Endocrine

Question 1

goiter

Answer 1

an enlargement of thyroid gland w/ or w/o s/s of thyroid dysfx

Excess TSH

low iodine levels (these goiters tend to be larger)

goitrogens–ie lithium

Question 2

Hashimoto’s

Answer 2

thyroid receptor antibodies
antithyroglobulin antibody (anti-Tg)
antithyroperoxidase antibody (anti- TPO)--hallmark of disorder

Question 3

Risk factors for hypothyroidism

Answer 3

female
age > 50
caucasian
pregnancy
hx of other autoimmune disorders
family hx
meds--lithium, amiodarone
treatments for hyperthyroidism

Question 4

hypothyroidism

early manifestations

Answer 4

cold intolerance
weight gain
lethargy
fatigue
memory deficits
poor attn span
increased cholesterol
muscle cramps
raises carotene levels (yellows skin)
constipation
decreased fertility
puffy face
hair loss
brittle nails
anemia
hoarse voice

Question 5

hypothyroidism

late manifestations

Answer 5

below normal temp.
bradycardia
weight gain
decreased LOC
thickened skin
cardiac complications (cardiomegaly)

Question 6

myxedema

Answer 6

life-threatening
severe hypo (coma) → undiagnosed or untreated

Question 7

hypothyroidism treatment

Answer 7

levothyroxine (synthetic T4, converted to T3 in body)
taken for life
take on empty stomach
↑ risk for bleeding with warfarin

Question 8

hyperthyroidism (Thyrotoxicosis)

Answer 8

excessive secretion of T3 and T4

Primary → Grave’s disease
Secondary (pituitary) → over secretes TSH
Tertiary (hypothalamus)

Question 9

hyperthyroidism risk factors

Answer 9

family hx of Graves
age > 40
female
caucasian
meds
excessive iodine intake
pregnancy

Question 10

Graves’ disease

Answer 10

autoimmune
excess levels of T3 and T4
thyroid-stimulating antibodies → thyroid continues to secrete hormones w/o stimulation from pituitary gland

Question 11

graves’ disease

clinical manifestations

Answer 11

nervousness
insomnia
sensitivity to heat
weight loss
gland usually enlarged and palpable
audible bruit may be heard
atrial fib
myxedema--dermatologic manifestations
exophthalmos

Question 12

Graves’ disease diagnosis

Answer 12

Low TSH
↑ T3
↑ T4
antithyroglobulin
antithyrotropin receptor antibody
ultrasound with color doppler eval
radioactive iodine scanning and measurements of iodine uptake-- ↑ iodine uptake and distributed diffusely

Question 13

treatment of hyperthyroidism

Answer 13

• propylthiouracil (PTU) - blocks thyroid hormone synthesis, suppresses conversion of T4-T3
• BLACK BOX - hepatotoxic
• used in 1st trimester with caution
• radioactive iodine treatment
• surgery - hormone replacement needed for life

Question 14

thyrotoxic crisis

Answer 14

overwhelming release of thyroid hormones that exerts an intense stimulus on the metabolism

reaction to major stressor

life threatening condition most commonly precipitated by surgery, trauma, or infection

body revved up and can result in death if not treated within 48 hours

Question 15

hypoparathyroidism

Answer 15

s/s r/t insufficient PTH secretion and the resulting ↓ Ca

muscle cramps
irritability
tetany
convulsions
trousseau's and chvostek's sign

Question 16

hypoparathyroidism treatment

Answer 16

replace PTH

normalize serum Ca and vit D levels

if parathyroid removed, replacement treatments are for life

Question 17

hyperparathyroidism

Answer 17

s/s r/t excessive secretion of PTH with hypercalcemia and bone breakdown

muscle weakness
poor concentration
neuropathies
kidney stones
metabolic acidosis
osteopenia
pathological fractures
constipation
depression, confusion, subtle cognitive deficits

Question 18

hyperparathyroidism treatment

Answer 18

↓ Ca levels
diuretics
calcitonin
bisphosphonates
Vit D
surgical intervention

Question 19

SIADH etiology

Answer 19

malignant tumors
CNS disorders (trauma, stroke, brain tumors)
drug therapy
misc. (hypothyroidism, infection)

Question 20

SIADH

Answer 20

↓ serum osmolality
dilutional hyponatremia
↑ urine specific gravity & osmolality
weight gain
↓ urine ouput

Question 21

SIADH clinical manifestations

Answer 21

hyponatremia:
dyspnea, fatigue
dulled sensorium, confusion, lethargy
muscle twitching, convulsions
impaired taste, anorexia, vomiting, cramps

Question 22

SIADH treatment

Answer 22

treat the underlying cause

chronic SIADH - demeclocyline

severe cases may call for hypertonic solution

Question 23

demeclocycline

Answer 23

tetracycline
interferes with renal response to ADH
AE: photosensitivity, teeth staining, nephrotoxic

Question 24

Neurogenic DI etiology

Answer 24

hypothalamus or pituitary gland damgage

associated disorders: stroke, traumatic brain injury, brain surgery, cerebral infections

sudden onset, usually permanent

treatment: desmopressin (DDAVP) - synthetic ADH replacement therapy, comes in nasal spray; give as small of dose as possible

Question 25

Nephrogenic DI etiology

Answer 25

loss of kidney function
often drug related ie lithium
CKD

slow onset and progressive

treatment: thiazide diuretics

Question 26

Cushings clinical manifestations

Answer 26

↑ cortisol

glucose intolerance, hyperglycemia
HTN, capillary friability
muscle wasting, weakness; thinning of skin, osteoporosis and bone pain
redistribution of fat to abd, shoulders and face
impaired wound healing & immune response, risk for infection
mood swings, insomnia

Question 27

drug therapy for cushings

Answer 27

• treatment dependent on cause
• tumor- surgery or radiation
• exogenous steroids - taper
• drug therapy is not primary, but adjunct w/radiation or surgery; helps with elevated cortisol levels

Question 28

aminoglutethimide

Answer 28

blocks synthesis of all adrenal steroids

used in ppl awaiting surgery, no longer than 3 months

reduces cortisol levels by 50%

AE: drowsiness, nausea, anorexia, rash

Question 29

ketoconazole

Answer 29

antifungal that also inhibits glucocorticoid synthesis

adjunct therapy to radiation, surgery

severe liver damage
do not take with ETOH or other hepatotoxic drugs
teratogenic

Question 30

addison disease clinical manifestations

Answer 30

slow onset
early s/s
anorexia, weight loss
weakness, malaise, apathy
electrolyte imbalances
skin hyperpigmentation