endocrine Flashcards
POS diagnosis
2 of the following:
irregular ovulation
elevated levels of androgens
appearance of polycystic ovaries on ultrasound
PCOS is a risk factor for
cardiovascular disease
insulin resistance
hyperlipidemia
PCOS symptomatology
menstrual abnormalities
hyperandrogenism - hirsutism
infertility
obesity
diabetes
PCOS meds
PO contraceptives
Clomiphene if trying to conceive
metformin
synthroid dosing
initial 25-75 mcg PO daily
increase by 25 mcg q 1-2 weeks
goal TSH 0.4-2.0mU/L
pt>60 - start low, go slow!
myxedema coma s/s
AMS - stupor, delirium, seizures, coma
extreme hypothermia
hyponatremia
respiratory depression
hypotension
bradyarrhythmias
myxedema coma treatment
check TSH, but start therapy before lab results
synthroid 400 mcg IV x1, then 50-100 mcg IV daily
hydrocortisone
hyperthyroidism management
propranolol 10-80 mg PO for symptom relief
thiourea drugs (methimazole, propylthiouracil)
radioactive iodine
thyroidectomy
hyperthyroid red flags
fever
tachycardia
hypertension
neurologic/GI abnormalities
hyperthyroid red flags
fever
tachycardia
hypertension
neurologic/GI abnormalities
thyroid storm management
D5 IVF resuscitation
ABCs
beta blockers
high-dose PTU, methimazole
avoid aspirin!!!
Cushing’s triad
hypokalemia
hyperglycemia
leukocytosis
Cushing’s diagnosis
elevated plasma cortisol in AM
high urine cortisol
ACTH normal
Cushing’s treatment
high-protein diet
tumor resection
gradual withdrawal of glucocorticoids if that’s the cause
long term f/u - osteoporosis, immunosuppression, DM, HTN, risk for adrenal crisis (stress dose steroids in acute illness)
primary cause of Addison’s disease
autoimmune destruction of adrenal gland
Addison’s triad
hypoglycemia
hyponatremia
hyperkalemia
Addison’s s/s
weakness, fatigue, weight loss, anorexia, N/V/D
hyperpigmentation
orthostatic hypotension
scant body hair
Addison’s diagnosis
plasma cortisol <3mg/dL at 8pm
low ACTH
Addison’s treatment
supplemental glucocorticoids
will need to increase doses in times of stress
diabetes insipidus
insufficient vasopressin (ADH)
passage of large volume (>3L/24h) of dilute urine (<300mOsm/kg)
diabetes insipidus s/s
thirst
polyuria
weight loss, fatigue
LOC change
dizziness
febrile
tachycardia, hypotension
poor skin turgor
DI lab findings
hypernatremia
elevated BUN/Crt
serum osmolal >300
urine osmolal <100
USG <1.005
central - plasma vasospressin <1
TBW deficit calc
0.6 * weight in kg * (Na/140 - 1)
DI fluid replacement
give fluids hypoosmolar to serum
Na > 150 - D5W
Na < 150 - 0.45% or 0.9% NS
try to decrease Na by 0.5 mmol/L/h
DI treatment
central - DDAVP
nephrogenic - thiazide diuretic or indomethacin
fluids
SIADH
excess ADH
excess water
hyponatremia`
SIADH s/s
headache, seizures, coma, cold intolerance, decreased DTRs
weight gain, edema
SIADH labs
hyponatremiaa
serum osmolality <280
urine osmolality >100
urine Na >20
SIADH treatment
if Na >120: 1L fluid restriction
if Na 110-120 w/o symptoms: 500 ml fluid restriction
if Na <110 or neuro symptoms: isotonic or hypertonic saline 3% at 0.5ml/kg/hr & lasix 0.1-1mg/kg
pheochromocytoma syndromes
- von hippel-lindau (VHL) syndrome
- multiple endocrine neoplasia type 2 (MEN2)
- neurofibromatosis type 1 (NF1)
s/s of pheochromocytoma
HA
polydipsia, polyphagia
anxiety
palpitations
diaphoresis
weight loss
dyspnea
labile HTN
hyperglycemia
postural hypotension
pheochromocytoma diagnostics
plasma free metanephrines
24 hour urine for metanephrines
pheochromocytoma treatment
tumor resection
BP control - <140/90
alpha adrenergic blockers - phentolamine
