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Endocrine Flashcards

1
Q

Diabetic meds that cause hypoglycemia

A

Sulfonylureas(increase insulin)=glipizide, glyburide, glimiperide

Incretins (increase insulin)=byetta, januvia

Amylin analog =Pramlintide /symlin

Non-sulfonylurea insulin release(“glinides”)= Prandin/starlix

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2
Q

Other anti-diabetics side effects

A
  • 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
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3
Q

Symogyi effect

A

BS down then a Surge=Symogi

tx: reduce HS insulin dose

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4
Q

Dawn effect

A

slowly rising BS, like the sun rising

tx: add or increase HS insulin dose

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5
Q

High levels of TSH = what disease?

A

Hypothyroidism

T4 may be low

T3

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6
Q

Most common cause of hypothyroidism?

A

Hashimoto’s thyroiditis

Caused by auto=immune

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7
Q

Symptoms of hypothyroidism

A

Weakness

Fatigue

cold intolerance

constipation

hair loss

brittle nails

puffy eyes, edema of hands and face

bradycardia

Hypoactive bowel sounds

Slowed DTR

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8
Q

Labs in hypothyroidism

A

Tsh high, T4 low or normal

T3 is not reliable

hyponatremia

hypoglycemia

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9
Q

Most common presentation of thyroiditis

A

Grave’s dz

autoimmune

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10
Q

High T3 and low TSH is what condition?

A

Hyperthyroidism

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11
Q

Rare cause of thyroiditis

A

Subacute thyroiditis=viral

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12
Q

symptoms of hyperthyroidism

A

Nervousness

Anxiety

sweating

weight loss

Smooth skin

fine hair

exopthalmus

tachycardia

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13
Q

Which test establishes etiology of hyperthyroidism?

A

Thyroid radioactive iodine uptake

High in Grave’s

Low in Sub-acute

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14
Q

What drug is used to tx symptoms and the mainstay tx for subacute thyroiditis?

A

Propranolol, non-cardio selective beta blocker

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15
Q

What drugs are used to treat thyroid storm?

A

Thioureas: PTU or methimazole

Lugol’s soln gtts

sodium iodine slow IV

propranolol

Hydrocortisone with fast taper to tx hypoglycemia

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16
Q

What is used to destroy goiters?

A

Radioactive iodine 131-I

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17
Q

What blood test is used to monitor PTU?

A

CBC with diff to eval for agranulocytosis

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18
Q

Tx for hypothyroidism

A

Synthroid 50-100 mcg daily

derease dose in elderly

Take 2 hrs apart from food

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19
Q

Management of myxedema coma

A

Protect airway

Fluid replacement

Levothyroxine IV (T4)

Support BP

Slow rewarming to avoid circulatory collapse with vasodilation

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20
Q

Difference between a hot nodule

and a cold nodule in thyroid issues?

A

Hot nodule produces hormone ectopically

and a cold does NOT

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21
Q

What is the most sensitive maker of thyroid function?

A

TSH

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22
Q

Adrenal cortex makes what 3 compounds?

A

Glucocorticoids=cortisol

Mineralocorticoids=Aldosterone

Androgens

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23
Q

Sodium and glucose go together

A
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24
Q

Glucocorticoid function

A

Support stress response

elevated BP

decrease inflammation

moves glucose

shedding extra fluid

increased vascular tone

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25
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
26
Triad of Cushing's Labs
hyperglycemia hypernatremia hypokalemia leukocytosis (help with healing) plasma cortisol elevated in am serum ACTH elevated
27
Cushing's symptoms
Buffalo hump Central obesity Moon face striae hypertension hirsutism amenorrhea weakness/ muscle wasting impotence headache frequent infections
28
What test is used to differentiate cause of Cushing's?
Dexamethasone supression test
29
Aldosterone function
retention of sodium and water excretion of potassium
30
Which diseases can lead to myxedema coma?
Addison's dz and hypothyroidsim
31
Cushing's management
Transphenoidal resection of pituitary tumor stop glucocorticoids
32
Adrenal insufficiency
Autoimmune destruction of the adrenal gland is the most common cause Deficiency of all 3 hormones
33
Symptoms of Addison's Dz
Hypotension always Hyperpigmentation (knuckles, nipples, scant secondary sex characteristics fever changes in LOC inflammation/ joint pain
34
Triad of labs in Addison's Dz
Hypoglycemia Hyponatremia Hyperkalemia Hypotension Elevated ESR due to inflammation Lymphocytosis Plasma coritsol \<5 in am
35
TSH normal value
0.4-4
36
T3 normal value
100-200
37
T4 normal value
4.5-11
38
Two drugs used in out-pt treatment of Addison's dz?
Glucocorticoid=hydrocortisone Mineralocorticoid=fludrocortisone (florinef)
39
In patient managment of Addison's dz?
Hydrocortisone Iv with D5NS (to replace low BS) Treat underlying cause
40
What is a common, common cause of Addison's dz?
Underlying infection such as UTI Vasopressors are often ineffective
41
What is the am plasma cortisol level in Addison's dz?
low \< 5
42
Addison's symptoms
Orthostasis and Hypotension Fatigue Hyperpigmentation Cant pubic and axillary hair Fever, change in LOC (think myxedema coma)
43
ADH retains what? ACTH retains what?
ADH retains water ACTH retains salt
44
Difference between cushings and addisons?
Cushing's = too much ACTH Addisons= not enough ACTH ACTH retains salt NA and GLucose go together!
45
Difference between SIADH and DI?
SIADH= too much ADH DI= not enough ADH ADH retains water
46
Labs in SIADH
Hyponatremic but euvolemic Decreased serum osmo \<280 Urine Na \> 20
47
Common symptoms in SIADH
Neuro changes from low Na Decreased DTR's hypothermia weight gain/edema cold intolerance
48
Common etiology of SIADH
Head trauma Tumor producing ADH Chronic lung disease
49
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
50
DI symptoms
thirst plyuria wieght loss fatigue diziness fever tachycardia hypotension
51
Lab results in DI
high serum osmo \>290 urine osmo \< 100 urine specific gravity low \<1.005 hypernatremia increased BUN/Creat
52
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
53
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
54
SIADH treatment
Treat the underlying cause ## Footnote 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
55
Pheochromocytosis cause
Tumor of the adrenal medulla result of chatecholamine release
56
Symptoms of pheo
labile BP diaphoresis tachycardia sweating weight loss postural hypotension
57
Pheo diagnostics
TSH is normal - r/o thyroid cause Plasma free metaphrines Urine tests: * VMU * Chatecholamines * creatinine * metanephrines
58
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
59
Things to monitor for post-op pheo sg:
Hypotension adrenal insufficiency hemorrhage
60
Anti-TPO antibodies cause what kind of thyroid dysfunction?
Hypothyroidism
61
Pheo diagnostic in an acute crisis?
Use CT scan of the adrenals Screening exam? urine tests
62
Every patient with symptomatic hyperthyroidism should be on wht kind of drug?
Non-cardioselective BB propranolol
63
Cardinal finding in osteoporosis?
fractures
64
Amenorrhea and headache, order what test?
prolactin level (posterior pituitary)
65
What level do you check to see if synthroid is working?
TSH
66
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
67
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
68
Low urine Na, high serum osmo, high serum Na+ is what condition?
DI
69
TSH is down and T3 is high, free thyroxine index is increased in what condition?
Hyperthyroidism, Grave's is most common
70
To diagnose IDDM
BS\> 200 Repeat x 2 FBS \>126
71
Normal HgA1C
5.5-7, like to keep pts at 6
72
presence of what type of antibodies are in IDDM?
HLADR3, HLA-DR4
73
IDDM is characterized by what finding?
Ketones
74
What is impaired glucose tolerance?
FBS \>100 \<125
75
When to start insulin? Regimen?
Ketones 0.5 units/kg/day with 2/3 in morning and 1/3 evening
76
Conventional split dose insulin therapy
morning: 2/3 reg, 1/3 NPH evening: 1/2 reg, 1/2 NPH
77
Intensive therapy
reduce or omit evening dose and add bedtime dose
78
Name 3 insulin analogs
Novolog/aspart- rapid Glargine/Lantus=Long acting Lispro/Humalog-rapid
79
Metabolic syndrome criteria
Waist \>35 women, 40 men HTN \>130/85 Triglycerides \>150 FBS \>100 HDL \<50 women, \<40
80
81
Muscle pain in a diabetic might be seen with what drug for diabetes?
Metformin=Lactic acidosis
82
83
The G drugs for diabetes
glyburide, glipizide, glimiperide =Sulfonylureas - increase insulin release
84
Metformin
Biguinide Standard of care inhibits gluconeogenesis
85
Acarbose, miglitol
alpha-glucosidase inhibitors - bind so less sugar is absorbed
86
What category of fluid hydrates the cell?
1/2 NS
87
Calculating an insulin gtt
0.1 unit/kg/hr blous followed by 0.1/units/kg/hr gtt
88
What pH value is treated with bicarb?
\<7.1
89
90
Thiazolidinediones
Glitazones decrease gluconeogeneis
91
Prandin, starlix
Non-sulfonylurea insulin relase stimulators pill form
92
Incretins
increase insuliln byetta, januvia
93
only drug for type 1 and 2 diabetes
symlin, slows absorption of glucose in gut injectible
94
Intracellular dehydration characterized by Kussmaul's resp and ketones
DKA BS \>250 Metabolic acidosis Hyperkalemia Hyperosmolar
95
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
96
Intra cellular dehydration with BS \>800-1000
Osmotic diuresis due to high BS HHNK \*\*Normal anion gap\*\*
97
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
98
Signs of hyperthyroidism
Anxiety tremors wieght loss smooth skin exopthalmos hyperreflexia tachycardia heat intolerance
99
What condition has hyponatremia and euvolemic?
SIADH
100
Common causes of SIADH?
Skull fx Trauma Chronic lung disease
101
normal serum osmo
280-290
102
normal urine specific gravity
1.010-1.030

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