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Review > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Thyroid cancer risk is increased by

A
  • history of radiation therapy during childhood for Wilm’s tumor, lymphoma, neuroblastoma
  • low-iodine diet
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2
Q

Hyperprolactinemia can be a sign of

A

-pituitary adenoma

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3
Q

Hyperprolactinemia presentation

A
  • slow onset
  • amenorrhea
  • galactorrhea in both males and females
  • serum prolactin elevated
  • if large tumor, c/o HA and vision changes
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4
Q

Prolactin purpose

A

-stimulate breast milk production after childbirth

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5
Q

Hormones from anterior pituitary

A 
FSH
LH
TSH
GH
ACTH
MSH
Prolactin
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6
Q

Hypothalamus stimulates what

A

anterior pituitary

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7
Q

Posterior pituitary secretes

A 
antidiuretic hormone (vasopressin)
oxytocin
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8
Q

Thyroid gland uses what to produce T3 and T4

A

iodine

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9
Q

Parathyroid gland is responsible for

A
  • PTH

- for calcium balance from bones, kidneys, and GI

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10
Q

Pineal gland produces

A

melatonin

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11
Q

Primary hyperthyroidism (Thyrotoxicosis) findings

A

-very low TSH with elevated free T4 and T3

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12
Q

Most common cause of primary hyperthyroidism in US

A

Grave’s disease

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13
Q

Grave’s disease presentation

A
  • middle aged women
  • rapid weight loss
  • anxiety
  • insomnia
  • Cardiac: palpitations, HTN, afib, PAC
  • warm and moist skin, diaphoretic
  • opthalmopathy and lid lag
  • diarrhea
  • amenorrhea
  • heat intolerance
  • goiter
  • pretibial myxedema: thickened skin over ankles, orange-peel look
  • brisk DTR
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14
Q

Grave’s disease labs

A
  • Low TSH
  • elevated free T3, T4
  • Positive thyrotropin receptor antibodies (TSI)
  • Thyroid peroxidase antibody (TPO): positive with graves and hashimoto’s
  • palpable thyroid
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15
Q

Grave’s disease treatment

A
  • Thyroid ultrasound

- refer to endocrinologist

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16
Q

Grave’s disease medications

A

PTU: shrink thyroid, decrease hormone production
Methimazole: same

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17
Q

Grave’s disease medication side effects

A
  • skin rash
  • aplastic anemia
  • thrombocytopenia
  • hepatic necrosis
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18
Q

Medication to manage symptoms of hyperstimulation in Grave’s

A

beta blockers

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19
Q

Thyroid storm

A

need hospitalization

-look for decreased LOC, fever, abdominal pain

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20
Q

Diagnostic test for thyroid cancer

A

fine-needle biopsy

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21
Q

Monitoring response to treatment of thyroid disease

A
  • recheck TSH every 6-8 weeks
  • TSH goal is less than 5
  • when stable, recheck every 6-12 months
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22
Q

Primary hypothyroidism findings

A
  • high TSH with low free T4

- common causes: Hashimoto’s thyroiditis, postpartum thyroiditis, thyroid ablation with radioactive iodine

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23
Q

Most common cause of hypothyroidism in US

A

Hashimoto’s

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24
Q

Hashimoto’s patho

A
  • chronic autoimmune disorder of thyroid gland

- body produces destructive antibodies (TPO) against thyroid gland

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25
Q

Hashimoto’s presentation

A
  • overweight
  • fatigue
  • weight gain
  • cold intolerance
  • constipation
  • menstrual abnormalities
  • alopecia
  • serum cholesterol elevated
  • history of autoimmune disorders
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26
Q

Myxedema

A
  • severe hypothyroidism
  • endocrine emergency
  • cognitive symptoms
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27
Q

Hashimoto’s labs

A
  • TSH, if elevated, order again with free T4

- Order TPO to confirm Hashimoto’s thyroiditis

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28
Q

Gold standard for diagnosing Hashimoto

A

TPO

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29
Q

Subclinical hypothyroidism

A
  • TSH >5 but serum free T4 WNL
  • asymptomatic to mild symptoms
  • recheck again in 6 months
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30
Q

Hypothyroidism treatment

A
  • Levothyroxine start 25-50 mcg/day
  • start with lowest dose for elderly with CVD history (12.5)
  • Increase every few weeks until TSH normal
  • recheck every 6-8 weeks until normal, then check every 12 months when stable
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31
Q

Radioactive treatment for hyperthyroidism results in

A

hypothyroidism for life

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32
Q

Levothyroxine is synthetic ___

A

T4

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33
Q

Which thyroid hormone is more active

A

T3

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34
Q

Subclinical hypothyroidism with TSH >10

A

treat to prevent conversion to primary hypothyroidism

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35
Q

Subclinical hypothyroidism with TSH 4.5-10

A
  • treatment not recommended

- recheck in 6-12 months unless they are symptomatic

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36
Q

Major risks of prescribing levothyroxine

A
  • accelerated bone loss

- afib

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37
Q

Suggested Synthroid starting dose for young (<50) patients

A

1.6 mcg/kg/day

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38
Q

Suggested Synthroid starting dose for middle (50-60) patients

A

50 mcg

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39
Q

Suggested Synthroid starting dose for older or with CVD, or multiple comorbidities

A

25 mcg

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40
Q

T1DM patho

A
  • destruction of B-cell sin islets of Langerhans
  • abrupt cessation of insulin production
  • ketone buildup–> DKA and coma
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41
Q

Ketone

A

-byproduct of fat breakdown

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42
Q

T2DM patho

A
  • progressive decreased secretion of insulin resulting in chronic state of hyperglycemia and hyperinsulinemia
  • genetic component
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43
Q

Other names for metabolic syndrome

A
  • insulin-resistance syndrome

- syndrome X

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44
Q

Metabolic syndrome increases risk for

A

CVD

T2DM

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45
Q

Prediabetes labs

A
  • A1C: 5.7-6.4
  • Fasting glucose: 100-125
  • 2 OGTT: 140-199
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46
Q

Diagnostic criteria for DM

A
  • A1C: >6.5
  • FPG: >126
  • hyperglycemia symptoms: polyuria, polydipsia, polyphagia + random glucose >200
  • 2 hour OGTT >200
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47
Q

Normal serum blood glucose

A
  • FPG: 70-100
  • Peak postprandial glucose: <180
  • A1C: <6
  • Elderly may have A1C <8 if tolerable
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48
Q

Newly diagnosed diabetic labs

A
  • A1C every 3 months until normal
  • A1C every 6 months once stabilized
  • lipid panel once a year
  • random urine for microalbuminuria once a year
  • CMP, TSH, LFT’s
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49
Q

LDL goal for DM

A

<100

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50
Q

A1C goal for DM

A

<7

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51
Q

BP goal for DM

A

<140/80

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52
Q

Preprandial plasma glucose goal

A

70-130

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53
Q

DM what to check every visit

A
  • BP, feet, weight, BMI, blood sugar
  • vibratory sense
  • light and deep touch
  • pedal pulses, reflexes
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54
Q

DM preventative care

A
  • > 50: Shingrix, 0, 2-6 months
  • flu shot annually
  • pneumococcal vaccine
  • ASA 81 mg if risk for MI, stroke (not rec in <30)
  • Yearly dilated exam
  • T2DM: eye exam at diagnosis
  • T1DM: first exam 5 years after diagnosis
  • podiatry: once to twice a year
  • BP goal: 130/80
  • Dental health
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55
Q

Level 1 hypoglycemia

A

FBS < 70

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56
Q

Level 2 hypoglycemia

A

FBS < 54

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57
Q

What medication can blunt hypoglycemic response

A

beta blockers

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58
Q

A1C goal for T1Dm and most pregnant patients

A

<6

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59
Q

A1C goal for older adults with T2DM comorbids

A

<8-8.5

60
Q

A1C goal for T2DM and healthy older adult

A

<7.5

61
Q

A1C goal for T2DM for most adults

A

<7

62
Q

Screening for T2DM

A
  • annual for BMI> 25 and one or more risk factors for DM

- entire population >45 every 3 years if screening is normal

63
Q

Hypoglycemia treatment

A
  • glucose 15-20 g for conscious patients
  • orange juice, soft drink, candy
  • recheck in 15 minutes
  • glucagon for severe hypoglycemia (<54)
64
Q

Exercising and DM

A
  • may need to decrease medication before

- increased risk of hypoglycemia if they do not compensate

65
Q

Dawn phenomenon

A
  • normal physiological event
  • FBG elevation between 4-8 am
  • normal people have insulin to combat this
66
Q

Somogyi effect

A
  • aka rebound hyperglycemia
  • severe nocturnal hypoglycemia stimulates counterregulatory hormones (glucagon) from liver
  • results in high fasting blood glucose by 7am
  • due to overtreatment with evening and or bedtime insulin
  • more common with T1DM
67
Q

How to diagnose Somogyi effect

A

-check blood glucose early in morning (3am) for 1-2 weeks

68
Q

Somogyi effect treatment

A
  • eat snack before HS

- or remove dinnertime NPH or lower dose

69
Q

Diabetic retinopathy findings

A
  • neovascularization (new growth of fragile arterioles)
  • microaneurysms (dot and blot hemorrhages d/t neovascularization)
  • cotton-wool spots or soft exudates (nerve fiber layer infarcts)
  • hard exudates
70
Q

T/F Patients with diabetic neuropathy should avoid excessive running or walking

A

True: avoid risk of foot injury

71
Q

Charcot’s foot and ankle

A
  • aka neuropathic arthropathy
  • deformity of foot caused by joint and bone dislocation and fractures due to neuropathy
  • midfoot arch collapse (rocker bottom foot)
72
Q

First line medication for T2DM

A

Metformin (glucophage)

73
Q

Metformin (glucophage) mechanism

A
  • biguanide
  • decrease gluconeogenesis
  • decrease peripheral insulin resistance
  • rare hypoglycemia
74
Q

Metformin side effects

A

-diarrhea

nausea

75
Q

Metformin contraindications

A
  • renal disease
  • hepatic disease acidosis
  • alcoholics
  • hypoxia
76
Q

Metformin labs

A
  • renal function

- LFTs

77
Q

Metformin has increased risk for

A
  • lactic acidosis

- occurs with hypoxia, hypoperfusion, renal insufficiency

78
Q

Metformin and IV contrast dye

A

-hold on day of procedure and 48 hours after

79
Q

Sulfonylurea mechanism

A

-stimulate beta cells of pancreas to secrete more insulin

80
Q

Sulfonylurea examples

A

glipizide
Glyburide
Glimepiride

81
Q

Sulfonylurea adverse effects

A
  • increased risk of CV mortality
  • hypoglycemia
  • increased risk of photosensitivity
  • blood dyscrasias
  • avoid if impaired hepatic or renal function (monitor LFTs, creatinine, UA)
  • Causes weight gain
82
Q

Thiazolidinediones examples

A

-Pioglitazone (Actos)

83
Q

TZD mechanism

A

-enhance insulin sensitivity in muscles and reduce hepatic glucagon production

84
Q

TZD can be combined with

A

-metformin
-sulfonylurea
-GLP-1
-SGLT2
-DPP-4
-insulins
…so any diabetic med

85
Q

TZD contraindications

A
  • BBW: NYHA class 3 and 4, symptomatic heart failure
  • water retention and edema ‘
  • avoid with bladder cancer or history
  • active liver disease
  • Type 1 DM
  • pregnancy
86
Q

Bile-acid sequestrant example

A

-Cholestyramine

87
Q

Bile-acid sequestrant mechanism

A

reduce hepatic glucose production and reduce intestinal absorption of glucose
-take with meals, lower LDL

88
Q

Meglitinide (Glinides) examples

A
  • Repaglinide (Prandin)

- Nateglinide (Starlix)

89
Q

Meglitinide mechanism

A
  • stimulate pancreatic secretion of insulin

- For T2DM with postprandial hyperglycemia

90
Q

Meglitinide side effects

A
  • weight neutral
  • may cause hypoglycemia
  • take before meals or 30 minutes after
  • Hold if skipping a meal
  • bloating, abdominal cramps, diarrhea, farting
91
Q

Rapid acting insulins

A
  • Lispro
  • Aspart
  • Glulisine
92
Q

Basal insulins

A
  • Glargine (lantus)

- Detemir (Levemir)

93
Q

alpha glucosidase inhibitors mechanism

A

Acarbose (Precose)

  • slow intestinal carb digestion and absorption
  • no hypoglycemia
  • modest effect on A1C
  • GI s/e: farting, diarrhea
94
Q

Incretin mimetics or glucagonlike peptide mimetics examples

A
  • Exenatide (Byetta)

- Liraglutide (Victoza) injections

95
Q

GLP-1 mechanism

A

-stimulate GLP-1
-increase in insulin production and inhibit postprandial glucagon release
increase satiety

96
Q

GLP-1 may cause

A
  • weight loss
  • appetite suppression
  • NO hypoglycemia
  • Pancreatitis
  • medullary thyroid tumors
97
Q

GLP-1 contraindication

A

-personal or fam hx of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2

98
Q

SGLT2 inhibitor examples

A
  • Canagliflozin (Invokana)
  • Dapagliflozin (Farxiga)
  • Empagliflozin (Jardiance)
99
Q

SGLT2 inhibitor mechanism

A

-blocks glucose reabsorption by kidney and increases glucosuria

100
Q

SGLT2 is effective for

A

T2DM in any stage

-no hypoglycemia

101
Q

SGLT2 FDA warning

A
  • may lead to DKA

- weight loss, hypotension

102
Q

SGLT2 renal s/sx

A
  • polyuria
  • increased creatinine
  • increase in UTIs
  • PN
103
Q

SGLT2 increased risk for

A

leg and foot amputations

104
Q

DPP-4 inhibitor examples

A
  • Sitagliptin (Januvia)
  • Saxagliptin (Onglyza)
  • Linagliptin (Tradjenta)
105
Q

DPP-4 inhibitor mechanism

A
  • inhibit DPP-4 activity
  • increase active incretin concentrations
  • increase insulin secretion
  • decrease glucagon
  • no hypoglycemia
106
Q

DPP-4 inhibitor FDA warning

A

may cause joint pain that can be severe and disability

  • occur on day 1 or years later
  • angioedema
  • urticaria
  • acute pancreatitis
107
Q

T/F Incretin mimetics and Incretin enhancers can be combined

A

False

108
Q

Treatment for mild A1C elevation

A

-try lifestyle modifications for 3-6 months

109
Q

Metformin starting dose

A

500 mg daily

max 2000 mg

110
Q

If patient on max metformin and A1C not within range, then what

A

add sulfonylurea

111
Q

Other choices for adding onto metformin

A
  • any other medication
  • DPP-4 inhibitor
  • incretin mimetics
  • TZD
112
Q

Insulin should not be combined with what

A

meglitinides

-severe hypoglycemia

113
Q

Which diabetic meds can cause hypoglycemia

A
  • sulfonylureas
  • meglitinides
  • rarely metformin
114
Q

If A1C still elevated with metformin and sulfonylurea..

A

consider adding basal insulin

115
Q

Causes weight loss

A
  • metformin
  • incretin mimetic
  • GLT-2 inhibitors
116
Q

Causes weight gain

A
  • insulins
  • sulfonylureas
  • TZDs
117
Q

Weight neutral

A
  • meglitinides
  • bile-acid sequestrants
  • alpha-glucosidase inhibitors
118
Q

Primary prevention for patients at high risk for T2DM

A
  • encourage weight loss
  • regular physical activity
  • increase fiber
119
Q

Metformin dosage increments

A
  • 500mg once daily
  • 500 mg BID
  • 1000 mg BID
120
Q

Initial A1C 9, plan

A

-start basal insulin

121
Q

Diabetics are at risk for which eye problems

A
  • cataracts

- glaucoma

122
Q

With new onset-afib, what endocrine complication should be checked

A

TSH

123
Q

Insulin sensitivity and labs

A

-Elevated TG with low HDL

124
Q

What other medications should be started with diabetics

A
  • Statin

- ACEI

125
Q

What second agent should be considered in a patient with DM and ASCVD

A
  • SGLT2-I
  • empagliflozin (Jardiance)
  • or Liraglutide (Victoza)
126
Q

Dose to start basal insulin

A

0.1-0.2 units/kg
or 10 units daily
adjust 2-4 units once-twice weekly to reach FBG goal
if hypoglycemia, reduce by 4 units

127
Q

Postprandial glucose goal

A

<180

128
Q

Addison’s disease

A
  • adrenal insufficiency
  • deficiency of cortisol and aldosterone
  • aldosterone: sodium and K balance
  • cortisol: maintain BP, cardiac function, blood sugars
129
Q

Addison’s disease presentation

A
  • dysphagia
  • fatigue
  • weight loss
  • hypotension
  • abdominal pain
  • amenorrhea
  • NV
  • thin, brittle nail
  • hyperpigmentation
130
Q

Addison’s disease diagnosis

A
  • measure AM serum cortisol level
  • low cortisol level with normal to high K and low to normal Na
  • ACTH stimulation test: measure cortisol level before and after injection
  • CT
131
Q

Addison’s disease treatment

A
  • Hydrocortisone (Cortef), prednisone, or methylprednisolone
  • Fludrocortisone to replace aldosterone
  • increase salt intake
132
Q

Addisonian crisis treatment

A
  • ED

- IV corticosteroids, saline, dextrose

133
Q

Cushing syndrome

A

-excess cortisol from adrenal glands

134
Q

Cushing syndrome presentation

A
  • red cheeks
  • Buffalo hump
  • abdominal stretch marks
  • easy brusing
  • pendulous abdomen
  • thin arms and legs
  • thin skin
135
Q

Cushing syndrome diagnosis

A
  • cortisol levels

- CT MRI

136
Q

Cushing syndrome treatment

A
  • reduce corticosteroid use
  • surgery if due to tumor
  • Ketoconazole, Mifepristone (if with T2DM)
  • i guess refer to endocrinology
137
Q

Which diabetic med should be used with caution in patient with severe sulfa allergy

A

-Glyburide

138
Q

T/F hyperglycemia can occur as a result of aerobic exercise

A

False

139
Q

Which diabetic medication is helpful for minimizing postprandial hyperglycemia

A

meglitinide

140
Q

T/F Insulin resistance can contribute to prothrombotic and proatherogenic state

A

true

141
Q

Prolonged metformin usage increases risk for

A

Vitamin B12 deficiency

142
Q

GLP-1 agonists increases risk for

A

pancreatitis

143
Q

At minimum, what interval should TSH be reassessed after Synthroid dosage adjustment?

A

6-8 weeks

144
Q

Hypercalcemia with suppressed PTH should raise concern for what

A

malignancy

145
Q

How to distinguish between T1DM and T2DM

A

T1DM has HLA-DR3 or HLA-DR4

146
Q

Normal free T4

A

4.6-11.2 mcg/dL

147
Q

Which diabetic medication is contraindicated with history of medullary thyroid carcinoma?

A

GLP-1 agonists

Review (24 decks)

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