Endocrine Boards - Sheet1 (2) Flashcards
Elevated PTH and calcium. Low phosphate. Short QT interval. Bones, stones, and moans, psych groans
Primary hyperparathyroid
Elevated PTH. Normal/Low calcium. Renal failure and Vit D deficiency
Secondary hyperparathyroid
Neck Surgery. Chvostek and Trousseau. Prolonged QT
Hypoparathyroid
Eye and Skin manifestation
Graves
PTU - first trimester. methimazole - after first trimester
Hyperthyroid Treatment
Low TSH and Free T4. Check adrenal function
Central hypothyroid
TSH. Ultrasound. Warm Nodules are benign. Cold nodules are cancer
Thyroid nodule
Pituitary adenoma. Lung tumor. Adrenal tumor. Low ACTH = adrenal. High ACTH = pituitary or lung.
Cushings
Increased ACTH = adrenal. Low ACTH = pituitary. ACTH stimulation test. Hyponatremia & Hyperkalemia. Fludrocortisone
Addisons
Androgen and/or estrogen secreting = cancer. CT scan. Surgery
Adrenal cortical carcinoma
Increased growth hormone. Pituitary tumor. Large hands/feet. Increased insulin like growth factor.
Acromegaly
Low C-peptide. Antibodies. Beta cell destruction.
Type 1 DM
Insulin insensitivity. Weight loss. Metformin.
Type 2 DM
Hyperglycemia( < 1,000 (but usually about 350). Type 1. Anion gap metabolic acidosis and serum ketones. Infection. Hypokalemia.
Diabetic Ketoacidosis
Glucose > 1,000. Type 2
Hyperosmolar hyperglycemia
Triglycerides > 1,000 = pancreatitis. Statins first line.
Hyperlipidemia
Galactorrhea, oligomenorrhea, amenorrhea. Hook effect. HCG, TSH, MRI. Cabergoline.
Prolactinemia
Decreases hepatic glucose production and peripheral glucose utilization, decreases intestinal glucose absorption
Metformin
Stimulates pancreatic beta cell insulin release (insulin secretagogue - non glucose dependent)
Sulfonylureas (glyburide and glipizide)
Increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells
Thiazolidinediones (Pioglitazone - Actos and Rosiglitazone - Avandia)
Delays intestinal glucose absorption
α-Glucosidase inhibitors (Acarbose precose and Miglitol glyset)
Stimulates pancreatic beta cell insulin release
Meglitinides (Repaglinide prandin and Nateglinide)
Lowers blood sugar by mimicking incretin - causes insulin secretion, decreased glucagon and delays gastric emptying
GLP-1 Agonists (Exenatide Byetta)
Dipetpidylpetase inhibition - inhibits degradation of GLP-1 so more circulating GLP-1
DDP-4 Inhibitors (Sitagliptin Januvia)
SGLT-2 inhibition lowers renal glucose threshold which results in increased urinary glucose excretion
SGLT-2 Inhibitor (Canagliflozin)
A1C 5.7-6.4, Fasting glucose 100-125, 2-hour oral glucose tolerance test 140-199
Pre-diabetes
Name the diagnostic criteria for diabetes
Fasting blood glucose > 126 mg/dl at least 8 hours on two occasions GOLD STANDARD! –Hemoglobin A1C > 6.5 indicates average blood sugar 10-12 weeks prior to measurement – 2 hour plasma glucose of > 200 on an oral glucose tolerance test – 3 hour GTT is gold standard in GDM – Random plasma glucose > 220 in patients with classical symptoms of hyperglycemia
At what serum creatinine level should Metformin be stopped
Cr > 1.5
Early morning hyperglycemia - Normal glucose until 2-8 am when it rises. Results from decreased insulin sensitivity and nightly surge of counterregulatory hormones during nighttime fasting
Dawn Phenomenon
Nocturnal hypoglycemia followed by rebound hyperglycemia due to surge in growth hormone
Somogyi effect
Diabetic w/ anorexia, anemia, wt loss, pallor
Chronic renal failure
Gastroparesis, impotence, recurrent infections, stocking-glove paresthesia
Diabetic neuropathy (Treat w/ TCA (amitriptyline)
Hypoglycemia despite glucose administration. Increased C-peptide
Insulinoma
Hypoglycemia in alcoholic
Give Thiamine before glucose to prevent Wernicke’s encephalopathy
Decreased radioactive iodine uptake, decreased free T4, increased TSH
Hashimoto’s thyroiditis
Female, weight loss, palpitations, atrial fibrillation
Hyperthyroid (work it up with TSH, T4)
Exopthalmos, palpitations, wt. loss. Elevated radioactive idodine uptake
Hyperthyroid, Graves Dx - Tx w/ Radioactive iodine
Post thyroidectomy - most likely injury
Recurrent laryngeal nerve = hoarseness
Post thyroidectomy - electrolyte watch
Hypocalcemia
Infant w/ round face, large protruding tongue, dry skin, umbilical hernia, constipation, enlarged abdomen, poor feeding, delayed developmental milestones
Congenital Hypothyroidism
Recurrent HA, HTN not responding to meds, sweating. Attacks of severe HA, HTN, glycosuria. Urinary catecholamines, urinary metanephrines
Pheochromocytoma - Tx pre-op w/ alpha blocker
HTN not responsive to meds
Renal artery stenosis (Infrarenal artery)
HTN w/ hypernatremia, hypokalemia
Primary Aldosteronism
Wt. gain, edema, coarse dry skin, hair, menorrhagia, cold intolerance, hx transphenoidal surgery & radiation
Hypothyroidism
Tetany, hypocalcemia, cataracts
Hypoparathyroidism
Exogenous corticosteroid use
Cushing syndrome
Dexamethasone suppression test
Cushing syndrome
Central obesity, abdominal stria, hyperglycemia, moon facies, buffalo hump, easy bruising
Cushing syndrome
Acute steroid withdrawal
Addison’s disease, crisis
Hyperpigmentation, hypoglycemia, orthostatic hypotension, hypotension not responsive to fluids, hypotension following an illness, trauma, or surgery
Addison’s disease, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
Worsening fatigue, wt loss, weakness, recurrent abdominal pain, hair loss, hyperpigmentation. Hyponatremia, hyperkalemia
Addison’s disease, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
Hyponatremia, hyperkalemia
Acute adrenal insufficiency (Addison’s crisis)
Polyuria, polydipsia. Dilute urine, Hypernatremia
Diabetes insipidus
Concentrated urine. Hyponatremia
SIADH
45,X - low hairline, low set ears, webbed neck, short stature; shield chest, wide set nipples, infertility, lack of Secondary sex characteristics
Turners (gonadal dysgenesis
XXY ♂ - short stature, ↓ intelligence; small firm testes, gynecomastia, abn arm-body length
Klinefelters (hypogonadism)
