Endocrine Flashcards
Hyperthyroidism info
more common in women 8:1. onset 20-40 years old.
Causes: Grave’s disease, toxic adenoma, subacute thyroiditis, TSH secretory pituitary tumor, high dose amiodarone
Hyperthyroid symptoms vs Hypothyroid symptoms
Hyper: nervous, anxious, sweating, fatigue, emotionally labile, fine tremor, hyperreflexia, increased appetite, weight loss, smooth/ warm/ moist skin, fine/thin hair, exophthalmos, lid lag, tachycardia, heat intolerance, increased a.fib
Hypo: extreme weakness, muscle fatigue, arthralgias, cramps, cold intolerance, constipation, weight gain, dry skin, hair loss, brittle nails, puffy eyes, edema of hands and face, bradycardia, slow DTRs,
Hypothyroidism info
primary disease of thyroid gland pituitary deficiency of TSH hypothalamus deficiency of TRH- thyrotropic releasing hormone iodine deficiency Hashimoto's thyroiditis idiopathic causes, damage to gland TX: thyroid supplementation Dx: check TSH
Hyperthyroid diagnosis & management
TSH assay- low
Serum T3, T4, thyroid resin uptake, free thyroxine index: all increased
T4 can be normal, but T3 elevated
thyroid radioactive iodine uptake and scan- high iodine uptake: Grave’s disease. low uptake: subacute thyroiditis.
Management: propranolol- symptomatic relief for subacute thyroiditis
thiourea drugs- for mild cases, small goiters (methimazole or propylthiouracil PTU). Radioactive iodine- destroy goiter. or thyroid surgery, requires thyroid supplementation afterwards
Hypothyroid diagnosis and management
TSH high T4 low or low normal T3 uptake- decreased (not reliable test) hyponatremia, hypoglycemia TX: Synthroid 50-100mcg daily until symptoms stabilize. > 60 years- decrease dosage.
Hyperthyroid crisis
PTU- propylthiouracil 150-250mg q6 hours OR methimazole 15-25 mg q 6 hours with lugol’s solution 10 drops TID, sodium iodide IV push 1gm and propranolol 0.5-2gm IV q 4 hours. or PO ever 6 hours with steroids
steroids: hydrocortisone 50 mg q 6 hours with rapid reduction as situation improves
avoid aspirin- will exacerbate the thyroid storm
Hypothyroid Crisis: Myxedema Coma
protect airway- mechanical ventilation likely needed
fluid replacement,
Synthroid IV 400mcg, then 100mcg every day
support hypotension
slow rewarming with blankets- avoid circulatory collapse
symptomatic care
Cushing’s Syndrome
Too much cortisol: ACTH hypersecretion by pituitary. adrenal tumors, chronic administration of glucocorticoids
Presentation: central obesity, moon face, buffalo hump, acne, purple striae, hirsutism, hypertension, weakness, amenorrhea, impotence, polyuria, polydipsia, diabetes, labile mood, frequent infections
Addison’s Disease
deficient in cortisol, androgens and aldosterone,
CAUSE: autoimmune destruction of adrenal gland. metastatic cancer, bilateral adrenal hemorrhage with anticoagulation therapy. pituitary failure resulting in decreased ACTH
Symptoms: hyperpigmentation in mouth and skin creases- nail beds, nipples, palmar creases, posterior neck
diffuse tanning and freckles, lack of pubic hair, armpit hair,
**orthostasis and hypotension, fever (acute), changes in consciousness (acute)
Cushing’s diagnostics and management
Labs: hyperglycemia, hypernatremia, hypokalemia, glucosuria, leukocytosis, elevated plasma cortisol in the mornings .dexamethasone suppression test to differentiate cause, serum ACTH elevated
TX: discontinue medications that cause (glucocorticoids), TSR of pituitary adenoma, surgical removal of adrenal tumors, manage electrolyte balance
Addison’s disease diagnosis and management
hypoglycemia, hyponatremia, hyperkalemia, elevated ESR, lymphocytosis, low plasma cortisol, cosyntropin simulation test- for Addison’s
TX: glucocorticoid and mineralocorticoid replacement: cortisol, androgen, aldosterone.: hydrocortisone, fludrocortisone (outpatient chronic management)
Inpatient tx: hydrocortisone IV with NS, replace volume with D%NS at 500cc/hour x 4 hours, then taper. vasopressors are ineffective for BP maintenance. treat underlying cause: sepsis.
SIADH vs DI
SIADH: water retention
DI: profound diuresis
SIADH causes and diagnosis
release of ADH independent of osmolality or volume dependent stimulation: due to tumor production of ADH or skull fractures/ head trauma, CNS disorder, chronic lung disease
Symptoms: hyponatremia- causes headache, seizures, coma
decreased DTRs, hypothermia, weight gain, nausea, vomiting, cold intolerance
DI causes and diagnosis
inadequate output of ADH pituitary hormone, or lack of response by kidney to ADH
Centra;: pituitary or hypothalamus- ADH deficiency- idiopathic, damage: surgery or trauma, infection, cancer
Nephrogenic: defect in renal tubule, familial X-linked trait, acquired d/t pyelonephritis, K depletion, sickle cell anemia, chronic hypercalcemia, medications
Psychogenic: refer
Symptoms: polydipsia, polyuria, weight loss, fatigue, AMS, dizziness, fever, tachy, hypotension, dehydration signs
SIADH diagnostic and management
euvolemic hyponatremia, decreased serum osm. increased urine osm. urine sodium? 20. renal cardiac and thyroid function normal.
Tx underlying cause, can restrict fluid intake if sodium low, especially if symptomatic. also hypertonic saline and Lasix if Na< 110. Monitor sodium and potassium losses hourly and replace
