Endocrine Flashcards
PDT for primary hyperaldosteronism
Etiology: Bilateral Adrenal Hyperplasia or unilateral adrenal adenoma
P:hypertension (tx resistant), hypokalemic alkalosis (reslting in muscle weakness + parasthesias)
Dx: Elevated plasma aldosterone, low plasma renin, aldosterone remains elevated following oral salinel load
Work up: CT to ID b/l adrenal hyperpalasia vs. adrenal adenoma.
Tx: For pts w b/l adrenal hyperplasia: aldosterone antagonists such as sipronolacone, eplerenone)
Diabetic foot ulcer caused by?
peripheral sensory neuropathy (microvascular damage is secondary)
Most common cause of hypothyroidism and lab findings?
hashimoto thyroditis. High TSH, low T4, anti-TPO
Most common cause of Cushing syndrome
Corticosteroids. Second most common is Cushing dz
HTN, hypoK, and metabolic alkalosis
Primary hyperaldosteronism (due to Conn syndrome or b/l adrenal hyperplasi)
Which anti-adrenergic (alpha or beta) drugs come first in treating pheochromocytoma?
alpha-antagonists first (phenoxybenzamine)
Treatment for central DI
DDAVP and free-water restriction
Postop patient with significant pain p/w hyponatremia and normal volume status
SIADH 2/2 stress of surgery
DM II w Lactic acidosis. what drug?
metformn
Pt with weakness, nausea, vomiting, weight loss, and skin hyperpigmentation. Lab results show HypoNa and HyperK, Tx?
Primary adrenal insufficiency (Addison disease). Tx w glucocorticoids, mineralocorticoids, and IV fluids.
Goal HbA1c in Type II DM?
Less than 7%
Bone pain, hearing loss, and increased AlkPhos. Dx?
Paget disease
Increased insulin-like growth factor-1. Dx?
Acromegaly
Classic CAH. What enzyme is deficient?
21-OH deficiency. 17-hydroxyprogesterone is elevated. 46, XX baby will show ambiguous genitalia and have hypotension
46, XY may have normal genitalia at birth or enlarged phallus
MEN 1 syndrome
3 Ps: pancreas, pituitary, and parathyroid tumors
Men 2A
2 Ps: Medullary thyroid cancer, parathyroid tumors, pheochromocytoma,
MEN 2B
1P: MNoP: Medullary thyroid cancer, Neuromas, Pheochromcyomas
4 types of thyroid cancer
Papillary (most Popular, Psammoma bodies, Orphan Annie Nuclei, lymphatic spread)
Follicular (hematologic spread)
Medullary (associated with MEN2A/B)
Anaplastic
Hypercalcemia causes: CHIMPANZEES
Calcium supplementation, Hyperparathyroidism/hyperthyroidism Iatrogenic - thiazides, parenteral nutrition OR Immobility Milk-Alkali Paget Dz of Bone Adrenal Insufficiency OR Acromegaly Neoplasia Zollinger Ellison Syndrome (MEN1) Excess Vitamin D Excess Vitmain A Sarcoidosis (and TB)
SIADH PDT+ Path
Too much ADH (can come from posterior pituitary lesion or brain injury) = too much water = hypotonic serum
D: Euvolemic Hyponatremia
Decreased serum Osms
Increased Urine Na and Urine Osms
Tx: H2O restriction, demclocycline or Vaptan
Central DI PDT+ Path
No ADH production
P: polyuria, polydipsia, NL Blood glucose
D: H2O restrict, then if corrects with desmopressin (DDAVP), then it’s central
T:DDAVP
Nephrogenic DI PDT+ Path
Kidney resistant to ADH
P: polyuria, polydipsia, NL Blood glucose
D: H2O restrict,
if doesn’t correct with desmopressin (DDAVP), then it’s nephrogenic
T: Gentle diuresis w loop diuretic
PDT for Secondary hyperaldosteronism
Path: young woman, fibromuscular dysplasia OR old man w renal artery stenosis P: HTn + hypoK D: Aldo/Renin<10 Angiogram Tx: RAS=medical management Fibromuscular dysplasia=stent
Multinodular goiter scan will show?
The thyroid scan is now demonstrating an enlarged gland with multiple nodules (“areas”), some avid/hyperfunctioning and other relatively depressed (either not “hyper”-functioning and thus relatively cold or actually cold, most commonly filled with colloid).
ca and vit. D levels in sarcoidosis
Chronic sarcoidosis
↑ Calcium due to elevated levels of 1,25-(OH)2-vitamin D3
↓ CD4+ T cells: T helper cells are consumed during granuloma formation → CD4+ levels are low in serum and high in bronchoalveolar lavage.
