ENDOCRINE Flashcards
What regulates Ca homeostasis?
Parathyroid hormone
What stimulates the release of PTH?
Lox Ca levels
What can often occur after having neck surgery or surgery for thyroid cancer?
Hypoparathyroidism
If a pt is having significant muscle spasm, paresthesia, Chvostek sign (tapping on the face that causes facial twitching), or trousseau sign (inflating the BP cuff causes tetany) -dx?
Hypoparathyroidism
How do you dx hypoparathyroidism?
Decreased PTH, Serum Ca, and increased Phosphorus
EKG – prolonged QT interval
How do you treat hypoparathyroidism?
replace Ca and Mg
If you elevated PTH and serum Ca, and low phosphate – dx?
HYperparathyroidism
What is the MC cause hyperparathyroidism?
Single adenoma
If a pt has renal stones, nausea, constipation, and decreased bone mineral density – dx?
Hyperaparthyroidism
“Bones, stones, and groans”
What will you see on EKG with hyperparathyroidism?
short QT interval
If PTH is low with elevated Ca – dx?
Need to think of other causes (aka malignancy)
How do you treat hyperparathyroidism?
Surgery for symptomatic patients
Asymptomatic + serum Ca over 1.0, reduced CrCl, osteoporosis, and under 50 – go to surgery
What would secondary hyperparathyroidism be caused from? Tx?
Chronic renal failure and Vit D deficiency
Tx – Replace Vit D or dietary phosphate restriction
What’s more common, hyper or hypothyroidism?
Hypothyroidism
Hashimoto’s is associated with what?
Hypothyroidism
What is grave’s disease associated with?
Hyperthyroidism
If a pt has constipation, weight gain, fatigue, hair loss, and cold intolerance – dx?
Hypothyroidism
What would the labs show for hypothyroidism?
TSH = High T4 = Low
How do we treat hypothyroidism?
Levothyroxine (take on an empty stomach and wait 4 hours before taking Ca or Fe)
What are the causes of hyperthyroidism?
Grave’s Dz (autoimmune that leads to TSH receptor antibodies)
Subacute Thyroiditis = post-infectious, tender thyroid
Silent thyroiditis = occurs post-partum
Toxic nodular goiter – nodular felt on exam
Pituitary adenoma – nothing in particular in Hx or exam
If a pt has heat intolerance, weight loss, palpitations, hyper defication, and anxiety – dx?
Hyperthyroidism
What will the labs look like with hyperthyroidism?
TSH – suppressed
T4 – elevated
What if free T4 is also elevated, along with T4, and TSH is suppressed – what should you do?
Pituitary adenoma – get an MRI
How do you treat a thyroid storm?
PTU or methimazole
How do you treat an adenoma?
surgical resection
How do you treat someone who is preggo with hyperthyroidism?
PTU in 1st tri, methimazole in 2nd and 3rd
What’s the definitive treatment for hyperthyroidism?
Radioactive iodine
- Methimazole can lead to leukopenia/agranulocytosis
- PTU can cause hepatotoxicity
A pt presents with a fixed hard mass in the throat, cervical lymphadenopathy, and vocal cord paralysis -dx?
Thyroid cancer
How do you move forward with a thyroid nodule?
Always draw a TSH
If normal, do an U/S
What If a pt has a thyroid nodule and the TSH is low, what do you do?
Do a radionucleotide iodine uptake scan
Non-functioning (cold) à BIOPSY
Hyper-functioning (warm) à serial ultrasounds
When should we always biopsy a thyroid nodule?
Solid nodule greater than 1 cm
Cystic nodule greater than 2cm
What are the 2 types of adrenal insufficiency?
Cushing Syndrome
Cushing Disease
What is Cushing syndrome?
Increased cortisol levels from any source
What is Cushing disease?
Increased cortisol levels from a pituitary adenoma
How does a pt present with Cushing?
Central obesity, proximal weakness, striae, moon face, buffalo hump, HTN, DM.
How can we diagnose cushing?
Need 2 positives showing elevated cortisol levels
24 hour urine free cortisol, low dose dexamethasone (1mg), or late night salivary test
THEN measure ACTH (normal pituitary function = low ACTH)
So, when testing for Cushing what do you do when the ACTH comes back as low?
Low ACTH = ATCH independent à CT the adrenals
If it’s not the adrenals, then it’s exogenous use (prednisone)
So, when testing for Cushing what do you do when the ACTH comes back as high?
High ACTH = ACTH dependent à pituitary adenoma or tumor in lungs
High dose dexamethasone (8mg) – if cortisol is suppressed = pituitary adenoma à get an MRI of pituitary
If no suppression = tumor à get MRI or CT chest
In general, how do we treat Cushing?
Pituitary adenoma or adrenal tumors are treated with surgery
What are some of the risk factors to Type 2 diabetes?
Over the age of 45, BMI greater than 25, DM in a 1st degree relative, sedentary lifestyle, gestational DM, Hx of delivering a child 9lbs or heavier, dyslipidemia, PCOS
When do we screen for diabetes?
Aged 40-70 with BMI greater than 25, every 3 years
What would indicate diabetes?
Fasting glucose greater than 126 or
One glucose greater than 200 or
HA1c greater than 6.5 or
Positive 2-hr oral glucose tolerance test
Give an example and time frame for a rapid acting insulin:
Rapid Acting – lispro, aspart, glulisine (onset 5-15 min; peak 1 hr; lasts 4 hours)
Give an example and time frame for a fast acting insulin:
Fast Acting – Regular (onset 30-60mins, peaks 2 hours, last 6 hours)
Give an example and time frame for a Intermediate acting insulin:
Intermediate – NPH – onset 2 hours, peak 6 hours, lasts 14 hours
Give an example and time frame for a Long-acting insulin:
Long-acting – glargine (onset 1-2 hours, no peak, lasts 24 hours)
Where do we start when someone is pre-diabetic or has a slightly positive A1c?
Weight loss, proper nutrition, and exercise
What is first line medication for diabetes?
Metformin
What can we add if Metformin is not enough?
Sulfonylureas
If oral’s aren’t working to control diabetes, then what?
Basal insulin, can add an rapid acting as well
If an A1c is greater than 9%, what do we do?
They must start insulin
What should a diabetic have done yearly?
Eye exam, urine for microalbumin, LDL (statin), BP less than 140/90 (ACE or ARB first line), ASA if 10 year risk is greater than 10% or greater than 30 years of age
What are some of the risk factors to hypercholesterolemia?
HTN, Smoking, DM, obesity, age over 45 (males; 65 for females), and Family Hx
How and when do we screen for hypercholesterolemia?
HDL, LDL, total cholesterol, and trigs
High risk males over 25 and females over 35
Non-high risk males over 35 and females over 45
How do we treat hypercholesterolemia?
Diet, exercise, weight loss, and no tobacco products
LDL is greater than 190 = high statin
DM ages 40-75 with LDL between 70-180 = moderate statin
CVD or DM w/ LDL between 70-189 and a 10year risk of atherosclerotic dz >7.5% = moderate to high statin
Why would we treat hypertriglyceridemia?
To reduce CV risk
If levels are greater than 1,000 pts at risk of pancreatitis
What’s the difference between acromegaly and gigantism?
Acromegaly = adults Gigantism = kids (before fusion of growth plates)
How do we diagnose acromegaly and gigantism?
Increased Insulin-growth factor
If high, draw growth hormone after giving oral glucose load
Normally, glucose should completely suppress growth hormone, If HIGH = + test à get an MRI
A pt with low urine osmolality and high serum osmolality – what should you think of?
Diabetes insipidus
What is occurring in diabetes insipidus?
ADH is not made or does not work
