Endocrine KPs Flashcards
When to use metformin for prevention of type 2 diabetes?
patients who are younger than 60 years of age, have a BMI greater than 35, or have a history of gestational diabetes
Treatment for gestational DM?
If fails?
Lifestyle modifcations
Insulin
Screening for a patient who has a history of gestational diabetes?
4 to 12 weeks postpartum and every 3 years thereafter.
Role of insulin > other therapy in type 1 DM?
reduces early microvascular disease
Metformin contraindicated with?
GFR<30
For ICU when to start IV insulin? Goal?
BG >200
140-200
Clinically significant hypoglycemia is defined as?
BG<54
Indication for moderate intensity statin?
diabetics 40+ years of age and an atherosclerotic cardiovascular disease 10-year risk less than 7.5%.
Indication for highintensity statin?
Pt with diabetes and known cardiovascular or vascular disease;
LDL cholesterol greater than 190 mg/dL (4.9 mmol/L),
atherosclerotic cardiovascular disease 10-year risk of equal to or greater than 7.5%.
How to prevent diabetic retinopathy? How to treat it?
Optimal blood glucose and blood pressure control
Laser photocoagulation
levated urinary albumin excretion is defined as?
> 30
Initial tests for pituitary incidentally noted masses? (5)
8 AM cortisol, thyroid-stimulating hormone, free (or total) thyroxine (T4), prolactin, and insulin-like growth factor 1.
Empty sella? Clinical correlation?
normal pituitary gland is not visualized or is excessively small on MRI
None
most common causes of hypopituitarism?
Pituitary tumors and surgery for pituitary tumors
patient with pituitary apoplexy or infarction - immediate next step?
Stress-dose glucocorticoid replacement
secondary (vs primary) cortisol deficiency
isolated glucocorticoid deficiency without mineralocorticoid deficiency
do not develop hyperpigmentation or bronzing of the skin (no ACTH)
Labs suggestive of secondary hypothyroidism?
Central hypothyroidism
inappropriately normal or low thyroid-stimulating hormone and low thyroxine (T4) (free or total) level
evaluation for growth hormone deficiency should be reserved for adults with at least one known pituitary hormone deficiency - why?
Isolated adult-onset growth hormone deficiency is extremely rare, and its clinical significance is debated
Treatment of central diabetes insipidus?
1-2x daily desmopressin
Patients with panhypopituitarism require lifelong replacement of ?
thyroxine (T4), cortisol, and antidiuretic hormone
Management of A patient with primary hypothyroidism and hyperprolactinemia?
thyroid hormone replacement with retesting of the prolactin level once the thyroid-stimulating hormone level has normalized.
first-line therapy for symptomatic patients with hyperprolactinemia and prolactinomas?
Dopamine agonists (bromocriptine and cabergoline)
Pt with acromegaly - adjuvant therapy for residual disease.
radiation therapy injectable somatostatin analogues
Cushing disease v syndrome?
Disease - ACTH secreting pituitary adenoma
Any cause
Treatment of Cushing’s disease?
transsphenoidal pituitary tumor resection
Initial tests for Cushing syndrome?
vernight low-dose dexamethasone suppression test, 24-hour urine free cortisol, and late-night salivary cortisol.
Pheochromocytomas are seen with? (4 genetic conditions)
MEN 2A/2B, NF1, VHL
test if clinical suspicion of pheochromocytoma or paraganglioma is low?
Test if suspicion is high?
measurement of 24-hour urine fractionated metanephrines
plasma free metanephrines
Long term management post-pheochromocytoma management?
lifelong annual plasma free metaephrines
How to test for hyperaldo?
midmorning ambulatory plasma renin activity and plasma aldosterone levels
positive if aldo>15 or ratio>20
When does an adrenal mass need to be removed?
Larger than 4 cm, pheo or “worrisome radiographic findings”
Outline thyroid testing?
TSH ->
if high T4
if low, T4 AND T3
Radioactive iodine uptake is only used in patients with?
Hyperthyroidism
Do not use radioactive iodine if?
severe thyrotoxicosis, (radioactive iodine may provide additional substrate to the hyperfunctioning gland)
Thionamides - adverse effects?
LFT abnormalities (PTU worse can can lead to hepatotoxicity), reversible agranulocytosis,
Pt with subclinical hyperthyroidism - next step?
Treatment for subclinical hyperthyroidism is recommended when?
Repeat test in 6-12 weeks
TSH<0.1
Lab that suggests Hasimoto?
TPO antibodies
When to start thyroid supplementation for hypothyroidism?
TSH>10
Medication that causes a temporary rise in TSH and low T3/T4?
Amiodarone
those at highest risk for amiodarone-induced hypothyroidism?
women with preexisting thyroid peroxidase antibody positivity.
In pregnant patients on levothyroxine replacement, likely need to change the dose by?
up 30-50%
typical pattern of euthyroid sick syndrome?
Low T3/T4 with normal TSH
Then low TSH
Outline management of thyroid nodule?
TSH -> if low, T3/T4 and radionuclide scan
If high, US, and FNA if >1 cm
Malignancy risk in multinodular goiter v single nodule?
same
Treatment of well-differentiated thyroid cancer ?
surgery, radioactive iodine, and levothyroxine suppression of thyroid-stimulating hormone
most common causes of secondary amenorrhea?
pregnancy, structural abnormalities, and PCOS
evaluation of primary and secondary amenorrhea?
If negative?
Prolactin, FSH, LH, estradiol, and TSH
Progesterone challenge for bleeding (if bleeds, not an estrogen problem -> likely PCOS)
Measurement of testosterone levels is not recommended if?
Testosterone deficiency is diagnosed with?ee
If diagnosed, next step before replacement?
Regular AM erections, no gynomastia and normal testicular exam
Early AM total testosterone levels
Identigy the cause (prolactinoma, hemochromatosis, or intracranial mass.)
Monitoring for patients requiring testosterone replacement therapy?
testosterone, prostate specific antigen, and hematocrit
Best way to investigate semen for infertility?
Semen analysis obtained after 48 to 72 hours of abstinence from sexual activity
AND Need repeat for confirmation
Unilateral gynecomastia - think? Next step?
malignancy. Mammogram.
Classic symptoms of hypercalcemia?
Polyuria/polydipsia, constipation, Abdominal pain, AMS
Primary hyperparathyroidism is diagnosed with?
elevated serum calcium levels, with an inappropriately normal or elevated intact parathyroid hormone level.
Regardless of a DEXA result, a patient has osteoporosis if?
Vertebral compression fracture
most common clinical manifestation of Paget disease of bone?
Treatment?
asymptomatic elevated alkaline phosphate levels.
nitrogen-containing bisphosphonate medications (alendronate, pamidronate, risedronate, and zoledronic acid).
