ENDOCRINE Flashcards
What can occur from a very traumatic birth regarding growth hormone?
GH deficiency – why we check the growth charts
What happens to growth hormones in hypopituitarism?
Children – serious growth disturbance
What might GnRh cause?
lack of sexual organ development
If you’re considering a growth hormone deficiency, what do you check?
GH levels, provocative tests, and imaging
What type of provocative test could stimulate growth hormone levels, and see if you’re getting the proper response?
Insulin
After giving growth hormone and getting levels normalized, when do we need to monitor levels again
Once growth is completed
What is acromegaly?
When excessive growth hormone is released
What causes acromegaly?
Almost always from a pituitary adenoma
What is specific about the adenoma of gigantism?
Develops BEFORE closure of epiphyses
What is specific about the adenoma of acromegaly?
Develops AFTER closure of epiphyses
How do we treat excessive growth hormone?
Somatostatin
What does prolactin do?
Induces lactation during pregnancy
What controls prolactin?
Always being inhibited by dopamine
What is the role of thyroid hormone, especially at birth?
Crucial for cell differentiation – if absent at birth can cause severe mental retardation = “creatinism”
What must you always check on PE in someone you suspect with a thyroid disorder?
visual/eyes, weight, scalp/hair, neck, skin, heart, abdomen, extremities, reflexes and thyroid exam neuro
What’s the normal range for TSH?
0.27-4.2
If TSH is low, what does that usually indicate?
Hyperthyroidism (at the gland level = primary)
If TSH is high, what does that usually indicate?
Hypothyroidism
What would cause hypothyroidism?
Congenital = In utero exposure to radioiodine
Acquired (later in life) = Hashimoto’s, irradiation, too much iodine
If a child presents with a thick tongue, hypotonia, large fontanel’s, dry skin, with a hoarse cry, and constipation, what diagnosis do you think?
Hypothyroidism
What is hypothyroidism?
Autoimmune, AKA Hashimoto’s Thyroiditis
What labs would we get for hypothyroidism?
TSH, decreased T4, and anti-thyroid anti-bodies (for Hashimoto’s specifically)
How do we prevent and treat congenital hypothyroidism?
Early detection – required at birth!
Replacement therapy (10-15uq/day of Levothyroxine)
Continue to monitor!
If a patient presents with unexplained weight loss, fatigue, who often feels hot and anxious – what diagnosis are you thinking?
Hyperthyroidism
What else is hyperthyroidism known as?
Thyrotoxicosis
What is the most common etiology of hyperthyroidism?
Graves disease
What are other etiologies for hyperthyroidism?
Toxic (“hot”) adenomas, early phase hasimoto’s (from stored hormone), factitious (excessive thyroid hormone intake), TSH adenoma, or amiodarone
What is Graves disease?
Autoimmune disease, caused by TSH-receptor antibody (IgG) causes hypersecretion, hypertrophy, and hyperplasia of the thyroid (goiter)
What 2 signs & symptoms are unique to Graves disease?
Opthalmopathy – Proptosis with lid-lag, conjunctival inflammation and corneal drying
Dermopathy – pre-tibial areas leading to edema, thickened skin (pre-tibial myxedema)
Along with tachycardia, tremor, brisk DTR, and accelerated growth
How can we treat Graves disease?
MUST have an endocrinologist consult Propranolol (heart)
Thiourea drugs = Propylthiouricil (PTU) or
Methimazole – inhibits thyroid peroxidase and block organification of iodine.
What is the definitive treatment of choice for Grave’s disease in the US?
Radioactive iodine (131I) – destroy overactive thyroid tissue (when it doesn’t resolve)
When would thyroid surgery be indicated?
Graves in children
What would cause thyroiditis?
Bacterial infection (so think fevers, chills, sore throat, and very tender thyroid)
What is parathyroid important for?
Calcium & phosphate metabolism (along with Vit. D, calcitonin, and Mg)
If a patient presents with muscle cramps, irritability, tetany, seizures, and parasthesias of the hands & feet, what diagnosis are you thinking?
Hypoparathyroidism
What is hypoparathyroidism and what causes it?
LOW ionized calcium, most commonly after a thyroidectomy (or congenital)
What PE signs do we look for hypoparathyroidism?
Chvostek (face) & Trousseau (BP cuff with contracture)
What can develop with hypoparathyroidism?
Chronic magnesium deficiency
What labs would you order for hypoparathyroidism?
Total serum & ionized Ca – LOW
PO4 – High
Urine Ca – LOW
Magnesium!
ECG: Prolonged Q-T
If you see low Ca levels on lab work, what other diagnosis would you think of besides hypoparathyroidism?
Malabsorption, Vitamin D deficiency, and Hypomagnesemia
How do you treat hypoparathyroidism?
Acute – IV calcium
Chronic – oral Calcium
Magnesium supplement if needed
If you have a problem absorbing calcium into the system (you don’t have a problem with producing it), what diagnosis?
Ricketts
What can form on the back of the neck with diabetes?
Acanthosis Nigrans (velvety, hyperpigmented plaque)
What is occurring in Type 1 diabetes?
Auto-immune destruction of Beta-cells in the pancreas. Mainly due to islet cell antibodies
What are clinical findings for Type 1 DM?
Polyuria, thirst, weight loss, dehydration, polyphagia, ketoacidosis, hyperosmolality
What’s the fasting BG level that diagnosis diabetes?
> 126 & A1c >6.5
What labs do you usually see with DKA?
BS >300
pH less than 7.3
bicarb is low (increased anion gap! Lab test = ABG)
total body K is low
What causes DKA?
Not enough insulin, leading to increased blood glucose & LOTS of fat & protein breakdown
May have lots of nausea, vomiting, and diarrhea
How do you treat DKA?
Give FLUIDS! Give insulin once you know K levels
What diagnosis are we concerned about in kids, how do we treat it?
Type 2 DM! Lifestyle changes (diet & exercise)
What is metabolic syndrome? What does metabolic syndrome lead to? What are some qualifying factors for it?
Insulin resistance syndrome
Can lead to an increased risk of atherosclerosis
Central obesity (>88cm or 35” in women, >102cm or 40” in men); hyperglycemia >110; Hypertension 135/85; Triglycerides >150; Low HDL
Mullerian ducts develop into? Wolffian ducts develop into?
Wolffian = Male
Mullerian = Female
What diagnosis is associated with a deficiency in 21 alpha hydroxylase (deficiencies leading to cortisol or aldosterone issues)? What else is this diagnosis associated with?
Congenital adrenal hyperplasia
Also associated with salt wasting
if a child has ambiguous genitalia, what diagnosis? What about development later in life?
Ambiguous = Severe congenital adrenal hyperplasia
Later development = Moderate congenital adrenal hyperplasia (or mild when they can’t get pregnant)
if a child is genetically male, but has female genitalia, what is the diagnosis?
Complete androgen insensitivity syndrome
What are inborn errors of metabolism?
Autosomal recessive disorders – deficiency in a single enzyme leading do a disruption in a metabolic pathway
What are some examples of how a child would present with an inborn error of metabolism?
Zellwagger (high forehead with cherry spot in the eye), vomiting, abnormal tone, myopathy, dystonia
What is it known as when blood is taken from the newborn to screen for tons of different things?
Tandem Mass Spectrometry (just a screen, not diagnostic)
What will you often see on diagnostics with inborn errors?
Acid-Base disorder (since there is an increase in metabolites)
