Endocrine Flashcards
What gene is DMI associated with
GAD65
Smogyl effect and treatment
Early morning hyperglycemia caused by nocturnal hypoglycemia
Tx: reduce bedtime insulin
Dawn phenomenon and treatment
Tissues desensitized to nocturnal insulin progressively elevating BG in am
Tx: increase bedtime insulin
What is syndrome X
Obesity, HTN, abnormal lipid profile
What is metabolic syndrome
Increased weight circumference, elevated triglycerides, HTN, elevated glucose, low HDL
3 or more is Metabolic syndrome
Places patient at risk for sudden cardioembolic death
Serum fasting glucose, random glucose, Hgb A1C that indicate diabetes
More than one occasion
Fasting: >126
Random: >200
Hgb A1C: >6.5
Type 2 DM treatment
Weight control, diet, exercise
Metformin first then can add GLP1 agonist (duleglutide) prior to starting insulin
Side effects of Metformin
GI complaints, muscle pain
Lactic acidosis when used with contrast
GLP1 agonist Duleglutide (Ozempic) side effects
GI disturbances, pancreatitis, THYROID CA
Jardiance side effect
Euglycemic metabolic acidosis
DKA diagnostics
Serum glucose: 250-300, ph <7.0, BHB >8, positive ketones
DKA treatment
Protect airway
IVF , insulin drip (0.1units/kg bolus with 0.1u/kg/hr drip)
Switch to D5 1/2 NSS when BG hits 250
Ensure K is not low, if less than five consider repletment first
HHNL s/s, diagnostics, and treatment
polyuria, weakness, hypotension, poor skin tugor
Labs: Glucose >600, hyperosmolarity >310, normal pH and anion gap
Tx: protect airway, IVF, insulin drip 0.1u/kg/hr, switch to D5 1/2 NSS when BG hits 250
What is the most common presentation of hyperthyroidism
Graves’ disease
S/s of hyperthyroidism
Nervousness, sweating, fatigue, hyperreflexia, increased appetite, weight loss, hyper metabolic, exopthalamus, tachycardia, heat intolerance
Hyperthyroidism labs/diagnostics/ treatment
Labs: low TSH, elevated T3 and T4, elevated ANA
Diagnostics: iodine uptake
Tx: Endocrine referral, propranolol for hyper metabolism, methimozole, PTU, radioactive iodine, thyroid surgery
What is thyroid storm and treatment
Hyperparathyroidism exacerbation
PTU or methimazole or iodine w/ propranolol w/hydrocortisone within the first hour
NO ASPIRIN
Hypothyroidism s/s, labs, diagnostics, and tx
Hashimoto’s
S/s: sluggish, cold intolerance, dry skin, hair loss, weight gain, brittle nails, bradycardia, slow DTRs
Tx: Levothyroxine
Myxedema coma treatment
Intubate, fluid replacement, synthroid IV, rewarm slowly
What is the difference between Cushing syndrome and disease
Disease: pituitary issue causing ACTH release
Syndrome: tumor making too much cortisol
Causes of Cushings
Tumor, glucocorticoids
Cushing disease s/s, labs, diagnostics, and treatment
S/s: moon face, buffalo hump, central obesity, thin arms/legs, purple striae, impotence, hyperglycemia
Labs: hyperglycemia, hypernatremia, hypokalemia, elevated plasma cortisol
Diagnostics: dexamethasone suppression test, serum ACTH
Tx: Aldactone or norvasc for HTN, Ketoconazole for hypercortisolism, surgical removal
Causes of Addison’s disease, s/s, labs, and treatment
Auto immune, cancer, adrenal hemorrhage, sepsis
S/s: hyperpigmentation in skin creases, diffuse tanning/freckles, orthostasis, hypotension, scant pubic hair
Labs: Hypoglycemia, hyponatremia, hyperkalemia, elevated ESR, low plasma cortisol
Diagnostic: Cosyntropin test
Management: Glucocorticoids and mineral corticoids
What is SIADH, s/s, management
Release of too much ADK
S/s neuro changes, decreased DTR, hypothermia, n/v, cold intolerance, concentrated urine
Labs: Hyponatremia despite euvolemia, decreased serum osmo, increased urine osmo
Management: treat underlying cause, Na (fluid restriction, 3% Na and lasix)
DI what is it, s/s, labs, management
Inadequate ADH
Causes: pituitary tumor, idiopathic, trauma, meds, psychogenic, renal
S/S: large amount of dilute urine, excessive thirst, hypotension
Labs: hyponatremia, elevated BUN/CRT, serum osmo elevated, urine osmo low, 1.10-1.30 elevated urine specific gravity
Management: D5W IV 1/2 volume in 24 hours (too rapid causes cerebral edema), switch to 1/2 NSS or NSS. Vasopressin DDAVP
What is pheochormocytoma s/s, labs, and treatment
Excessive catecholamine release typically caused by tumor release
S/s: HTN, diaphoresis, hyperglycemia, tremor, tachycardia, weight loss
Labs: TSH should be normal, blood/urine metanepherines, urine catecholamines, 24 Hr urine
Treatment: alpha adrenergic meds, tumor removal
Post op concerns: hypotension, adrenal insufficiency, and hemorrhage
Serum fasting glucose and random glucose along with A1C that indicate diabetes
Fasting: >126 on more than one occasion
Random: >200 with signs of hyperglycemia
A1C: >6.5
Black box warning for Metformin
Lactic acidosis secondary to IV contrast
D/C on admission to hospital
SGLT2 inhibitors (glifozin) side effects
Increased risk for foot and leg amputations
What is the presentation difference between DKA and HHS
DKA has kussmal breathing and fruity breath
What medication class is given to diabetics as the first pharmacological therapy after weight reduction methods in order to reduce weight?
Gilaunides (metformin)
What is the reaction between sulfanyreas and ETOH
Hypoglycemia
Hypothyroidism. What lab do you follow to evaluate the effectiveness of treatment
TSH
What is a vasopressin challenge
Used to confirm DI and differentiates between nephrogenic and central DI
When should synthroid levels be optimal
May increase dose every 1-2 weeks until symptoms stabilize
Blood glucose, sodium, and potassium effects with Cushings
BG: hyperglycemia
Hypernatremia
Hypokalemia
BG, sodium, and potassium with Addison’s
Hypoglycemia, hyponatremia, and hyperkalemia
