Endocrine Flashcards
What is normal TSH?
0.4-4
What is normal T4?
4.5-11.2
High TSH and low T4 indicates what?
Hypothyroid
How is hypothyroid treated?
Levothyroxine
What are two most common causes of hypothyroid?
Low iodine intake and Hashimoto’s
What drug is given for symptom relief of hyperthyroid?
Beta blockers
Radioactive iodine is given for hyper or hypothyroid?
Hyperthyroid
Myxedema coma is severe what?
Hypothyroidism
Myxedema coma will have what on CBC?
Normal WBC with increased bands
Levothyroxine is what?
T4
With what drug and dose is myxedema coma treated?
500-800 mcg Levothyroxine IV
Low TSH and high T4 indicate what?
Hyperthyroid
Thyroid crisis is a complication of what?
Hyperthyroid
What does CBC look like in thyroid crisis?
May be mildly elevated
What kind of fluid to give for thyroid crisis?
Dextrose
Should a pt with thyroid crisis be cooled?
Yes
What is the first med given for thyroid crisis?
Propranolol
Glucocorticoids can be given for what thyroid complication?
Thyroid crisis
What is Cushing’s syndrome?
A set of symptoms that result from excess exposure to cortisol
What is Cushing’s disease?
Excess cortisol production from adrenal tumor
Is Cushing’s syndrome more often exogenous or endogenous?
Exogenous
Cushing’s causes what labs abnormalities?
Hypernatremia and hypokalemia
What should you do if you suspect Cushing’s?
Consult endocrine
Is Cushing’s an emergency?
No
How do you work up Cushing’s?
24 hour urine collection and low dose dexamethasone ACTH suppression test
How to treat exogenously caused Cushing’s?
Stop giving steroids
How to treat endogenously caused Cushing’s?
Locate and resect tumor
Pasireotide treats what?
Endogenous Cushing’s
What is adrenal insufficiency?
Low cortisol output
What is Addison’s?
Failure of the adrenal gland
What is secondary adrenal insufficiency?
Failure to produce ACTH
What labs are seen in Addison’s?
Hyponatremia and hyperkalemia
How to diagnose acute adrenal insufficiency?
Send random cortisol level
Random cortisol level above what excludes acute adrenal insufficiency?
18
ACTH stress test failing to reach what level at any time of day indicates adrenal insufficiency?
18
ACTH stress test failing to rise by what in the morning indicates adrenal insufficiency?
9
Primary AI is treated how?
Glucocorticoids and mineralocorticoid
Secondary AI is treated how?
Only glucocorticoids
What is a pheochromocytoma?
A catecholamine secreting tumor
What is typical age of onset of pheochromocytoma?
20-50
You should have 3 of what 4 symptoms to suspect pheochromocytoma?
Headache, diaphoresis, hypertension, palpitations
What imaging is used to diagnose pheochromocytoma d?
CT abdomen or MRI
What labs are used to diagnose pheochromocytoma?
Plasma free metanephrines / urine fractionated metanephrines
When do you use imaging to diagnose pheochromocytoma?
If labs come back positive
If you see a tumor on CT/MRI when attempting to find a pheochromocytoma what is the next step?
MIBG
What two meds to use to treat pheochromocytoma?
Phenoxybenzamine and metoprolol
Besides meds, how else do you treat pheochromocytoma?
Surgical resection
What is diabetes insipidus defined as?
Polyuria with greater than 3L urine output
What occurs in central DI?
Inability to make ADH
What occurs in nephrogenic DI?
Inability of the kidneys to react to ADH
What occurs in psychogenic DI?
Increased water intake 2/2 psychiatric issues
How to treat central DI?
Desmopressin IV
What is the apparent fluid status of SIADH on physical exam?
Euvolemic
Do patients with SIADH usually have peripheral edema?
No
What is serum os in SIADH?
Hypoosomolar
What is urine sodium in SIADH?
Normal to high
What is urine os in SIADH?
High
How do you treat SIADH if they are very symptomatic?
HTS
Non-emergent SIADH should have a water restriction of how much?
500mL- 1.5L per day
