Endocrine Disorders

Question 1

primary dysfunction of the endocrine disorders

Answer 1

disease within the endocrine gland

Question 2

secondary dysfunction of endocrine disorders

Answer 2

disease in the pituitary

Question 3

tertiary dysfunction of endocrine disorders

Answer 3

dysfunction of the hypothalamus and its releasing hormones

Question 4

excessive thyroid hormones, thyrotoxicosis elevated levels of t4 t3

Answer 4

hyperthyroidism

Question 5

common forms of hyperthyroidism

Answer 5

diffuse toxic goiter (graves disease) toxic multinodular goiter (plummer disease) and toxic adenoma

Question 6

clinical presentation of hyperthyroidism

Answer 6

heat intolerance sweating anxiety palpitation everything faster weight loss weakness due to things like afib in the elderly they tired out and heart failure hyper metabolism, tachycarida, manic, fine thin hair, emotional restless, exopthalmos brisk tendon relfexes everything super fast and quick

Question 7

diagnosing hyperthyroid labs

Answer 7

increased t4 t3 but a low tsh, 24 hour radioactive iodine uptake elevated

Question 8

drugs that block the effect of thryoid hormones (inc heart rate)

Answer 8

propanolol, metropolol

Question 9

drugs that inhibit thyroid hormone synthesis (thionamides)

Answer 9

PTU methimazole

Question 10

drugs that inhibit release of the tyroid hormone

Answer 10

lugols solution taken before surgery to reduce the vascularity of the gland

Question 11

how do you manage a patient with hyperthryroidism

Answer 11

RAI therapy, stop the tionamides 3 days before treatment and or a thyriodectomy

Question 12

remove the thyroid how is post op managment

Answer 12

VS, patient might be hoarse voice, check the back of the neck check the drainage??? do we need to know this???

Question 13

thyroid storm

Answer 13

crisis situation usually caused by graves, fever tachy, htn, gi hypermobility, restlessness, confused, psychotic

Question 14

decreased secretion of thyroid hormone, leads to low metabolism with build up of metabolites, this causes edema

Answer 14

hypothyroidism,

Question 15

rare but deadly for hypothyroidism

Answer 15

myxedema coma (everything is moving sloooowww)

Question 16

management of myxedema coma

Answer 16

Inpatient hospitalization
O2 supplementation and mechanical ventilation
Consider fluid restriction for severe hyponatremia
Consider D50W for severe hypoglycemia
IV thyroid replacement, T4, T3 until oral tolerated
Hydrocortisone if adrenal insufficiency suspected

Question 17

presentation of myxedema coma

Answer 17

Bradycardia
Hypothermia
Bradypnea
Fluid buildup
CNS Changes
Respiratory failure
Anemia
Hyponatremia
Hypoglycemia
Elevated serum cholesterol and creatine kinase levels

Question 18

management for hypothyroidism

Answer 18

Synthetic form of T4 Levothyroxine 50-75mcg daily (1.6 mcg/kg) Increase by 25mcg q 6-8 weeks
Over 70 and those with known cardiac problems, always use lowest dose possible
T3 (Cytomel) not first line
Combined therapy T3. T4 not recommended

for life

start low go slow

Question 19

labs and diagnosis for hypothyroidism

Answer 19

tsh high but the t3 t4 is low, we replace t4 not typically t3

elevated triglycerised and cholesterol

Question 20

patient is hypothyroidism looks like this

Answer 20

sleeping slow, weight gain, lethargic moves slow, slow motility constipation, muscle aches menorrhagia, cold intolerance, dyspnea, dry hair, course, enlarged tongue lack of expression integumentary changes vocal changes cardiac slow brady dysfunction and possibility impotence

Question 21

Inability to suppress the secretion of antidiuretic hormone (ADH).
ADH is released from the posterior pituitary gland or from malignant tumors
Severe water retention despite a low serum osmolality.

Answer 21

SIADH

Question 22

SIADH

Answer 22

Inability to suppress the secretion of antidiuretic hormone (ADH).
ADH is released from the posterior pituitary gland or from malignant tumors
Severe water retention despite a low serum osmolality.

Question 23

-Water is retained but no edema–
* Dilutional Hyponatremia
* Sodium loss from kidneys further leads to hyponatremia
* Elevated ADH release persists even with increased plasma volume and decreased osmolality

Answer 23

SIADH

Question 24

SIADH WATER OR EDEMA?

Answer 24

-Water is retained but no edema–
* Dilutional Hyponatremia
* Sodium loss from kidneys further leads to hyponatremia
* Elevated ADH release persists even with increased plasma volume and decreased osmolality

Question 25

how does siadh occur?

Answer 25

cna disorders malignancy chronic lung disorders or pharmacological agents

Question 26

diagnostics for adrenals- Cushing syndrome

Answer 26

elevated serum cortisol, elevated urinary cortisol, hyper glyecemia, glycosuria, hypernatremia, hypokalemia, leukocytosis

Question 27

adrenal insufficiency

Answer 27

do not produce sufficient amounts of steriods could be primary or secodnary

Question 28

primary adrenal insufficiency

Answer 28

addisons disease do not make enough (autoimmune disease) production of aldosterone and androgens is also low

Question 29

secondary adrenal insufficency

Answer 29

more commons occurs when the pituitary does not signal the adrenal gland acth to make cortisol

Question 30

clinical manifestistations for adrenal insufficiency

Answer 30

hypoglycemia, hyperpigmentation,hyperkalemia

Question 31

rifampin neomycin flaygl treatment for

Answer 31

hepatic encephalopathy

Question 32

carbapenem piptazo and imipenem treatment for

Answer 32

acute cholangitis

Question 33

Treatment in acute adrenal insufficiency

Answer 33

Give hydrocortisone 100 mg IVQ8 hours until the patient is hemodynamic stable

Question 34

In chronic adrenal insufficiency, what would you give?

Answer 34

Hydrocortisone PO or fludrocortisone PO

Question 35

Is the random cortisol level is greater than 20 mi./dL in an acute adrenal insufficiency

Answer 35

Steroid therapy is not indicated

Question 36

In acute adrenal insufficiency, if the random cortisol level is less than 20, what do you treat with?

Answer 36

Treat with stress steroids

Question 37

Adrenal cortical trophic hormone simulation test should _______ be performed to identify adrenal insufficiency, and patient with septic shock for ARDS

Answer 37

Not

Question 38

Treatment in a patient with adrenal crisis

Answer 38

Restore volume with D5NS, assess fluid status, frequency, reducing anxiety, do not give methylprednisolone loan, give cortisol Q6 saw cortex IV if given with saline, it proves the adequate and replacement of aldosterone because these patients are in an adrenal crisis they do not have volume on board and they don’t have a way of holding in the salt in the water so we need to do that

Question 39

Rare benign tumor that arises in the adrenal medulla that results in the hyper secretion of epinephrine and Nor epinephrine

Answer 39

Pheochromocytoma

Question 40

Pheochromocytoma is typically a tumor that what

Answer 40

More commonly on the right side in middle-age women that can occur with thyroid, cancer and hyperparathyroidism

Question 41

A patient with fetal chromocytoma will typically present

Answer 41

High blood pressure, exaggerated fighter flight response, ends organ damage significant orthostatic hypotension, pounding heart, deep, breathing, headache, or basal, hyperglycemia, and anxiety

Question 42

How do you diagnose a patient has pheotochromocytoma

Answer 42

First, you must rule out all the disorders check the thyroid hormone levels check the urine and plasma metabephrine levels and then do a CT scan to reveal the

Question 43

What is the management of pheotochromocytoma?

Answer 43

You are going to do surgical removal, stop all the meds with Alfred gene

Question 44

This is the inability to suppress the secretion of anti diuretic hormone

Answer 44

So because you’re secret so much syndrome of inappropriate antidiuretic hormone ADH is just being released from the posterior pituitary gland could be a malignant tumor and thus causes you to have severe water retention despite a low serum osmolarity

Question 45

In SIADH

Answer 45

Water is retained, but you don’t have any edema. It’s a delusional, hyponatremia sodium loss from the kidneys further leads to hyponatremia and elevated ADH releases persistence, even with an increased plasma volume and a decrease osmolarity.

Question 46

What is a ideology common of SIADH

Answer 46

Patients with small cell lung cancer can cause the pituitary to release ADH inappropriately and could result in SIADH

Question 47

How do these patients clinically manifest to the ED if they have SIADH

Answer 47

I’ll have Neuro changes from the hyponatremia they’ll have super concentrated urine but a decrease urine output and they’ll even have decreased deep tendon reflexes

Question 48

How do you diagnose SIADH

Answer 48

Hyponatremic less than 120, serum osmolarity decrease less than 280, urine osmolarity is elevated above 150 and you have increased urine sodium

Question 49

What is the management of SIADH?

Answer 49

You are going to restrict fluids because they have too much on board about 500 to 600 cc in 24 hours monitor eyes and nose, possibly diuretic and you could possibly give them 3% hypertonic sailing but to use with caution