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NP 730 Diagnostic Measures > Endocrine disorders > Flashcards

Endocrine disorders Flashcards

1
Q

Diagnostic Criteria Lab values for Diabetes

FBG, hgbA1c%, Random plasma glucose

A

FBG: ≥ 126 (Fasting = no intake for 8hrs other than black coffee or water)

HgbA1c %: ≥ 6.5%

Oral Glucose Tolerance Test

Random Plasma Glucose: ≥ 200 W/ SYMPTOMS

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2
Q

Which is the most accurate and best test for diabetes?

Do you repeat lab testing?

A

Lab based HgbA1c %

YES

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3
Q

HgbA1c

A
  • Avg amount of glucose in blood over the last 3 months
    • More heavily weighted in the last 6 to 8 weeks
    • No need to fast
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4
Q

What can effect HgbA1c%? (3)

A

With less RBCs → lowers A1c % b/c there’s not much RBCs for glucose to hang onto

Recent Blood transfusions/erythropoetin therapy

Chronic renal disease

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5
Q

Oral Glucose Tolerance Test (procedure and purpose)

A
  • Best Dx gestational DM in pregnancy
  • Person fasts for 8-16 hours
  • FPG checked
  • Done at 24-28 weeks for screening
    • Give 75gm then tested again in 2hrs
  • Fasting: ≥ 92
  • One hour: ≥ 180
  • Two hour: ≥ 153
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6
Q

Type 1 DM

A
  • Loss of all beta cell function in pancreas
  • Dependent on exogenous insulin
  • NO PO INSULIN
  • S/s: young, thin pt w/DM s/s
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7
Q

Type 2 DM

A
  • Multifactorial, often relate to insulin resistance
  • Responds to oral meds → eventually exogenous insulin
  • S/s: later in life, obese
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8
Q

Type 1 DM vs. Type 2 DM if can’t tell?

What would you test for?

A
  • Test for autoantibodies
    • DM1: Thin pt w/poor response to initial therapy w/metformin of Sulfonylureas
    • DM1: Personal of FMHx of autoimmune disease
    • Overweight or obese children or adolescents presenting w/apparent DM2 BUT have early presentation of DM1
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9
Q

DM Autoantibodies (4)

A
  • Both Islet cell Abs and GAD65 enzyme released and elevated when pancreatic cells start being destroyed
  • Insulinoma associated autoantibodies (low insulin production)
    • Insulin antibodies - attack body’s insulin (not commonly detected in adults)
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10
Q

Regulation of Thyroid Hormone production

A

Hypothalamus → TRH → AP → TSH → thyroid gland → T4

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11
Q

Thyroid Stimulating Hormone

Increased vs. decreased

A

Presence of thyroid hormone that turns ON/OFF TSH

Elevated = hypothyroid

Decreased = hyperthyroid

INVERSE RELATIONSHIP

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12
Q

Free Thyroxine (FT4)

When would you get this lab?

A
  • Controls feedback system
  • Add this on if TSH abnormal → tells you how well thyroid is functioning → monitoring
  • Add if TSH normal BUT showing hyperthyroid s/s
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13
Q

Triiodothyronine (T3)

A
  • Converted from T4 by removal of iodine molecule in liver and tissues
  • More active form of thyroid hormone
  • Useful in evaluation of hyperthyroid - low TSH but normal FT4 then check T3
  • If TSH decreased but T4 normal → order T3 to create better dx picture
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14
Q

What do you order for s/s of thyroid disease?

A

TSH

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15
Q

What do you order to monitor effectiveness of thyroid replacement?

A

TSH

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16
Q

Thyroid labs to order for initial monitoring of hyperthyroidism

A

TSH, T4, T3

Once steady → TSH

17
Q

Serum TSH level Normal, you order…

A

NO TEST NEEDED

18
Q

Serum TSH HIGH, you order…

A

Free T4 added to determine degree of hypothyroidism

19
Q

Serum TSH LOW, you order…

A

Free T4 and T3 added to determine degree of hyperthyroidism

-The TSH might be sub normal for weeks. Use T4, sometimes T3.

20
Q

Thyroid Autoantibodies

What do they do to the thyroid?

A
  • Develop when immune system targets thyroid gland/thyroid proteins resulting in thyroid inflammation and/or disruption of function
    • Can result in hyperthyroidism (Grave’s) or hypothyroidism (hasimoto’s)
21
Q

Two tests for thyroid antibodies and what do they test?

A
  • Thyroid peroxidase (TPO): predicts likelihood that subclinical hypothyroidism will progress to overt hypothyroidism
    • Subclinical hypothyroidism → TSH abnormal
      • HIGH TSH but NORMAL T3, T4
  • Thyroiglobulin (Tg): Not routinely used except for in those s/p thyroidectomy for thyroid cancer
22
Q

Best imaging modality for thyroid nodule

What lab would you check as well?

A

Thyroid ultrasound → suspected thyroid nodule or goiter on exam → NOT DX OR SCREENING TOOL

Check TSH

23
Q

Malignant Thyroid nodule characteristics on U/S

A.B.H.I.I.M.

A
  • Hypoechoic = more dense
  • Microcalcifications
  • Border irregularity
  • Infiltrative margins
  • Abnormal cervical lymph nodes
  • Increased intra-nodular vascularity
24
Q

Nuclear thyroid testing and procedure

A
  • Use radioactive iodine as thyroid will take up iodine → needed to make thyroid hormones for thyroid function
  • Procedure
    • RI-123 administered either PO or IV
      • Just thyroid scan - IV
      • Both scan and RAIU → PO ~24rhs prior to scan
    • Gamma camera or probe used to check for uptake
  • CONTRAINDICATED W/PREGOS
  • Avoid certain foods containing iodine (shellfish) and/or meds prior to exam
25
Q

2 types of radioactive iodine

A
  • I-123 - harmless to thyroid cells
  • I-131 - destroys thyroid cells
26
Q

Thyroid Scan

A

Used to determine size, shape, and position of thyroid → used for further eval of thyroid nodules

27
Q

Radioactive Iodine Uptake Scan (RAIU)

A
  • Evaluates function of gland
  • Primarily used to determine cause of HYPERthyroidism
28
Q

Prolactin

A
  • Hormone produced by anterior pituitary - promotes lactation
29
Q

When is prolactin elevated?

A
  • Normally elevated in pregnant/lactating women
  • Cases of a prolactinoma - pituitary tumor which secretes prolactin, typically benign
  • Medications: antipsychotics, metoclopramide, verapamil, methyldopamide, verapamil, methyldopa
30
Q

Result of prolactinoma

A

Amenorrhea - common result

31
Q

Imaging for prolactinoma

A

Brain MRI

32
Q

Symptoms of prolactinoma

A
  • Headaches
  • Visual changes
  • Unexplained nipple discharge
33
Q

Indications for testing prolactin levels

A
  • Symptoms of prolactinoma
  • Infertility, a/oligomenorrhea
  • In men: decreased libido, low testosterone, infertility, nipple discharge

NP 730 Diagnostic Measures (11 decks)

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