Endocrine Flashcards
Treatment of Central DI
Desmopressin
Dx of acromegaly
IGF-1
Tx of acromegaly
pituitary resection; octreotide/lanreotide adjuvantly
Which diagnosis? Low TSH and normal T4
Subclinical thyrotoxicosis
Indication for RAIU scan
Low TSH and High T4
Indication for checking thyroglobulin
Low TSH/High T4 and low/absent RAIU
Which diagnosis? hyperthyroid labs and low thyroglobulin
Factitious
Indication for thyroid nodule biopsy/FNA
> 1cm
Mx of thyroid storm (4)
propranolol, Methimazole/PTU, inorganic iodide, +/- steroids
Dx of primary adrenal insufficiency
Cosyntropin/ACTH stim test
Tx of acute primary adrenal insufficiency
High dose steroids and IVF
Screening for Cushing Syndrome (3)
Midnight salivary cortisol, 1mg Dexamethasone suppression test, 24 hour urine cortisol
Confirmatory testing for Cushing Syndrome
2mg dexamethasone suppression test
Next best test after confirming Cushing Syndrome
ACTH level
Screening for hyperaldosteronism
Aldosterone/Renin ratio
Confirmatory testing for hyperaldosteronism
Sodium challenge/Aldosterone suppression test
Tx of hyperaldosteronism secondary to bilateral adrenal hyperplasia (2)
Aldosterone antagonist, dietary salt restriction
Medical Mx of pheochromocytoma
Alpha blocker (phenoxybenzamine), then beta-blocker
DM screening
BP >135/80, overweight with risk factors, all at age 45
Which DM medication? decreases hepatic glucose production
Metformin
Which DM medication? can cause hypoglycemia and weight gain
Sulfonylureas (glipizide, glyburide)
Which DM medication? injectable, may help weight loss
GLP-1 agonist (exenatide, liraglutide)
Which DM medication? weight neutral, may cause urticaria/angioedema
DPP-4 inhibitors (-gliptin)
Which DM medication? may improve lipid profile, edema and heart failure risk, increased risk of bladder cancer
Thiazolidinediones (-glitazone)
Which DM medication? flatulence abdominal discomfort
acarbose (other alpha-glucosidase inhibitors)
Which DM medication? Increased risk of vulvovaginal candidiasis/UTI
SGLT2 inhibitors (-gliflozin)
Indication for ACEI in diabetic nephropathy
Alb/Cr ratio >30mg/g
Tx DKA- Insulin/fluids
0.15U/kg insulin bolus then 0.1U/kg/hr, NS switch to D5-1/2NS at glucose 200-250
Target glucose reduction in DKA
50-100/hr
HHS vs. DKA Mx
HHS 1L NS prior to insulin; 0.1U/kg bolus
Target osmolality reduction in HHS
3mOsm/hr
C/I to bisphosphonates
CKD