Endocrine Flashcards
What are common lab abnormalities in Cushing Disease?
Common laboratory abnormalitis found in Cushing Disease include
hyperglycemia
hypokalemia
leukocytosis
Iatrogenic glucocorticoid overuse is the most common cause of Cushing’s disease.
What test is used to confirm a diagnosis of Cushing Disease?
Cushing syndrome is confirmed using a High-dose dexamethasone supression test.
Cushing syndrome can be caused by a paraneoplastic disease such as small cell carcinoma of the lung and adrenocortical carcinomas.
After a high dose dexamethasone suppression test:
ACTH undetectable and cortisol is not suppressed
primary hypercortisolism- the tissue is producing cortisol without regulation or ACTH stimulation
After a high dose dexamethasone suppression test:
ACTH is elevated and cortisol is not suppressed
paraneoplastic syndrome producing ACTH.
Chest CT and abdominal CT are indicated to evaluate for a malignancy unless its already been diagnosed
After a high dose dexamethasone suppression test
High-normal ACTH and suppressed cortisol
High-normal ACTH and suppressed cortisol suggests an ACTH pituitary adenoma (aka Cushing’s disease)
What are considered normal findings after a low-dose dexamethasone suppression test?
A low-dose dexamethasone suppression test is considered normal if the ACTH is suppressed and there is a decrease in cortisol levels.
If ACTH and cortisol are not suppressed by low-dose dexamethasone, then high-dose dexamethasone suppression test is warranted for diagnosis.
What test is likely to confirm a diagnosis of Riedel thyroiditis?
The diagnosis of Riedel thyroiditis is confirmed by
OPEN SURGICAL BIOPSY.
Riedel thyroiditis presents with an expanding painless neck mass with or without symptoms of obstruction (neck pressure, airway obstruction, dysphagia, dystonia, chokin, cough)
what is the goal A1c level for a patient who is elderly, has a life expectancy of <10 years, or multiple co-morbidities?
8.0% in elderly patients, those with a life expectancy <10 yrs, or those with multiple comorbidities.
Typically the goal hemoglobin A1c is less than 7%
a patient in their 60s-70s with a hx of thyroid disease, a rapidly growing neck mass
Consider anaplastic thyroid carcinoma.
Anaplastic thyroid carcinoma can metastasize to the lungs (dyspnea and effusion), bones (pain and pathologic fractures) and brain (AMS).
The mass will present the same as Riedel thyroiditis and a surgical biopsy is needed to distinguish the two.
