Endocrine Flashcards
Diabetic meds that cause hypoglycemia
Sulfonylureas(increase insulin)=glipizide, glyburide, glimiperide
Incretins (increase insulin)=byetta, januvia
Amylin analog =Pramlintide /symlin
Non-sulfonylurea insulin release(“glinides”)= Prandin/starlix
Other anti-diabetics side effects
- Biguinides (inhibits gluconeogenesis) = metformin-, Lactic acidosis, Renal issues
- Alpha-glucosidase inhibitors (decrease absorption in gut) =Precose, glycet - GI effects, not for Chrohns, IBS
- Thiazolidolidinediones (decrease gluconeogenesis) =actos/avandia, heart, transaminases, bladder CA
- Incretin mimetics (increase insulin)=byetta, januvia =pancreatitis, gastroparesis
Symogyi effect
BS down then a Surge=Symogi
tx: reduce HS insulin dose
Dawn effect
slowly rising BS, like the sun rising
tx: add or increase HS insulin dose
High levels of TSH = what disease?
Hypothyroidism
T4 may be low
T3
Most common cause of hypothyroidism?
Hashimoto’s thyroiditis
Caused by auto=immune
Symptoms of hypothyroidism
Weakness
Fatigue
cold intolerance
constipation
hair loss
brittle nails
puffy eyes, edema of hands and face
bradycardia
Hypoactive bowel sounds
Slowed DTR
Labs in hypothyroidism
Tsh high, T4 low or normal
T3 is not reliable
hyponatremia
hypoglycemia
Most common presentation of thyroiditis
Grave’s dz
autoimmune
High T3 and low TSH is what condition?
Hyperthyroidism
Rare cause of thyroiditis
Subacute thyroiditis=viral
symptoms of hyperthyroidism
Nervousness
Anxiety
sweating
weight loss
Smooth skin
fine hair
exopthalmus
tachycardia
Which test establishes etiology of hyperthyroidism?
Thyroid radioactive iodine uptake
High in Grave’s
Low in Sub-acute
What drug is used to tx symptoms and the mainstay tx for subacute thyroiditis?
Propranolol, non-cardio selective beta blocker
What drugs are used to treat thyroid storm?
Thioureas: PTU or methimazole
Lugol’s soln gtts
sodium iodine slow IV
propranolol
Hydrocortisone with fast taper to tx hypoglycemia
What is used to destroy goiters?
Radioactive iodine 131-I
What blood test is used to monitor PTU?
CBC with diff to eval for agranulocytosis
Tx for hypothyroidism
Synthroid 50-100 mcg daily
derease dose in elderly
Take 2 hrs apart from food
Management of myxedema coma
Protect airway
Fluid replacement
Levothyroxine IV (T4)
Support BP
Slow rewarming to avoid circulatory collapse with vasodilation
Difference between a hot nodule
and a cold nodule in thyroid issues?
Hot nodule produces hormone ectopically
and a cold does NOT
What is the most sensitive maker of thyroid function?
TSH
Adrenal cortex makes what 3 compounds?
Glucocorticoids=cortisol
Mineralocorticoids=Aldosterone
Androgens
Sodium and glucose go together
Glucocorticoid function
Support stress response
elevated BP
decrease inflammation
moves glucose
shedding extra fluid
increased vascular tone
Cushings etiology x 3 types
ACTH hypersecretion by pituitary tumor **most common cause
Adrenal tumors
Chronic glucocorticoids
get too much androgen and cortisol, not too much aldosterone
Triad of Cushing’s Labs
hyperglycemia
hypernatremia
hypokalemia
leukocytosis (help with healing)
plasma cortisol elevated in am
serum ACTH elevated
Cushing’s symptoms
Buffalo hump
Central obesity
Moon face
striae
hypertension
hirsutism
amenorrhea
weakness/ muscle wasting
impotence
headache
frequent infections
What test is used to differentiate cause of Cushing’s?
Dexamethasone supression test
Aldosterone function
retention of sodium and water
excretion of potassium
Which diseases can lead to myxedema coma?
Addison’s dz and hypothyroidsim
Cushing’s management
Transphenoidal resection of pituitary tumor
stop glucocorticoids
Adrenal insufficiency
Autoimmune destruction of the adrenal gland is the most common cause
Deficiency of all 3 hormones
Symptoms of Addison’s Dz
Hypotension always
Hyperpigmentation (knuckles, nipples,
scant secondary sex characteristics
fever
changes in LOC
inflammation/ joint pain
Triad of labs in Addison’s Dz
Hypoglycemia
Hyponatremia
Hyperkalemia
Hypotension
Elevated ESR due to inflammation
Lymphocytosis
Plasma coritsol <5 in am
TSH normal value
0.4-4
T3 normal value
100-200
T4 normal value
4.5-11
Two drugs used in out-pt treatment of Addison’s dz?
Glucocorticoid=hydrocortisone
Mineralocorticoid=fludrocortisone (florinef)
In patient managment of Addison’s dz?
Hydrocortisone Iv with D5NS (to replace low BS)
Treat underlying cause
What is a common, common cause of Addison’s dz?
Underlying infection such as UTI
Vasopressors are often ineffective
What is the am plasma cortisol level in Addison’s dz?
low < 5
Addison’s symptoms
Orthostasis and Hypotension
Fatigue
Hyperpigmentation
Cant pubic and axillary hair
Fever, change in LOC (think myxedema coma)
ADH retains what?
ACTH retains what?
ADH retains water
ACTH retains salt
Difference between cushings and addisons?
Cushing’s = too much ACTH
Addisons= not enough ACTH
ACTH retains salt
NA and GLucose go together!
Difference between SIADH and DI?
SIADH= too much ADH
DI= not enough ADH
ADH retains water
Labs in SIADH
Hyponatremic but euvolemic
Decreased serum osmo <280
Urine Na > 20
Common symptoms in SIADH
Neuro changes from low Na
Decreased DTR’s
hypothermia
weight gain/edema
cold intolerance
Common etiology of SIADH
Head trauma
Tumor producing ADH
Chronic lung disease
Common etiology of DI
Central
- pituitary of hypothalamus damage-low ADH
- trauma
- infection
- metastatic CA
Nephrogenic
- defect in renal tubules causes insensitivity to the ADH
- genetic (x -linked trait)
- Acquired with pyelo, sickle cell, lithium toxicity
Psychogenic - drinks too much water
DI symptoms
thirst
plyuria
wieght loss
fatigue
diziness
fever
tachycardia
hypotension
Lab results in DI
high serum osmo >290
urine osmo < 100
urine specific gravity low <1.005
hypernatremia
increased BUN/Creat
DI treatment
Na+ > 150, give D5W (free water) to replace 1/2 of volume defecit in 12-24 hrs
too fast=cerebral edema
Na+ < 150 = use 1/2 NS or NS
DDAVP=vasopressin=ADH
DDAVP 1-4 mcg IV or SQ Q 12-24 hrs
Maintenance at home DDAVP intranasally 10 mcg q 12-24 hrs
Results of testing for differential of DI etiology
Vasopressin/Desmopressin challenge
given with measurement of urine
+ in central DI
- in nephrogenic DI
If no apparent cause, MRI
SIADH treatment
Treat the underlying cause
Serum NA >120 = FR x 1 L/24 hrs
Serum Na 110-120, no sx = FR 500 mL/24 hrs
Serum Na < 110 OR with sx = NS or 3% saline followed by lasix gtt
Monitor electrolytes hourly and replace
Pheochromocytosis cause
Tumor of the adrenal medulla
result of chatecholamine release
Symptoms of pheo
labile BP
diaphoresis
tachycardia
sweating
weight loss
postural hypotension
Pheo diagnostics
TSH is normal - r/o thyroid cause
Plasma free metaphrines
Urine tests:
- VMU
- Chatecholamines
- creatinine
- metanephrines
Treatment of pheo
Tumor resection
alpha-adrenergic meds pre=op (cardura/minipress)
Phentolamine: Regitine 1-2 mg IV until BP controlled, convert to phenoxybenzamine PO asap
PR=Pheo=Regitine
Things to monitor for post-op pheo sg:
Hypotension
adrenal insufficiency
hemorrhage
Anti-TPO antibodies cause what kind of thyroid dysfunction?
Hypothyroidism
Pheo diagnostic in an acute crisis?
Use CT scan of the adrenals
Screening exam? urine tests
Every patient with symptomatic hyperthyroidism should be on wht kind of drug?
Non-cardioselective BB
propranolol
Cardinal finding in osteoporosis?
fractures
Amenorrhea and headache, order what test?
prolactin level (posterior pituitary)
What level do you check to see if synthroid is working?
TSH
If ill and unable to eat, a patient taking insulin should do what with their am insulin dose?
Hold all insulin and check BS frequently
What does serum fructosamine indicate?
It measures 2-3 weeks avg glucose in a pt that can’t have a HgA1C
fructose is glycosylated protein
Low urine Na, high serum osmo, high serum Na+ is what condition?
DI
TSH is down and T3 is high, free thyroxine index is increased in what condition?
Hyperthyroidism, Grave’s is most common
To diagnose IDDM
BS> 200
Repeat x 2 FBS >126
Normal HgA1C
5.5-7, like to keep pts at 6
presence of what type of antibodies are in IDDM?
HLADR3, HLA-DR4
IDDM is characterized by what finding?
Ketones
What is impaired glucose tolerance?
FBS >100 <125
When to start insulin?
Regimen?
Ketones
0.5 units/kg/day with 2/3 in morning and 1/3 evening
Conventional split dose insulin therapy
morning: 2/3 reg, 1/3 NPH
evening: 1/2 reg, 1/2 NPH
Intensive therapy
reduce or omit evening dose and add bedtime dose
Name 3 insulin analogs
Novolog/aspart- rapid
Glargine/Lantus=Long acting
Lispro/Humalog-rapid
Metabolic syndrome criteria
Waist >35 women, 40 men
HTN >130/85
Triglycerides >150
FBS >100
HDL <50 women, <40
Muscle pain in a diabetic might be seen with what drug for diabetes?
Metformin=Lactic acidosis
The G drugs for diabetes
glyburide, glipizide, glimiperide
=Sulfonylureas - increase insulin release
Metformin
Biguinide
Standard of care
inhibits gluconeogenesis
Acarbose, miglitol
alpha-glucosidase inhibitors - bind so less sugar is absorbed
What category of fluid hydrates the cell?
1/2 NS
Calculating an insulin gtt
0.1 unit/kg/hr blous followed by 0.1/units/kg/hr gtt
What pH value is treated with bicarb?
<7.1
Thiazolidinediones
Glitazones
decrease gluconeogeneis
Prandin, starlix
Non-sulfonylurea insulin relase stimulators
pill form
Incretins
increase insuliln
byetta, januvia
only drug for type 1 and 2 diabetes
symlin, slows absorption of glucose in gut
injectible
Intracellular dehydration characterized by Kussmaul’s resp and ketones
DKA
BS >250
Metabolic acidosis
Hyperkalemia
Hyperosmolar
Treatment for DKA
NS x 1 liter in first hr, then 500 mL/hr
1/2 NS if BS > 500 after 1st hr
D51/2 NS when BS < 250
Insulin gtt and bolus
Intra cellular dehydration with BS >800-1000
Osmotic diuresis due to high BS
HHNK
**Normal anion gap**
Tx for HHNK
NS for massive fluid replacement 6-10 L
once Na+ reaches 145, change to 1/2 NS
When BS 250, change to D51/2 NS
Insulin is 15 units reg followed by 10-15 units SQ
Signs of hyperthyroidism
Anxiety
tremors
wieght loss
smooth skin
exopthalmos
hyperreflexia
tachycardia
heat intolerance
What condition has hyponatremia and euvolemic?
SIADH
Common causes of SIADH?
Skull fx
Trauma
Chronic lung disease
normal serum osmo
280-290
normal urine specific gravity
1.010-1.030
