endocrine Flashcards
adrenal medulla
10% of gland and secretes catecholamines
Adrenal cortex
90% of gland and secretes Salt, Sugar, Sex
adrenal stimulation
CRH form hypothalamus and ACTH from pituitary
Primary adrenal insufficiency
Addisons disease is autoimmune issue common in women (CRH and ACTH high), leads to skin hyperpigmentation due to ACTH
Secondary adrenal insufficiency
ACTH secretion deficiency (Low CRH, ACTH and cortisol)
Exogenous glucocoritoid therapy (Low everything)
adrenal insufficiency Sx
weakless/lethargy
weight loss
nausea/vomiting
hypoglycemia
Mineralocorticoid deficiency
adrenal insufficiency diagnosis
Give synthetic ACTH and see if cortisol increases or not
Short acting steroids
8-12h
Hydrocortisone 1:1
cortisone 0.8:0.8
intermediate steroids
12-36h
prednisone 4:0.4
long acting
36-72h
betamethasone 40-0.01
Steroid dose for primary
Hydrocortisone 15-25mg daily split 2/3 Qam and 1/3 Qhs
add fludrocortisone 0.05-0.1mg qd for mineralocorticoid action
adrenal crises management
for when you are sick, take double dose during febrile illness and continue till feeling better
Hot water adrenal management
have to increase dose of mineralocorticoid 2-3 fold to account for water loss
Cushing syndrome
Issue with the adrenal gland producing too much or exogenous steroids
cushings disease
from too much ACTH from pituitary only
Cushings Sx
Fatigability and weakness
increased central body weight
HTN
Hair growth
muscle wasting
skin thinning
diagnosis of cushings
dexamethasone supression test <50nmol rules out cushings
>50nmol confirms cushings
cushings disease treatment
Cut out or irradiate adrenals
enzyme inhibitors (ketoconazole)
decrease ACTH production from pituitary (cabergoline or pasireotide)
cushings syndrome treatment
Does this patient really need exogenous steroids
monitor patients on >20mg prednisone for >3 weeks
drugs that can inhibit dopamine
antipsychotics, antidepressants, metoclopramide, domperidone
TSH >10
Overt hypothyroidism
TSH 6.5-10
subclinical hypo, can order a T4 to confirm but not recommended
Order a thyroid peroxidase Aby test to look for progression to overt
TSH <0.1
Then also test T4 if it is high than hyperthyroidism
if T4 is normal then order T3 to search for the various types of hyper
thyroid screening
not recommended in asymptomatic people
only for people with symptoms or increased risk (pregnant, lithium or amiodarone, other autoimmune, family history)
thyroid risk factors
(pregnant, lithium or amiodarone, other autoimmune, family history)
hypothyroidism Sx (5)
swelling of thyroid
hoarseness/deeping of voice
persistent dry sore throat
difficulty swallowing
infertility
types of primary hypothyroidism (5(
Hashimotos
lactogenic
iodine excess
lithium/amiodarone
congenital
types of secondary hypothyroidism (2)
pituitary or hypothalamic disease
Synthroid counselling notes
Take 60min before first meal
don’t take with iron, calcium or aluminum
don’t take with rifampin, carbamazepine and phenytoin
Synthroid dosing
Normal people start at 1.6mcg/day then test in 6-8 weeks and titrate by 12.5 to 25 mcg
old people start at 1mcg/day
people with heart issues start at 25mcg
synthroid over treatment
atrial fibrillation and stroke
bone loss and fracture
sleep disturbance and irritability
synthoid under treatment
increased lipids
slow heart rate
low BP
memory loss
mood impairment
are different brands of levothyroxine interchangeable
no
hypothyroid while pregnant
need to increase dose by 20% and keep TSH <2.5 1st and <3.5 for rest of preg
types of hyperthyroidism (6)
graves disease
toxic nodules
tumors
subacute thyroiditis
hashitoxicosis
excessive dosage
Beta-blockers for hyper
Can be used before diagnosis for symptom control, will decrease HR and BP will reduce heat intolerance and anxiety
Propylthiouracil (PTH)
second line but used for 1st trimester of pregnancy, needs more frequent dosing
methimazole
first line and can be used for longer
antithyroid drugs
inhibit thyroid peroxidase to prevent secretion of T4 and T3
antithyroid drug monitoring
Test T4 and T3 every 4 weeks, once normal add TSH and monitor for 2-3 months then taper to 30-50% of dose and continue for 12-18 months
radioactive iodine
to be used instead of surgery but not in pregnancy people or 6 months before/ after. needs 6-18 weeks for full affect
