Endocrine

Question 1

Thyroid Storm Treatment

Answer 1

PTU
Fever control - cooling blankets, APAP
IVF
Na Iodide
Hydrocortisone
Digoxin for arrythmia/HF
Propranolol or esmolol
Avoid aspirin

Question 2

Thyroid Storm Differential Dx

Answer 2

Thyroid Storm
Pheochromocytoma
Malignant Hyperthermia
Neuroleptic Malignant Syndrome
Carcinoid Syndrome

Question 3

Hyperthyroid Treatment

Answer 3

Emergent: B-blockers - propranolol (don’t prevent thyroid storm
Nonemergent - Delay elective surgeries until euthyroid
- Antithyroid medications (PTU, methimazole)
- Prevent hormone release - Potassium, Na Iodide
- Mask adrenergic overactivity - beta blockers
- Radioactive Iodine
- Glucocorticoids - reduce secretion, prevents conversion

Question 4

Hypothyroidism Causes

Answer 4

Hashimoto’s Thyroiditis
Iatrogenic - removal, radiation, medication
Genetic hormone synthesis defects
Anterior pituitary damage
Hypothalamic dysfunction

Question 5

SIADH

Answer 5

Hyponatremia (<130)
Euvolemia/hypervolemia
Plasma osm < 270
Urine Osm and Na high

Tx:
fluid restriction

Question 6

Carcinoid Syndrome

Answer 6

Neuroendocrine tumors of GI tract

Secrete serotonin (cramps, diarrhea, bronchospasm), kallekrein (flushing), histamine (vasodilation/bronchospasm)

Chronic serotonin exposure leads to Tricuspid Insufficiency and Pulmonic Stenosis (TIPS)

Dx: 5-HIAA urine levels, CT/MRI

Tx: Octreotide-inhibits carcinoid hormone release, antihistamines

Anes: A-line, prefer vasopressin & phenylephrine to avoid catecholamines, Octreotide, bolus + infusion for hypotension

Question 7

Pheochromocytoma

Answer 7

Alpha blockade - phenoxybenzamine (irreversible, non specific, long acting)
Doxazosin (reversible, specific, titrateable)

Beta blockade - after alphad