Endocrine Disorders Part 2 Flashcards
What are the 3 main causes of endocrine dysfunction?
1) Hormone excess
2) hormone Deficiency
3) Hormone Resistance
How to measure hormone levels?
- immunoassays
- plasma and primary samples
What two ways to test endocrine function?
1) suppression test = assess hyper function
2) stimulation test = assess hypo function
Treatment of hormone abnormalities?
- replacing deficient hormone
- suppressing excessive hormone production
Clinical presentation of hyperthyroidism?
- weight loss
- diaphoresis
- palpitations
- heat intolerance
- amenorrhea
- tremor
- increased appetite with weight loss
- proximal muscle weakness
- frequent bowel movements
Causes of hyperthyroidism?
- graves
- goiter
- adenoma
- deQuervain thyroiditits
- hashimoto (initial phase)
- AMIDARONE (beta blocker)
- clinically euthyroid
Differential for hyperthyroid?
- anxiety/panic
- mania
- cancer/pheochromocytoma
- exophthalmos due to orbital tumor
- atrial fib
- high estrogen (pregnancy)
Clinical presentation of hypothyroidism?
- fatigue
- weight gain
- anorexia
- dry,coarse skin
- cold intolerance
- weak
- impaired memory
- depressed
- brittle hair
Causes of hypothyroidism?
- hashimotos
- I- deficiency
- deQuervains thyroiditis
- severe illness
- drugs (amiodarone)
Differential for hypothyroidism?
- depression
- chronic fatigue syndrome
- HF
- irregular vaginal bleeding due to other causes
- anemia
- amyloidosis (think tongue, macroglossia)
Describe a thyroid examination?
posterior approach
- palpate for thyroid cartilage
- move down
- use finger tips to feel thyroid on side of trachea and push SCM out of way
Main role of Parathyroid?
blood calcium levels with no effect on metabolism
Describe Primary Hyperparathyroidism?
- bones, stones, and groans
- > too much PTH released, high blood Ca levels
- nephrolithiasis, osteoporosis, irritable (prolonged PTH exces)
- anorexia, nausea, constipation, polydipsia, polyuria (due to hypercalcemia)
Role of Kidney in consort with PTH?
Kidney contains 1A-OH which converts 25oh-vit D to active form of 1,25OH vit D
-this Vit D will cause increase absorption of Ca from intestine
Assessing Hypocalcemia?
-trosseau’s and Chvostek’s sign
Causes of Primary Hyperparathyroidism?
adenoma, hyperplasia, carcinoma (rare)
- multi. endocrine neoplasia
- chronic renal failure (secondary, or tertiary form of HPTH)
Differential for hyperPTH?
- hypercalcemia of malignancy
- multiple myeloma
- familial hypocalcuric hypercalcemia
- vitamin D intoxication
- sarcoidosis
- hyperthyroidism
Causes of hypoparathyroidism (hypocalcemia)?
- surgical removal of para glands during thyroidectomy
- DiGeorge Syndrome
- heridetary autoimmunity syndrome
Signs and symptoms of hypoparathyroidism?
1) neuropsych = seizures, dementia, anxiety, depression
2) neuromuscular = paresthesia around mouth and fingers/toes, muscle stiff, myalgia and spasms
3) CV : CHF, hypotension, prolonged QT interval
4) Autonomic = Hilary colic, bronchospasm, diaphoresis
5) cataracts, dry,coarse skin, hyperpigmentation, eczema, steatorrhea
Cushings Syndrome vs Cushing’s Disease
Syndrome = cortisol excess Disease = Cushing's syndrome secondary to pituitary ACTH hyper secretion
What causes Cushing’s syndrome and how does it clinically present?
-caused y overproduction of cortisol or ingestion of exogenous corticosteroids
presnets w.:
-HTN, central obesity, hirsutism, depression, striae, ecchymosis
Signs of Cushing’s syndrome?
- round,moon face
- flushed face
- purple striae
- buffalo hump
- visceral obesity
- easy bruising
- faical hair growth in women
Differential for Cushing’s?
- chronic alcoholism (pseudo-bushings)
- diabetes
- depression
- osteoporosis
- obesity due to other causes
- primary hyperaldosteronism
- anorexia nervosa w/ high free urinary cortisol
causes of Adrenal Insufficiency?
1) primary = autoimmune, surgical removal/trauma, infection (HIV patient w/ TB), metastatic CA, adrenal hemorrhage, congenital adrenal hyperplasia, hemochromatosis/amyloidosis
2) secondary = pituitary failure, exogenous steroids
