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NUR: 718 > Endocrine Disorders > Flashcards

Endocrine Disorders Flashcards

1
Q

What is DM Type 1?

A
  • autoimmune destruction of beta cells
  • inability to produce insulin
  • ↓ beta-cell mass → ↓ insulin secretion → ↑ blood glucose levels
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2
Q

DM Type 1 - Physical Exam Findings

A
  • usually normal

- *red flags (signs of DKA): Kussmaul respirations, dehydration, hypotension, AMS

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3
Q

Complications of DM Types 1 & 2

A
  • infections: cause of considerable morbidity and mortality, most common signs are skin and urinary tract
  • ophthalmologic: diabetic retinopathy, microvascular diseases, senile cataracts
  • nephropathy
  • neuropathy: peripheral sensory neuropathy is most common type
  • macrovascular: all diabetes experience faster atherosclerosis; small arteries of brain, lower extremities, and kidneys; increases risk of ischemic heart disease, PVD; leading cause of death of diabetics
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4
Q

Diagnostics for DM Types 1 & 2

A
  • *blood glucose studies: fasting BG > 126 x2 occasions (generally diagnostic)
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5
Q

DM Type 1 - Presentation

A
  • *polyuria, polydipsia, polyphagia (typically associated with glucose > 200)
  • acute onset
  • weight loss
  • blurry vision, muscle cramps
  • ketotic episode
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6
Q

DM Type 1 - components of management

A
  • self-monitoring, frequency of checks
  • insulin therapy
  • management of hypoglycemia and hyperglycemia
  • diet
  • activity: exercise regularly, may get hypoglycemic if rigorously exercising > 30 minutes
  • glycemic control during illness/surgery
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7
Q

Glycemic Control During Surgery/Illness

A
  • illness and surgery produce state of insulin resistance
  • *NPO and those who aren’t eating need to have sugars checked and insulin given if needed
  • *BG checks more frequently
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8
Q

DM - dietary teaching

A
  • carb counting or modified plate method
  • glycemic index
  • low glycemic index: lower glucose spikes after eating
  • artificial sweeteners don’t raise BG
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9
Q

DM Type 1 - Insulin

A
  • goal is to provide insulin in most physiologic way possible by giving basal (glargine or detemir) and pre-prandial
  • basal should be 40-50% of total insulin given/day
  • basal insulin should be given regardless of NPO status
  • short-acting: lispro, aspart
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10
Q

Estimated total daily amount of insulin needed

A
  • Patient weight in kg x 0.5

* there are a lot of different prescribing methods

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11
Q

Pre-breakfast hyperglycemia: Somogyi effect and Dawn phenomenon

A

Somogyi effect - nocturnal hypoglycemia , ↓ 0300 BG, ↑ pre-breakfast BG, ↓ HS (evening) dose

Dawn Phenomenon - sugar gets progressively higher throughout night, ↑ 0300 BG, ↑ pre-breakfast BG, ↑ HS (evening) dose

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12
Q

What is DM type 2?

A
  • dysfunction causing hyperglycemia
  • defective/decreased insulin secretion
  • insulin resistance
  • excessive/inappropriate glucagon secretion
  • followed by loss of beta cells
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13
Q

DM Type 2 - Presentation

A
  • asymptomatic
  • insidious onset
  • peripheral neuropathies
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14
Q

DM Type 2 - Physical Exam findings

A
  • normal exam
  • obesity?
  • more likely to see complications here
  • skin: acanthosis nigricans, candida infections
  • feet: dry, atrophy, claw toes, ulcers
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15
Q

DM Type 2 - Management

A
  • glycemic control (same as DM 1)
  • BP < 130/80 (ACE or ARB is first-line)
  • lifestyle optimization: essential, multidisciplinary approach, do not delay pharm therapy but should happen at same time
  • weight control
  • diet (same as DM 1)
  • oral antidiabetics
  • insulin therapy (if PO unsuccessful)
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16
Q

DM Type 2 - Pharm management

A
  • Biguanides (FIRST LINE): Metformin
  • AE: lactic acidosis (MSK pain = tip-off, GI (diarrhea)
  • CKD is no longer contraindication
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17
Q

DKA - Presentation

A
  • insidious increase in polyuria/polydipsia
  • malaise, weakness, fatigue
  • n/v
  • abdominal pain
  • decreased appetitie, anorexia
  • rapid weight loss
  • AMS (mild disorientation, confusion, frank coma)
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18
Q

DKA - exam findings

A
  • ill appearing
  • dry mucous membranes
  • *labored respirations (Kussmauls)
  • decreased skin turgor
  • acetone (ketotic) breath odor
  • VS change: tachycardia, hypotensive, hypothermia
  • *altered LOC/AMS
  • *abdominal tenderness
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19
Q

DKA - diagnosics

A
  • ABG: pH < 7.3, pCO2 decreased
  • CMP/BMP: bicarb < 15, hyperglycemia > 250
  • serum osmality (elevated)
  • serum ketones +
  • UA (glucosuria + ketonuria)
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20
Q

DKA - Management

A
  • admit to ICU
  • NPO
  • serial labs
  • correct fluid loss: *isotonic IVF (0.9% saline), 1-3L in first hour, change fluids to D5 0.45% when glucose < 250
  • correct hyperglycemia with insulin: bolus 0.1 unit/kg/hr, continuous 0.1 unit/kg/hr, optimal BG decline 100 mg/dL/h
  • correct electrolytes (especially K+): when acidosis corrects, K will go back into cells causing a drop
  • correction of acid-base balance: only if patient is decompensating from acidosis
  • tx of any concurrent infections
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21
Q

Hyperosmolar Hyperglycemic State (HHS) - what is it?

A
  • hyperglycemia
  • hyperosmolarity
  • dehydration
  • WITHOUT KETOACIDOSIS
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22
Q

Hyperosmolar Hyperglycemic State (HHS) - presentation

A
  • known hx of DM2
  • slightly insidious
  • thirst, polydipsia, polyuria, weight loss, weakness
  • focal/global neuro deficits (drowsiness, lethargy, delirium, coma, seizures, etc.)
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23
Q

Hyperosmolar Hyperglycemic State (HHS) - exam findings

A
  • hydration status
  • LOC
  • source(s) of infection?
  • VS: tachycardia, hypotension (late), tachypnea, temperature
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24
Q

Hyperosmolar Hyperglycemic State (HHS) - diagnostics

A
  • glucose > 600
  • serum osmolality > 310
  • no acidosis
  • CMP/BMP - normal anion gap, bicarb > 15
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25
Q

Hyperosmolar Hyperglycemic State (HHS) - management

A
  • admit to ICU
  • *vigorous rehydration: isotonic IVF (0.9% or 0.45% saline) = first line
  • maintain electrolyte hemostasis
  • correct hyperglycemia: don’t give initially, insulin drip
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26
Q

Hypoglycemia - presentation

A
  • neurogenic: sweating, shaky, tachycarida, anxiety
  • neuroglycopenic: weakness, tired, dizzy, confusion, blurry vision
  • *Whipple triad: hx of hypoglycemic episodes, low plasma glucose, relief of symptoms after ingesting fast-acting carbs
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27
Q

Hypoglycemia - exam findings

A
  • non-specific
  • VS: hypothermia, tachypnea, HTN
  • LOC
  • diaphoresis
  • know timing of onset in relation to meal ingestion
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28
Q

Hypoglycemia - management

A
  • PO glucose tabs at onset of symptoms (mainstay)
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29
Q

Metabolic Syndrome - presentation

A
  • HTN
  • hyperglycemia
  • hypertriglyceridemia
  • abdominal obesity
  • chest pains/SOB?
  • acanthosis nigricans
  • xanthomas/xanthelasmas
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30
Q

Metabolic Syndrome - diagnostics

A

At least 3/5 of following:

  • fasting glucose > 100
  • BP > 130/80
  • TG > 150
  • HDL < 40 (men), < 50 (women)
  • waist circumference > 102 cm/40 inches (men), 88 cm/25 inches (women)
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31
Q

Metabolic Syndrome - management

A
  • lifestyle modifications + weight loss
  • HLD: statins
  • BP: antihypertensives as appropriate
  • hyperglycemia: metformin
32
Q

Polycystic Ovarian Syndrome (PCOS) - major features

A
  • menstrual dysfunction
  • anovulation
  • signs of hyperadrogenism
33
Q

Polycystic Ovarian Syndrome (PCOS) - presentation/exam findings

A
  • menstrual disorders
  • hirsutism
  • infertility
  • obesity +/- metabolic syndrome
  • diabetes
  • s/s hyperaldosteronism (excess body hair in male pattern)
  • virilizing signs (deep voice, increased muscle mass)
  • acanthosis nigricans
34
Q

Polycystic Ovarian Syndrome (PCOS) - diagnostics

A
  • dx of exclusion
  • baseline screenings: thyroid function, serum prolactin, free androgen
  • hormones levels
  • US - transvaginal
  • CT/MRI - if tumor is suspected
35
Q

Polycystic Ovarian Syndrome (PCOS) - management

A
  • non-pharm = first line: diet, exercise, weight loss

- pharm (reserved for metabolic derangements such as anovulation, hirsutism, etc.) = PO contraceptives is first line

36
Q

Hypothyroidism - presentation/ exam findings

A
  • EVERYTHING IS SLOWER
  • weakness and muscle fatigue
  • cold intolerance
  • constipation
  • weight gain
  • hair loss and brittle nails
  • edema, puffy eyes
  • goiter
  • alopecia
  • RED FLAGS: AMS, hypothermia, bradycardia, hypercarbia, hyponatremia
37
Q

High serum vs. lower serum osmolality

A 
High = greater concentration of particles (hemoconcentrated)
Low = lower concentration of particles (hemodiluted)
38
Q

Normal Serum and Urine osmolality

A 
Serum = 285-295
Urine = 100-900
39
Q

Hypothyroidism - diagnostics

A
  • *TSH (elevated)
  • *Free T4 (low or normal)
  • BMP/CMP: hyponatremia, hypoglycemia
40
Q

Hypothyroidism - management

A

Levothyroxine (Synthroid)

  • initial: 25-75 mcg PO daily
  • increase by 25 mcg q1-2weeks
  • goal TSH 0.4-2.0 mU/L
41
Q

Myexedema Coma/Crisis - what is it?

A

severe hypothyroidism

42
Q

Myexedema Coma/Crisis - red flags of hypothyroidism

A
  • AMS (stupor, delirium, seizures, coma)

- severely slowed processes: extreme hypothermia, hyponatremia, repsiratory depression, hypotention, bradyarrhythmias

43
Q

Myexedema Coma/Crisis - presentation

A
  • hypotension/shock
  • hypothermia
  • bradycardia
  • bradypnea
  • macroglossia
  • edema
44
Q

Myexedema Coma/Crisis - management

A
  • admit to ICU
  • ABCs - may need intubated
  • *refer to endocrine!
  • *IV thyroid replacement: Levothyroxine
  • initial dose 400 mcg IV x1
  • subsequent doses 50-100 mcg IV daily
45
Q

Hyperthyroidism - presentation

A
  • EVERYTHING IS FASTER
  • nervousness/restless
  • anxiety
  • perspiration
  • heat intolerance
  • palpitations, tachycardia, atrial arrhythmias
  • weight loss
  • frequent BMs
  • fine hair
  • systolic HTN
  • menstrual irregularities
  • exophthalmos (Graves)
  • lid lag (Graves)
46
Q

Hyperthyroidism - diagnostics

A

Thyroid Function Studies
- low TSH, high free T4
Thyroid radioactive iodine uptake + scan
- high uptake indicates Graves

47
Q

Hyperthyroidism - management

A

Referral PRN
Pharm
- propranolol (Inderal) initiate 10 mg PO
- Thioruea drugs (mild cases, small goiters) such as Methimazole and PTU
Radioactive Iodine
Must be euthyroid before surgery
Long-term monitoring
- TSH 6 weeks, 12 weeks, 6 months, annually

48
Q

Thyroid Storm - red flags for hyperthyroidism

A
  • fever
  • tachycardia
  • HTN
  • neuro/GI abnormalities
49
Q

Thyroid Storm - presentation/exam findings

A
  • fever and sweating
  • poor feeding/weight loss
  • respiratory distress
  • fatigue
  • n/v/d + abdominal pain
  • anxiety
  • altered behavior
  • seizures
  • HTN
  • arrhythmias (a fib/flutter, VT)
  • agitation, confusion
50
Q

Thyroid Storm - management

A
  • admit to ICU
  • refer to endocrine
  • IVF resuscitation (D5 containing IVF)
  • aggressive temperature management
  • beta-blockade
  • correct hyperthyroid state: PTU or methimazoel
  • avoid ASA
  • decrease environmental stimuli
51
Q

Cushing’s Syndrome - presentation/ exam findings

A
  • weight gain
  • stretch marks
  • easy bruising
  • hirsutism
  • weakness
  • impotence
  • polyuria + thirst
  • labile mood
  • infections
  • buffalo hump
  • mood face
  • acne
  • central obesity
  • thin extremities
52
Q

Cushing’s Syndrome - diagnostics

A
  • TRIAD: HYPOkalemia, HYPERglycemia, leukocytosis
  • elevated plasma cortisol in AM
  • MRI to r/o pituitary tumor
53
Q

Cushing’s Syndrome - management

A
  • refer to endocrine
  • high-protein diet
  • surgery to resect tumor
  • gradual withdrawal of corticosteroids (if that is cause)
  • long-term follow up: osteoporosis, susceptibility to infection, DM, HTN, risk for adrenal crisis
54
Q

Addison’s Disease - presentation/exam findings

A
  • insidious or acute
  • weakness, fatigue
  • weight loss
  • n/v
  • arthralgias
  • hyperpigmentation (buccal mucosa, knuckles, nail beds, posterior neck, nipples)
  • freckles
  • orthostatic hypotension
  • scant axillary/pubic hair
55
Q

Addison’s Disease - diagnostics

A
  • TRIAD: HYPOglycemia, HYPOnatremia, HYPERkalemia

- low plasma cortisol in AM

56
Q

Addison’s Disease - management

A
  • refer to endocrine

- replacement therapy: hydrocortisone 15-25mg PO daily in 2 divided dosese

57
Q

Acute Adrenal Insufficiency (Addisonian Crisis) - red flag symptoms

A
  • profound fatigue
  • dehydration
  • severe abdominal pain
  • n/v
  • hypotension + shock
  • hypoglycemia
  • renal failure/shutdown
58
Q

Acute Adrenal Insufficiency (Addisonian Crisis) - management

A
  • admit to ICU
  • mechanical ventilation and vasopressor support
  • replace glucocorticoids: hydrocortisone 100-300 mg IV initially
59
Q

Diabetes Insipidus - what is it?

A
  • insufficient ADH

- passage of large volume (> 3L/24h) of DILUTE urine (< 300 mOsm/kg)

60
Q

Diabetes Insipidus - central vs. nephrogenic

A

Central - decreased secretion of ADH

Nephrogenic - inability of kidneys to concentrate urine d/t ADH resistance

61
Q

Diabetes Insipidus - presentation/exam findings

A
  • thirst/craving for water (intake 5-20 L/day)
  • polyuria (2-20 L/day)
  • weight loss
  • LOC changes
  • dizziness
  • febrile
  • tachycardic
  • hypotension
  • poor skin turgor and other signs of dehydration
62
Q

Diabetes Insipidus - diagnostics

A
  • hypernatremia
  • serum osmolality > 290 mOsm/kg (hemoconcentrated)
  • urine osmolality < 100 mOsm/kg (hemodiluted)
  • suspecting central DI? - DDAVP challenge
63
Q

Diabetes Insipidus - management

A
  • PO/IV fluid replacement
  • calculate TBW deficit = 0.6 x patient weight (kg) x (patient’s Na/140-1)
  • *Central? - DDAVP
  • nephrogenic? - thiazide diuretic
64
Q

SIADH - presentation/exam findings

A
  • HA
  • seizures/coma
  • weight gain/edema
  • n/v
  • cold intolerance
  • neurologic changes (AMS/LOC changes when Na < 125)
65
Q

SIADH - diagnostics

A
  • hyponatremic (BUT euvolemia)
  • *serum osmolality < 280 mOsm/kg (hemodiluted)
  • *urine osmolality > 100 (mOsm/kg (hemoconcentrated)
66
Q

SIADH - management

A
  • *treat underlying cause
  • possibly refer to renal
  • manage hyponatremia
67
Q

Pheochromocytoma - what is it?

A
  • tumor of adrenal medulla

- excess catacholamine release (epi/norepi)

68
Q

Pheochromocytoma - presentation/exam findings

A
  • severe HA
  • polydipsia, polyphagia
  • anxiety/panic-attack like symptoms
  • palpitations
  • profuse sweating
  • tremors
  • hyperglycemia
  • tachycardia
  • HTN
69
Q

Pheochromocytoma - diagnotics

A
  • TSH normal
  • increased plasma free metanephrines
  • 24 hour urine for metanephrines
  • MRI abdomen/pelvis (tumor)
70
Q

Pheochromocytoma - management

A
  • admit to ICU
  • fluid resuscitation
  • surgery - tumor resection
  • BP control (alpha-adrenergic blockers only pre-op)
  • follow up: BP, urine/serum metanephrines 2 weeks post-up, annually for 10 years
71
Q

Acromegaly & Gigantism - what is it?

A
  • same disorder but gigantism happens when epiphyseal plates are still open and acromegaly happens when epiphyseal plates are closed (adulthood)
72
Q

Acromegaly - presentation/exam findings

A
  • insidious
  • soft tissue swelling
  • enlargement of extremities
  • hyperhidrosis
  • increased shoe/ring size
  • coarsening of facial features
  • macroglossia
  • arthritis
73
Q

Gigantism - presentation/exam findings

A
  • dramatic
  • longitudinal acceleration of linear growth
  • HA, visual changes
74
Q

Acromegaly & Gigantism - diagnostics

A
  • fasting random serum IGF-I
  • serum GH
  • serum prolactin
  • MRI: pituitary tumor (90% of cases)
75
Q

Acromegaly & Gigantism - complications

A
  • metabolic/endocrine: DM, high triglycerides, goiter
  • respiratory: increased lung capacity, smaller airway, dyspnea, OSA
  • CV: HTN, cardiomyopathy
  • neuromuscular: weakness, spinal stenosis, carpal tunnel syndrome
  • cancer
76
Q

Acromegaly & Gigantism - mangement

A
  • surgery (tumor resection)

- follow-up imaging 12 weeks post-op

NUR: 718 (8 decks)

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