Endocrine

Question 1

what do ketones represent

Answer 1

increased lipolysis in the context of absent glucose

Question 2

causes of hypoglycemia

Answer 2

-meds: insulin, oral hypoglycemics
-decreased oral intake in DM with insulin
-critical illness: sepsis, liver failure
-EtOH
-malnourishment,
-cortisol deficiency
- pancreatic tumours (insulin secreting)

Question 3

threshold value for adult hypoglycemia

Answer 3

3.9 aka 4

Question 4

Tx of hypoglycemia

Answer 4

25 g of glucose carbs or 25 g or IV dextrose 50mL of D50 is 1 amp, then run infusion usually

Question 5

when is glucagon not effective, what is the dose

Answer 5

in elderly or alcoholics, dose= 1 mg IM

dextrose is always better choice

Question 6

4 I’s that cause DKA

Answer 6

-insulin (lack of)
-infection
-ischemia
-illicit drugs (cocaine)

Question 7

3 criteria for dx fo DKA

Answer 7

hyperglycemia, ketosis, WAGMA

Question 8

why can bicarb sometimes be normal in DKA

Answer 8

concurrent metabolic alkalosis from vomiting

Question 9

walk through DKA mgmt

Answer 9

-rehydrate with 1-2 L NS
-once initial bolus done, consider switching to 1/2 NS once hyponatremia is corrected
- replace K if needed, if less than 3.5 add 40 meq/L, if 3.5-5 add 20 meq/L
-start insulin and after K > 3.5 at 0.1U/kg/hr
-continue insulin until gap closed, once glucose < 14 switch to D5 1/2NS.

Question 10

when to give bicarb in DKA?

Answer 10

consider if pH < 6.9, evidence of impending CV collapse, or life-threatening hyperK

Question 11

how to spot cerebral edema?

Answer 11

HA, AMS, vomitting. usually occurs 6-10 hrs after tx started.
tx= reducing IVF rate and giving mannitol.

Question 12

difference of HHS vs DKA

Answer 12

slower process than DKA, higher glucose, higher osmolality, more volume depletion, normal pH

Question 13

criteria for HHS dx

Answer 13

glc >33
osmolality >315
bicarb >15
pH > 7.3
may or may not have ketones

Question 14

Tx of HHS

Answer 14

• basically same as DKA except they they need ++ fluid (often 8-12 L light)

give 2L over first 1 hr, continue intil hemodynamically stable then insulin/potassium is same as DKA

Question 15

typical HHS pt

Answer 15

elderly, weak, T2DM, with limited oral intake
33% have no previous dx of DM

Question 16

anterior and posterior pituitary hormones are:

Answer 16

post: oxytocin, ADH

ant: GLFTAP

Question 17

causes of hypopituitarism

Answer 17

pituitary tumour (most common, can be benign or malignant)
pituitary apoplexy (hemm)
sheehan syndrome (post partum hypoperfusion of pituitary)
other: infection, trauma, radiation, surgery, infiltrative dz

Question 18

treatment of hypopit

Answer 18

supportive, give steroids and thyroid hormone (if deficient), NEED to give steroids before Synthroid as it will cause adrenal crisis if dont

Question 19

3 ways parathyroid hormone increases Ca

Answer 19

increased kidney resorption
increase osteoclasts
increase GI resorption

Question 20

signs of myxedema coma?

Answer 20

hypothermia, AMS is characteristic

other findgins:
bradycardia, hypotension, resp failure,
edema, low ECG voltage, hypoglycemia, hyponatremia

often precipitated by major illness, cardiac or neuro event

Question 21

treatment of myxedema coma?

Answer 21

-supportive care
-empiric replacement of steroid (hydro cort 100 mg IV)
-then levothyroxine 500 ug IV

Question 22

precipitants of thyroid storm

Answer 22

infection, DKA, iodine load, stroke, ACS, PE, trauma, surgery

Question 23

clinical features of thyroid storm

Answer 23

tachycardia
hyperthermia
HF
CNS effects
GI/hepatic dysfunction

Question 24

scoring system for thyroid storm

Answer 24

Burch-Wartofsky
looks at temp, CNS, GI, HR, ?afib, CHF and precipitating event

Question 25

mgmt of thyroid storm

Answer 25

supportive care
propranolol
methimazole or PTU
steroid (dex or HC), will decrease t4 to t3 conversion
can also give inorganic iodine, 1 hr after PTU

Question 26

1 common drug for inducing hypo and hyper thyroidism

Answer 26

hypo: Lithium
hyper: amiodarone

Question 27

3 hormones released by adrenals

Answer 27

cortisol, aldosterone, catecholamine

Question 28

pheochromocytoma, what is it, what are symtpoms

Answer 28

adrenal tumor that causes release of catecholamine. classic triad: HA, sweating, tachycardia.. + other symptoms of epi/norepi excess

Question 29

adrenal insufficiency, what is it

Answer 29

decreased cortisol or aldosterone or both

if primary it will be both as issue is wiht gland, if secondary will just be cortisol as ACTH decreaed from pituitary

Question 30

how to know if adrenal insufficiency involves aldo deficiency too?

Answer 30

they will be hyperK

Question 31

adrenal crisis s/s? causes?

Answer 31

life threatning, refractory hypotension, hypoglyecmia, (hypoNa and hyperK if primary insufficiency)

Question 32

tx of acute adrenal crisis

Answer 32

hydrocortisone 100 mg IV if primary as it will replace both cortisol and aldo

if no hypoNa or hyper K and no known dx of adrenal insufficiency give dexamethasone 6 mg IV as it wont interfere with ACTH stim test

Question 33

waterhouse-Friedrichson syndrome

Answer 33

bilat adrenal hemm due to infection, often meningococcal.

Question 34

causes of adrenal insufficiency

Answer 34

primary: autoimmune, infectios, infiltrative, drugs, waterhouse-Friedrichson syndrome

secondary: prolonged steroid use, pituitary tumour, basal skull #, ICA stroke or aneurysm

Question 35

adrenal crisis (aka addison’s crisis) trigger?

Answer 35

acute physiologic stress, pituitary apoplexy, withdrawl of chronic steroids