Endocrine Flashcards
LH/FSH deficiency in MWB
M: no T/no sperm/ED/lower muscle mass
F: amenorrhea
B: decreased libido/decreased body hair
Kallman syndrome
Decreased GnRH leads to decreased FSH and LH
Anosmia
Renal Agenesis in 1/2
2 electrolytes that inhibit ADH’s effects
HyperCa
HypoK
How do you distinguish central and nephrogenic DI
Central: corrects with vasopressin
Nephrogenic: responds to correction of underlying cause
Cause of death in acromegaly
CHF and cardiomegaly
3 tests for acromegaly
Initial: IGF1
Accurate: glucose suppression test
Additional: Prolactin (consecrated with GH - increase causes ED)
Specific acromegaly medication
Pegvisomant: GH receptor antagonist inhibiting IGF release from the liver
What other hormone changes with hypothyroidism?
Prolactin increases
1) low thyroid levels
2) extremely high TRH
3) prolactin secretion
Meds that raise prolactin level
Verapamil, Antipsychotics, methyl dopa, metoclopramide, opioids, TCAs
What do you never do first with endocrine disorders
MRI the head!
What tests do you order after confirming a high prolactin (4 + bonus)
TFTs
Pregnancy test
BUN/Creatinine (renal disease raises prolactin)
LFTs (cirrhosis raises prolactin)
*MRI once level confirmed + not pregnant + 2ndary causes excluded
3 causes of hypothyroidism
Hashimotos»_space; iodine deficiency = amiodarone
What is the one process not slowed in hypothyroidism
Menstrual flow (actually increases)
If very high TSH and normal T4, how do you treat
Hormone replacement
If TSH is mildly elevated, how do you treat
Get antibody tests and replace thyroid hormone if they are positive
Thyroid abnormality tests
Initial: TSH
Suppressed TSH?: free T4
Hyperthyroidism with tender thyroid?
Subacute thyroid itis
High thyroid hormone with nonpalpable gland?
Exogenous use
Treating acute hyperthyroidism
Propranolol (blocks target organ effect/inhibits peripheral conversion)
MMU>PTU
Steroids (esp for eyes)
Next step after finding a mass on the thyroid?
Measure T4 and TSH (cancer is not hyper functioning)
What size thyroid nodule requires a biopsy
> 1cm needs FNA
Most common cause of high calcium
Hyperparathyroidism
Cardiovascular concerns with high calcium?
Short QT syndrome and HTN
Treating high calcium
1) saline hydration
2) bisphosphonates (pamidronate, zoledronic acid)
3 if BPs fail) Calcetonin
4 if sarcoidosis) prednisone
HyperPTH causes
Adenoma»_space;> hyperplasia of all 4 glands»_space; cancer
High PTH presents with high calcium and…
Low Phopshate
Causes of low calcium
Prior neck surgery»_space; hypomagnesium (needed to release PTH) > renal failure
What is the effect of low albumin on calcium
Decreases total calcium but free calcium stays normal (thus no symptoms)
EKG and eye findings of low calcium
Long QT
Early cataracts on slit lamp exam
Prolactin deficiency in men Sx
None!
High cortisol causes
Pituitary acth»_space;> adrenals > ectopic > unknown ACTH
Initial test for high cortisol (1st and 2nd choices)
24 hour urine cortisol (more specific) > 1mg overnight dex suppression test (false positive risk)
What is the next step if ACTH is elevated and does not suppress?
Brain MRI
Why do you not start with imaging the pituitary if you suspect a cortisol issue?
> 10% of people have a pituitary abnormality on MRI, so you may be removing the pituitary when the Adrenals are the problem
What tests do you order if you find an asymptomatic adrenal lesion on imaging?
metanephrines (rule out Pheo)
Renin/aldosterone (rule out hyperaldosteronism)
1mg overnight dex suppression test
How does acute adrenal crisis present?
Profound hypoTN, fever, confusion, coma
What is the most specific test of adrenal function
Cosyntropin (synthetic ACTH) –> should cause rise in cortisol if adrenals work
How do you treat a patient with suspected acute adrenal insufficiency?
Hydrocortisone (and then draw cortisol level to confirm)
Most common causes of primary hyperaldosteronism
Solitary adenoma»_space;> bilateral hyperplasia»_space; cancer
Testing for hyperaldosteronism
Initial: plasma renin to aldosterone ratio
Accurate: sample venous blood from adrenal for aldosterone level
Initial treatment of a pheochromocytoma
Phenoxybenzamine (alpha blocker)
Testing for Pheo
Initial: plasma free metanephrines
Confirmatory: 24 hour urine metanephrines
Diabetes dx criteria
2 fasting glucose levels >125
Single glucose of >200 with symptoms
Increased glucose level on oral tolerance testing
Hba1c >6.5 (best criteria to follow)
Goal of dm treatment
Hba1c
Metformin contraindication
Renal failure patients (can accumulate and cause metabolic acidosis)
Sitagliptin/ -gliptin
DPP-IV inhibitors: block incretin metabolism (GIP/GLP) –> insulin release is inhibited and glucagon release is maintained
Exanatide/ -glutide
Incretin mimetics
need to be injected
Slow gastric motility – weight loss!
Glitazones
TZDs: no clear benefits, contraindicated in CHF because they increase fluid overload
Nateglinide/ -glinide
Insulin stimulators
Acarbose/Miglitol
Alpha glucosidase inhibitors: block glucose absorption in the bowel
Decrease hba1c by .5
Cause stomach issues
Pramlintide
Amylin analog: decreases gastric emptying + decreases glucagon levels + decreases appetite
Insulin formulations and durations
Lispro/Aspart/Glulisine = peak @ 1, duration 3 hours Regular = peak @ 2, duration 6-8 NPH = peak @ 6, duration 10-20 Glargine = peak @ 1, duration 24
How do you best measure the severity of DKA
Serum bicarbonate (if low the AG is high which is bad)
Diabetes health maintainance
Pneumococcal vaccine
Yearly eye exam for proliferative retinopathy
Statin if ldl is >100
ACE/ARB if BP > 140/90 or positive urine microalbumin
ASA if >30 years old
Foot exam
How do you treat diabetes induces gastroparesis
Metoclopramide and erythromycin
How do you treat diabetes induced proliferative retinopathy
Laser photocoagulation
How do you treat the pain of diabetic neuropathy
Pregabalin/gabapentin/TCAs
