotum
RF for Fournier’s Gangrene
DM, etoh, HIV, obesity, malignancy
fx for Fournier’s Gangrene
- urgent surgical consultation!
- Vancomycin immediately post surgery
- then Piperacillin/Tazo
gas gangrene (clostridial myonecrosis) destroys subcutaneous fascia fat, AND
muscle
gas gangrene is caused by
clostridium perfingens
traumatic wounds/perforation of bowel
tx for gas gangrene
urgent surgical consultation!
MRSA is associated with
previous hospital stay dt infxn
surgical procedures
enteral feeding
prior abx
common complaint associated w. MRSA
spider bite
tx for MRSA
3rd gen Cephalosporins
Fluoroquinolones
Vancomycin
Community Acquired MRSA (CA-MRSA) causes atypical symptoms not usually associated w. s. aureus, including
necrotizing fasciitis
purpura fulminans
necrotizing PNA
community outbreaks
nasal MRSA is associated w. 10% increases risk for skin/soft tissue infxn; what is the tx for nasal MRSA
topical intranasal muciporin for 5 days
daily bathing w. antibacterial agent
MRSA has developed resistance to
clindamycin
newer tx for MRSA
- Linezolid
- Tedizolid
- Daptomycin
- Tygecycline
- Ceftaroline
- Oritavancin
- Dalbavancin
hot tub folliculitis is caused by
pseudomonas
tx for hot tub folliculitis
op: no tx
if progresses: Cipro
dog/cat bite treatment
- irrigate!
- Augmentin or Ampicillin
- rabies/tetanus vaccine
Eikenella corrodens is associated with
dog/cat bikes
measles prodrome triad
fever, cough, coryza
also: conjunctivitis, malaise
Kolik spots (maculopapular rash) are pathopneumonic for
measles
Hyperparathyroidism symptoms
stones, bones, abdominal groans, thrones, psychiatric overtones
hyperparathyroidism labs will show elevated PTH and elevated
calcium
5 symptoms of hypoparathyroidism
- abdominal cramps
- muscle cramps
- tetany
- numbness/tingling
- paresthesias
Chovstek sign is associated with
hypoparathyroidism
what is Chovstek sign
contraction of eye, nose, or mouth muscle by tapping facial nerve anterior to ear
Trosseau sign is associated with
hypoparathyroidism
what is Trosseau sign
spasm in hand/wrist w. compression to forearm
most common cause of hypoparathyroidism
post surgical removal of thyroid or parathyroid
1st test for growth hormone deficiency
- IGF
then: - 2 provocative stimulation tests: insulin, deep sleep, glucagon, exercise etc
tx for growth hormone deficiency
recombinant HGH SQ daily
monitor w. IGF and growth response
in kids, growth hormone excess is called
gigantism
in adults, growth hormone excess is called
acromegaly
growth hormone excess is almost always caused by
pituitary adenomas - usually benign macroadenomas
testing for growth hormone excess
- IGF1
- then fasting BG, prolactin, glucose, LFTs, BUN/CR
OGTT is gold standard: shows failure of GH to suppress
growth hormone tx
transphenoidal resection
growth hormone excess pharm
Somastatin analogs:
Ocreotide
Lanreotide
Dopamine agonists:
Cabergoline
GH receptor antagonist:
Pegvisomant