Endocrine Flashcards
Adrenal Insufficiency
- MCC primary
autoimmune adrenalitis in US
infectious such as TB worldwide
Adrenal insufficiency
- drug cases of primary
ketoconazole
mitotane
Adrenal Crisis
- clinical
- vasodilatory shock
- fatigue
- weakness
- abdominal pain
- nausea / vomiting
- weight loss
- confusion
- lethargy
- coma.
Primary Adrenal insufficiency
- clinical
- fatigue
- weakness
- malaise
- weight loss
- hyperpigmentation
- abd pain
- n/v
Secondary adrenal insufficiency
- MCC
- clinical
abrupt cessation in steroids
- fatigue
- weakness
- malaise
Adrenal insufficiency
- lab findings
- hyponatermia
- hyperkalemia
- hypoglycemia
Adrenal insufficiency
- Screening test
serum cortisol: if normal or high can r/o
Adrenal insufficiency
- test to distinguish between primary and secondary
Plasma corticotropin level (ACTH)
- primary: high
- secondary: low
*corticotropin stim test can be used to support dx of primary - cortisol levels will not increase
Klinefelter Syndrome
- describe
- MC sex chromosome abnl
- causes primary hypogonadism
- 47, xxy karyotype
Klinefelter Syndrome
- clinical
- present after puberty
- gynecomastia
- infertility
- decreased body hair, energy, libido, and muscle mass
- Small, firm testes
- tall stature
- long limbs
- Sparse facial hair.
Klinefelter Syndrome
- labs
- testosterone: low
- FSH/LH: normal
Klinefelter Syndrome
- at risk for 3 things
- testicular cancer
- autism spectrum disorders
- Social challenges
PTH
- 3 functions
- release of Ca from bone
- Increase of intestinal Ca absorption BY increasing production of calcitriol (active vitamin D)
- Increases tubular reabsorption of Ca in distal renal tubules
Hyperparathyroidism
- MCC
parathyroid adenoma
Hyperparathyroidism and MEN1
- risk for what
parathyroid adenomas and carcinomas
Hyperparathyroidism
- MC presenting sx
- other sx
None :)
- signs of hypercalcemia: bones, stones, moans, and groans
Thyroid storm
- pharm management in order
- beta blocker
- Thionamide (PTU/methimazole): blocks thyroid hormone synthesis
- Iodine: inhibits release of stored thyroid hormone
- steroids: decreases peripheral conversion of T4 to T3
Pheochromocytoma
- dx testing
- Fractionated metanephrines and catecholamines in 24 hour urine collection
- Plasma fractionated metanephrines
Pheochromocytoma
- mgmt
- sx resection
- pre-surgical alpha and beta-adrenergic blockade to prevent hemodynamic swings (PHEnoxyenzamine and PHEntolamine first, then BB)
Dyslipidemia
- Screening if higher risk (RF to look for and age range by sex)
RF: HTN, DM, Cigs, fam hx of premature coronary heart disease.
Men: initiate 25-30
Female: initiate 30-35
Dyslipidemia
- Screening if not high risk
- Men: start at 35
- Females: start at 45
- not recommended to screen once >75 yo
Diabetes insipidus
- 2 types
- central: decreased secretion of antidiuretic hormone (ADH)
- nephrogenic: decreased sensitivity to ADH in the kidneys
Central Diabetes insipidus
- Dx
- tx
- Vasopressin challenge test: > 50% increase in urine osmolality and decrease urine volume
- Intranasal DDAVP
Nephrogenic Diabetes Insipidus
- Dx
- tx
- water deprivation test: no change in urine osmolality
- Hctz, amiloride, indomethacin
Diabetes insipidus
- labs
- increase in plasma osmolality
- decrease in urine osmolality
Metabolic syndrome
- mgmt
- Lifestyle: healthy diet, regular physical activity
- Meds: orlistat, liraglutide, lorcaserin (phentermine and topiramate), phentermine mono therapy
Metabolic syndrome
- Pros/Cons to each med
- Liraglutide: good for T2DM, reduces risk of MI in people with DM
- Orlistat: GI ADR
- Lorcaserin: Similar to orlistat with fewer ADR
- phentermine: CI in uncontrolled HTN
What is the most important modifiable risk factor for type II diabetes in the US?
Obesity
Bisphosphonates
- MOA
inhibit osteoclast activity (reduces bone reduction and turnover)
Osteoporosis
- MC fx
- vertebral body compression fractures
Myxedema coma
- tx
- thyroid hormone (levothyroxine AND liothyronine)
- glucocorticoids (until coexisting adrenal insufficiency is ruled out)
- supportive care
Thyroid nodule
- first step in workup
TSH
- if nl/high: hypothyroidism
- subnormal/low: hyperthyroidism and hyperfunctioning nodule
Thyroid nodule with low TSH
- next steps in w/u
- Thyroid scinigrpahy
- If cold or indeterminate then FNA bx
Turner Syndrome
- overview
- sex chromosome disorder
- females
- 45, XO
Turner Syndrome
- clinical
- MC short stature with stocky appearance
- shield chest
- widely spaced nipples
- short, webbed neck
- small mandible
- high arched palate
- low set ears
- low hairline
scoliosis and kyphosis - premature ovarian failure
- no breast development
- primary amenorrhea (can have normal puberty)
Turner sydnrome
- MC cardio issues
- coarctation of aorta
- bicuspid aortic valve
- dyslipidemia
- HTN
Thyroid nodule
- characteristics that increase likelihood of malignancy
- irregular margins
- taller than wide
- microcalcification
- diameter >1 cm
- heterogeneous nodule echogenicity
Thyroid Cancer
- 4 types
- Papillary (MC), best prognosis
- Follicular
- medullary
- anaplastic, worst prognosis/most aggressive
Medullary thyroid cancer-
neuroendocrine tumors
- produce calcitonin
- may be part of MEN
Thyroid cancer
- dx
- initial: US
- Confirmation: FNA bx
Subacute thyroiditis
- progression
- damage to thyroid cells
- hyperthyroid first as thyroid hormone is released
- hypothyroid second until thyroid cells regenerate and can produce thyroid hormone again
Subacute thyroiditis
- mgmt
- Analgesia: NSAIDs, prednisone
- BB: hyperadrenergic sx if present
- Levothyroxine in some cases but usu not needed
- thionamides have no role!
Cushings
- dx
- 24 hour urinary free cortisol excretion
- late night salivary cortisol
- low-dose dexamethasone suppression test
- ACTH levels
Cushings
- MCC
ACTH-secreting pituitary tumor
T2DM
- screening for nephropathy
- urine albumin-to-creatinine ratio
- yearly beginning at time of dx
- nl: <30
- Persistent: 30-300, severe >300
Diabetic nephropathy
- tx
- ACE-i/ARB
- tight glycemic control
- BP control
