Endocrine, Diabetes, & Metabolism Flashcards
Common causes of Cushing Syndrome
- Etiology
- Pathologic findings
Primary hyperaldosteronism
- Etiology
- Clinical features
- Diagnosis
- Treatment
- Treatment
Unilateral adenoma: adrenalectomy
Bilateral adrenal hyperplasia: Aldosterone antagonists (spironolactone, eplenerone)
Administration of a thiazide diuretic in primary hyperaldosteronism
After administering diuretics, potassium can fall rapidly:
Muscle weakness
Leg cramps
Hypercalcemia of malignancy
- Causes
- Clinical features
- Diagnosis
Diagnosis of hypercalcemia
Complications of Roux-en-Y gastric bypass surgery
- Early
- Late
Features of Cushing syndrome
- Clinical manifestations
- Diagnosis
Differentiating between ACTH-dependent and ACTH-independent hypercortisolism
ACTH-dependent (ACTH-secreting pituitary adenoma, ectopic ACTH production)
High ACTH can cause hyperpigmentation due to co-secretion of MSH and direct stimulation by MSH receptors.
ACTH increases androgen production from the zona reticularis of the adrenal cortex, leading to androgenic symptoms
ACTH-independent (e.g. exogenous glucocorticoids, adrenal adenoma)
No hyperpigmentation, no androgen excess
Lifestyle modifications for prevention of future gout attacks
Indications for medications to lower serum urate in patients with gout
Repeated and disabling attacks of gouty arthritis
Tophi suggesting chronic disease
X-ray evidence of chronic gouty joint disease
Uric acid kidney stones
Renal insufficiency
Oral colchicine
Treatment for gouty arthritis
Can be used for short-term therapy (<6 months) to prevent gouty attacks while patients start urate lowering drugs (e.g., allopurinol).
Can cause neuropathy or myopathy, especially in patients taking statins.
Allopurinol
Febuxostat
Xanthine oxidase inhibitors
Decrease uric acid production.
Probenecid
Increases uric acid excretion in the kineys
Pheochromocytoma
Hypertension
+
Classic triad: headaches, tachycardia, diaphoresis
Pheochromocytoma
- Pathogenesis
- Symptoms
- Rule of 10s
- Diagnosis
Medical management of pheochromocytoma
Alpha blockade (phenoxybenzamine), then beta blockade
Unopposed beta blockade should be initiated first because administration of beta blockers alone can cause unopposed alpha adrenergic effects, leading to severe peripheral vasoconstrction and a paradoxical rise in blood pressure
Definitive treatment is adrenalectomy
High anion gap metabolic acidosis (mnemonic)
Calculating anion gap
Sodium - [Cl- + HCO3-]
Renal tubular acidosis Type I
Renal tubular acidosis Type II
Both cause non-anion gap metabolic acidosis
Type I: Impaired urine acidification in the distal renal tubules
Tyle II: Impaired urine acidification in the distal renal tubules occurs in RTA type I
When to give insulin + dextrose in DKA
If blood glucose <250
Diabetic ketoacidosis in children
- Clinical features
- Laboratory
- Workup
- Management
- Complications
Clinical manifestations of Graves disease
- General
- Eyes
- Skin
- Cardiovascular
- Nails
- Endocrine
- GI
- Neurology
Evaluation of secondary amenorrhea
Hypothyroidism can cause a variety of menstrual abnormalities anormalities, including amenorrhea, irregular menses, menorrhagia. Can also cause hyperprolactinemia with associated galactorrhea.
First line treatment for severe hypertriglyceridemia secondary to familial dysbetalipoproteinemia
Fibric acid derivatives
e.g., fenofibrate
Hypopituitarism with a mild to moderate increase in prolactin
Nonfunctioning (gonadotroph) adenoma
Common causes of hypogonadism in men
- Primary (testicular)
- Secondary (pituitary/hypothalamic)
- Combined (primary and secondary)
Autonomous thyroid hormone production
Occurs without stimulation by TSH
Evaluation of hyperthyroidism
Steroid hormone synthesis pathways
Differentiating between types of CAH
- Enzyme deficiency
- Hormonal abnormalities
- Symptoms
Milk-alkali syndrome
- Pathophysiology
- Symptoms
- Laboratory findings
- Treatment
Common causes of myopathy
- Connective tissue diseases
- Endocrine/metabolic
- Drugs/toxins
- Miscellaneous
Thyrotoxicosis with increased versus decreased radioactive iodine uptake (RAIU)
Management of hyperprolactinemia in premenopausal women
Diagnosis of hypercalcemia
PTH, vitamin D, and calcium axis
Euthyroid sick syndrome
“Low T3 syndrome”
Characterized by a fall in total and free T3 levels with normal T4 and TSH
Any patient with an acute, severe illness may have abnormal thyroid function tests
GLP-1 agonists & DPP-IV inhibitors
Oral Diabetes Medications
- Medication
- Decrease in A1C
- Points to remember
Pathogenesis of refeeding syndrome
Refeeding syndrome is the constellation of pathologic derangements resulting from a surge in insuline activity as the body resumes anabolism. Carbohydrate ingestion causes pancreastic insulin secretion and cellular uptake of phosphorus, potassium, and magnesium.
Phosphorus is required for energy (ATP)
Deficiencies in potassium and magnesium potentiate cardiac arrhythmias and cardiopulmonary failure).
Workup for hypertension and hypokalemia
Primary hyperaldosteronism: Prone to diruetic-induced hypokalemia
Metabolic alkalosis
Mild hypernatremia
No edema bc of aldosterone escape
Drugs for neuropathic pain
- Drug
- Mechanism of action
Chronic primary adrenal insufficiency
- Etiology
- Clinical features
- Diagnosis
Autoimmune adrenalitis is responisble for >90% of cases of PAI in developed countries
Evaluation of suspected hyperaldosteronism
Differential diagnosis of hyperandrogenism in females
- Diagnosis
- Clinical features
Clinical features of primary hyperaldosteronism
- Clinical presentation
- Diagnosis
- Treatment
Signs of hypocalcemia
High-volume blood transfusion can cause symptomatic hypocalcemia due to chelation of ionized calcium ions by citrate in transfused blood. Patients with impaired hepatic function are at increased risk due to decreased clearance of citrate by the liver.
Acute hypocalcemia
- Causes
- Clinical features
- Treatment
Carcinoid tumors
Slow-growing tumors most commonly in the distal small intestine, proximal colon, lung.
Secrete histamine, serotonin, vasoactive intestinal peptide (all metabolized in liver)
GI carcinoid tumors often metastasize to liver, and then these hormones are released into systemic circulation without being metabolized.
Features of carcinoid syndrome
- Clinical
Skin
GI
Cardiac
Pulmonary
Misc
2. Diagnosis
- Treatment
Carcinoid cells cause increased production of serotonin form tryptophan (required for niacin synthesis), resulting in niacin deficiency (i.e. dermatitis, diarrhea, dementia)
Important gluconeogenesis substates & steps
Clinical features of osteomalacia
- Causes
- Symptoms/signs
- Diagnosis
Osteomalacia is due to defective mineralizaton of the organic bone matrix.
Primary hyperthyroidism
- Calcium
- Phosphate
- Parathyroid hormone
- Calcium: Low
- Phosphate: Low
- Parathyroid hormone: High
Osteoperosis and Paget’s disease
- Calcium
- Phosphate
- Parathyroid hormone
- Calcium: Normal
- Phosphate: Normal
- Parathyroid hormone: Nromal
Common clinical features of acromegaly
- Local tumor effect
- Musculoskeletal/skin
- Cardiovascular
- Pulmonary/GI
- Englarged organs
- Endocrine
Differential diagnosis of myopathy (Disorder, clinical features, ESR, CK)
- Glucocorticoid-induced myopathy
- Polymyalgia rheumatica
- Inflammatory myopathies
- Statin-induced myopathy
- Hypothyroid myopathy
Glucocorticoids cause muscle atrophy
Late-onset (nonclassic) congential adrenal hyperplasia
21 hydroxylase deficiency
Manifests in late childrhood with signs of androgen excess
Advanced bone age, coarse axillary and pubic hair, severe cystic acne
Maternal thyroid testing in pregnancy, first trimester
(Hormone, change, mechanism)
- Total T4
- Free T4
- TSH
Potassium iodide
Inhibits thyroid horone synthesis and release
Used mainly in preparation for thyroidectomy in Graves disease and treating thyroid storm
Choice of treatment in Graves hyperthyroidism
1. Antithyroid drugs
- Radioactive iodine
- Thyroidecotmy
- Antithyroid drugs: propylthiouracil, methimazole
Screening for diabetes
Adults with blood pressure >135/90
Age >= 45
BMI >25 + additional risk factors
Screening tests for diabetes mellitus (Test, interpretation)
- A1C
- Fasting blood glucose
- Fandom glucose levels
- Oral glucose tolerance test
Pneumococcal vaccice guidelines
All adults >=65: PCV13, followed by PPSV23 6-12 months later
All adullts <65 with certain very high risk conditions: PCV13, followed by PPSV23 6-12 months later
Adults <65 who are current smokers or who have chronic medical conditions: PPSV23 alone
Lung Cancer Screening Recommendations
Annual low-dose CT screening for lung cancer in adults age 55-80 with a >=30 pack-year smoking history who currently smoke or have quit in the last 14 years.
Diabetic foot ulcers
- Risk factors
- Location
- Management
Follicular thyroid cancer
Peak incidence 40-60
Firm thyroid nodule
Invasion of the tumor capsule/blood vessels
Papillary thyroid cancer
Large cells with ground glass cytoplasm
Pale nuclei with inclusion bodies and central grooving
Psammoma bodies (grainy, lamellated calcifications)
Fever and sore throat in a patient taking
Propylthiouracil
Methimazole
Suspect agranulocytosis
Stop drug and check WBC
Diagnostic approach to hypocalcemia
