Endocrine Flashcards
Parathyroid regulates which mineral?
Calcium
Pt who is on metformin but struggling decreasing FBS, what is a good second choice drug?
Sulfonylurea (Glipizide/Glucotrol, Glyburide/Diabets) decreased FBS as well as postprandial.
For a pt on metformin but struggling with postprandial spikes but maintaining fbs, what second line therapy would be beneficial?
DPP4 (sitagliptin/Januvia), SGLT2 (Canagliflozin/Invokana or Empagliflozin/Jardiance) are both oral agents that exert action mostly on postprandial/
Patient with hypotension, hypoglycemia n/v, loss of appettie, pale in appearance with muscle fatigue and slow/sluggish movements should be screened for what condition?
Addisons (adrenal isufficiency) would have low am cortisol levels
How is addisons disease treated?
Corticosteroid replacent & ample sodium after potential insensible fluid loss.
How would a patient with Cushings disorder present?
Progressive weight gain increased abd obesity, fatty deposits upper back (buffalo hump), striae on abd, moon facies, thin and fragle skin (easily bruises), fatigue/muscle weakness, and hirsutism.
What tests would be done to confirm cushings disorder?
AM cortisol level (high)
What drug is used to reduce symptoms in hyperthyroid crisis?
Beta blockers (propranolol)
A non-tender and fixed thyroid nodule >4cm with dysphonia is likely to be?
Malignancy
In >4cm thyroid nodule with elevated TSH, what is the most common next step?
FNA (nodule is not metabolically active)
If TSH is low with a large thyroid nodule, what is the next step?
Nuclear med thryoid scan
Hot- metabolically active: radioactive ablation or surgery
Non hot- metabolically inactive: FNA
What laboratory findings are suggestive of hyperparathyroidism?
elevated Ca+and PTH
With low K+/Pho_
When TSH is low or normal BUT t4 is low, what is the likely condition?
Secondary hyperthyroidism (pituitary/hypothalmic disease)
Loss of lateral third of eyebrows and thin/brittle nails is suggestive of?
Hypothyroidism
Patient with hypothyroidism, what additional laboratory findings may be noted?
Hyperlipidemia, macrocytic anemia, and hyopnatremia
What TSH levels generally indicate need for treatment with levothyroxine?
TSH >10, although 4.5-10 would consider based on clinical presentation
What is the usual starting dose and treatment protocol for levothyroxine in hypothyroidism?
Levothyroxine starting 25-5mcg and increasing 12.5-60mcg q 2 mo until TSH normalizes. Usually dose is 1.6mcg/kg/d
How should patients be instructed to take levothyroxine?
In am (same time) on empty stomach without any other medications
When should branded version of levothyroxine (synthroid) be considered?
When unable to regulate with generic, some pts cannot metabolize generic.
Armour thyroid is ____?
Dessicated T3 and T4
It is not recommended for cardiac pts, older and pregnant women.
Low TSH but normal FT4/T3- what condition is likely present and what test should be ordered?
Subclinical hyperthyroidism (order radioactive uptake and scan)
What tests should be done w/ palpable nodules?
Thyroid scan
How does Adrenal Insufficiency usually presents?
Shocky: hypotension, N/V anorexia, confusion, weakness, fever
Common causes of acute adrenal insufficiency?
Sudden and abrupt cessation of steroids
Pituitary destruction, adrenalectomy/trauma
Stress,trauma, infection or prolonged fasting in someone with Addisions disease
Chronic adrenal insufficiency is known as?
Addisons disease
What are the hallmark laboratory signs suggestive of addison’s disease?
Hypotension and hyperkalemia
What are common signs of addison’s disease
Excessive pigment, volume and sodium depletion, chronic maliase/weakness/fatigue, anorexia n/v, scant pubic and axillary hair. Can have mild to mod depression and psychosis.
What is the treatment for addison’s disease
Lifelong replacement of gluticosteroids and mineralcorticoids
Addisons disease is ______?
Autoimmune destruction of adrenal cortices which causes chronic cortisol, aldosterone and adrenal androgen deficiency.
Common causes of cushing’s?
Syndrome: Adrenal hyperplasia or tumor, extra-adrenal tumors, Chronic glucocorticoid use
Disease: pituitary adenoma causing ACTH hypersecretion
What are common findings in cushings?
Truncal obesity, moon facies, buffalo hump, purple striae abd, thin extremities, progressive weight gain, acne, UE/LE weakness
Pts who have episodic HTN, HA, tachycardia and sweating should be evaluated for?
Pheochromocytoma- a tumor in the adrenal gland
Lab: 24hr urine (elevated catecholamines, metanephrines and Cr)
+UA: CT abd w & w/o oral/IV contrast
