Endocrine, Diabetes, and Metabolism Flashcards
labs/raiu exogenous thyroid
high T3 (dietary supps higher amounts), low thyroglobulin, suppressed TSH, <1% uptake
use of thyroglobulin
helpful differentiate exogenous vs other for thyrotoxicosis (low in exogenous)
increase risk of ? with acromegaly
cancer - esophageal, gastric, colon, melanoma
also - elevated CV risk
best lag dx acromegaly
IGF-1
phos in acromegaly
70% are hyperP (IGF-1 increases tubular P reabsorption)
monitoring and size for pituitary incidentaloma
greater 10mm - check hyper/hypofxn and visual field
5-9mm - follow up MRI 12 months
2-4mm - no further testing
T score cut offs
osteopenia -1.1 to -2.5
osteoporosis less than -2.5
tool to determine osteoporosis screening
FRAX
how to eval risk for adrenal incidentaloma
based on morphologic characteristics
- irregular, contrast enhancing, high attenuation
if B/L or larger 4cm - suggests malignancy
screening labs for adrenal incidentaloma
dex supp test - cushings
plasma/urine metanephrines - pheo
plasma aldo:renin ratio - hyperaldo
meds to give prior to pheo resection
alpha-blockade
typical Ca for malignancy
Ca more than 13
- most often PTH-rp secreting tumor
typical Ca for primary hyperPTH
mild (less than 11)
produced by lymphoma, leads to hyperCa
a1-hydroxylase
- leads to 1,25 vit D formation and GI absorption
tx diabetic peripheral neuropathy
antidepressant - amitriptyline/duloxetine
anticonvulsant - pregabalin/valproic acid
topical capsaicin
alpha-lipoic acid
TENS
lido patch
abx makes sulfonylurea hypoglycemia worse
bactrim
tx of dequervain thyroiditis
NSAIDs and supportive severe pain - glucocorticoids thyroid is ALWAYS tender thyrotoxicosis = consider BB monitor TSH every 2-8 weeks 95% recover
clinical course dequervain thyroiditis
hyperT - euthyroid - hypoT
each phase up to 8 weeks
rule out test for acromegaly
IGF-1
test if IGF-1 is positive
oral glucose suppression test
- if suppressed - no acromegaly
- if does NOT suppress - MRI brain
- MRI brain normal - check ectopic source GH
oral glucose suppression test
75g oral glucose load
- normal - GH decreases to less than 1ng/mL in 2hrs
- acromegaly - will have GH >2 - get brain MRI
labs for central hypoT
low TSH and low T4
work up central hypoT
neuroimaging
and other pituitary hormone testing
before start central hypoT on treatment
check for adrenal insufficiency
- can precipitate crisis!