Endocrine Flashcards
DDx for unexplained weight loss
Malignancy - especially in the elderly
Uncontrolled type 1 DM - more so in younger patients
Adrenal insufficiency - pituitary adenoma or Addison’s Disease
Pheochromocytoma - inappropriate catecholamine release
Hyperthyroidism
DDx for bone pain and pathologic fractures
Disorders of the parathyroid gland can cause alterations in bony reabsorption, leading to excessive bony demineralization
—-hyperparathyroidism is considered in cases of bone pain and hypercalcemia
Osteopenia - especially when encountered before age 60
–hyperthyroidism
–Cushing’s Syndrome - disorder of cortisol
Difference between type 1 and type 2 diabetes
DM I - presents in childhood
-Caused by pancreatic islet Beta cell destruction predominantly by an autoimmune process
–Islet autoantibodies are often present
-polyuria, polydipsia and weight loss associate with a random serum glucose >200
DM II - presents in adulthood
-Caused by insulin resistance with a defect in compensatory insulin secretion
—So much sugar/carbs in the diet that the body just begins to ignore the amount of insulin that is being made
What does insulin do?
Transport glucose to the cells for use
In DM I, there is not enough insulin to move the glucose, due to islet cell destruction
In DM II, the body is making a lot of insulin because there is so much glucose, therefore the cells are insensitive to the insulin so the glucose builds up
Diagnosis of DKA
Diagnosis:
-Hyperglycemia >250
-Acidosis pH <7.3
-Serum bicarb <15
-Serum positive for ketones: beta hydroxybutyrate >1.5
-Anion gap >15
-Elevated serum osm >330
-Kussmaul’s breathing - faster, deeper breathing
-Hypotension and tachycardia
-Parched mucous membranes
-Abd pain, n/v
Treatment of DKA
Intubate if pt is too altered to maintain airway
Give insulin: ALWAYS regular human insulin
—0.15 units/kg IV bolus
—0.1 units/kg/hr IV as gtt
—–Insulin gtt gets calculated hourly according to the change in glucose
Restore fluid deficit: usually 4-5L in an adult - NS preferred
—Once glucose is <250, change fluid to D5%W to maintain serum glucose 250-300
No need to treat hyperK. As you give insulin the K will come down because it will be pushed into the cell
Treat severe acidosis with bicarb until pH is >7.1
What electrolytes should you monitor in DKA
Watch for K
–Could present initially hyperK or normal K but the K will always drop during treatment so you might need to supplement
—check BMP every 4 hours
Also keep eye on bicarb - likely will be low initially but if you replete fluids, the bicarb will normal out
Treatment of hypoglycemia
If awake and alert, give sugary foods/drinks
If the pt has AMS: Given D50% 50cc IV, recheck glucose shortly after
—Feed as soon as possible, well balanced
If patient took overdose of metformin:
–Give Octreotide 75mcg SC/IM
–Feed the patient
–Observe for 12-24 hours given long half life
Lab findings in hyper- and hypothyroidism
Hyperthyroidism:
TSH will be low
T3 will be elevated
123I uptake and scan will be elevated
Antithyroglobulin will be elevated
Hypothyroidism:
TSH will be high
Free T4 will be elevated
If antithyroglobulin is high and TSH is high - Hashimoto’s
Thyroid nodules: High risk and low risk
Less worrisome:
-High TSH, low FT4
-Older women
-Cystic appearance on US
-Family hx of goiter
More worrisome:
-vocal changes
-Young men
-Hx of radiation exposure
-Any solitary, firm nodule
Causes of goiter
Iodine deficiency
Congenital hypothyroidism
Clinical features of hypothyroidism
fatigue
cold intolerance
constipation
depression
weight gain
puffy appearance to the face
Myxedema: Causes, clinical presentation, treatment
Usually occurs when a hypothyroid patient is placed under physiological stress (infection)
Clinical presentation:
-decreased LOC
-hypothermia
-hypoNa
-hypoglycemia
-hypotension
-hypoxia/hypercapnia
-Often coexists with acute adrenal insufficiency
Treatment:
Levothyroxine 400mcg IV once and then 100mcg IV daily
If adrenal insufficiency is present then hydrocortisone 100mg IV then 25-50mg IV every 8 hours
Fluid replacement
Slowly rewarm with blankets
Treatment of hyperthyroidism
Methimazole 30-60mg Daily until FT 4 levels return to normal
Propranolol as symptomatic relief
131I to destroy the thyroid and then thyroid hormone replacement for life
Clinical presentation and labs of hypoparathyroidism
Paraesthesias start first followed by abd cramping and tetany
Labs will show low serum and ionized calcium, high phosphate