Endocrine #2 Flashcards
Most aggressive type of thyroid cancer
-Anaplastic Thyroid Cancer
Symptoms of anaplastic Thyroid cancer
- Rapid growth, compressive symptoms (dyspnea, dysphagia)
- Rock hard thyroid mass
A medullary thyroid carcinoma is associated with
- Calcitonin synthesizing parafollicular cells
- MEN IIa or IIb
Follicular Thyroid Carcinoma has METs that go
Distant (lung MC, liver, brain, bone)
Think Follicular goes FAR
Risk Factors for thyroid nodules
-Extremes of age, history head and neck radiation
MC type of thyroid nodule
Follicular adenoma (colloid)
Symptoms of thyroid nodule
- Most asymptomatic
- Can have compressive symptoms (recurrent laryngeal nerve impingement)
On physical examination, what symptoms are concerning for malignant?
-rapid growth, fixed in place, no movement with swallowing
On PE, what is found on a benign thyroid nodule?
-Varied, smooth, firm, irregularly sharply outlined, discrete, painless
Diagnostics for thyroid nodule
- Thyroid function testing (initial). If TSH normal or high, FNA indicated
- Thyroid US: irregular margins, hypoechoic, central vascularity
- FNA: best test and done if (Nodules > 1.5 cm with normal TSH)
- Radioactive iodine uptake scan: Cold nodules (biopsied to rule out malignancy)
Do hot or cold nodules have a higher chance of malignancy?
Cold
Diagnostics for DM
- Fasting plasma glucose > 126 (at least 8 hours apart on 2 occasions) = GOLD
- 2 hour glucose tolerance test > 200
- A1c > 6.5%
- Random Plasma > 200
When to screen for DM?
-All adults > 45 every 3 years OR any adult with BMI > 25 and 1 additional risk factor
MOA for Metformin
- Decreased hepatic glucose production by inhibiting gluconeogenesis
- No effect on pancreatic beta cells; not associated with hypoglycemia
Adverse reactions to Metformin
- GI complaints (MC)
- Vitamin B12 deficiency
- Lactic Acidosis
Contraindications to Metformin
- Severe renal or hepatic impairment
- Excessive alcohol intake
- Hold before contrast and resumed within 48 hours
Somogyi Phenomenon
-Nocturnal hypoglycemia followed by rebound hyperglycemia
How to prevent Somogyi Phenomenon
- Decrease nighttime NPH dose
- Move evening NPH dose earlier
- Give bedtime snack
Dawn Phenomenon
-Normal glucose until rise in serum glucose levels between 2 AM - 8 AM
How to manage Dawn Phenomenon
- Bedtime injection of NPH
- Avoid carb snack late at night
How long does NPH normally work?
-Covers insulin for about a half day or overnight
When do you give Lispro or Aspart, which are rapid acting insulin agents?
At the same time as the meal.
Short-acting, or regular insulin, lasts how long?
-Given 30-60 minutes prior to meal
Symptoms of DKA
- Fruity (acetone) breath
- Kussmaul respirations (deep, continuous respirations)
- Tachycardia, tachypnea, hypotension, decreased skin turgor
What diagnostic shows DKA
- Plasma glucose > 250
- Positive ketones in the urine
- High anion gap metabolic acidosis
Treatment for DKA
- SIPS
- -Saline, Insulin (regular), Potassium Repletion, Search for underlying cause
- –Isotonic 0.9% (Normal saline)
- –Correction of DKA will invariably cause hypokalemia
_____ are more important than glucose levels in determining the severity of DKA
-Bicarbonate levels
Treatment for diabetic neuropathy
- Optimal glucose control
- Pregabalin and Duloxetine, Amitriptyline, or Gabapentin
Treatment for Gastroparesis from Diabetes
- Dietary modifications are initial management
- Prokinetics: Metoclopramide or Erythromycin
Diabetes mellitus is the MCC of
End stage renal disease
What is syndrome of inappropriate ADH (SIADH)
-Excess of ADH from pituitary gland or ectopic source leading to free water retention and hyponatremia due to kidney’s inability to dilute the urine
Symptoms of SIADH
-Neurologic symptoms of hyponatremia and cerebral edema (confusion, lethargy, seizure, coma)
Diagnostics for SIADH
- Hyponatremia
- Decreased serum osmolarity
- Increased urine osmolarity (>20)
- Increased ADH levels
Treatment for SIADH
- Water restriction
- IV hypertonic saline + Furosemide (if severe)
Diabetes Insipidus leads to production of
large amounts of dilute urine
Symptoms of Diabetes Insipidus
- Polyuria (20 L daily)
- Polydipsia
- Neurologic symptoms of hypernatremia (confusion, lethargy)
Labs for DI
- Increased serum osmolarity
- Decreased urine osmolarity
- Decreased specific gravity
- Increased urine volume
diagnostics for DI
- Fluid deprivation test: DI continues to produce large amounts of dilute urine
- Desmopressin Stim Test: Distinguishes the types
- —Central: reduction in urine output
- —Nephrogenic: continued production of large amounts of urine
Treatment for Central DI
Desmopressin (DDAVP)
Treatment for Nephrogenic DI
Hydrochlorothiazide, Indomethacin, Amiloride
Symptoms of Hypercalcemia
- Stones (Nephrolithiasis)
- Bones (bone pain and fractures)
- Abdominal groans (ileus, constipation)
- Psychic Moans (Depression, anxiety, cognitive dysfunction)
Diagnostics for hypercalcemia
- Intact PTH
- ECG: shortened QT interval
MCC of hypercalcemia
-Hyperparathyroidism
Symptoms of Hypocalcemia
- Increased muscular contractions: muscle cramps, bronchospasm, tetany, Chvostek Sign (facial spasm with tapping of facial nerve), Trousseau’s Sign (inflation of BP cuff above systolic causes carpal spasm)
- Increased DTR
What does an ECG for hypocalcemia show?
-ECG: prolonged QT interval classic
Treatment for hypocalcemia
- Oral Calcium + VItamin D
- IV calcium gluconate for severe
Triad of Symptoms for Primary hyperparathyroidism
-Hypercalcemia + Increased intact PTH + Decreased Phosphate
What is the treatment for primary hyperparathyroidism
Parathyroidectomy
Symptoms of a Prolactinoma
- Hypogonadism
- Amenorrhea
- Infertility
- Galactorrhea
- Headache, Visual Changes
- Bitemporal Hemianopsia
Diagnostic for prolactinoma
-Increased prolactin, decreased FSH, and LH
Treatment and Prolactin
-Dopamine agonists (Cabergoline or Bromocriptine) first-line treatment
What is the key component of Metabolic Syndrome
-Insulin resistance
Diagnostic Criteria of Metabolic Syndrome
- Decreased HDL: < 40 in men, < 50 in women
- High blood pressure
- High fasting TG levels: > 150
- High fasting blood sugar: > 100
- Abdominal obesity
What are some weight loss medications
- Phentermine
- Lorcaserin
- Orlistat
