Endocrine Topics 2 Flashcards
Primary vs Secondary vs Tertiary Disease
primary: inhibits downstream gland
secondary: pituitary gland
tertiary: hypothalamus dysfunction
Causes of Endocrine Dysfunction
Hormone excess
Hormone deficiency
Hormone Resistance
Endocrine Testing and Treatment
Testing
-Suppression test: assess endocrine hyperfunction
-Stimulation test: assesses endocrine hypofunction
Treatment
-Replacing deficient hormone
-Suppressing excessive hormone production
Causes of Hyperfunction Dysfunction
- Benign: Pit adenomas, hyperPTHism
- Malignant: cancer
- Ectopic: SIADH, Ectopic ACTH
- Multiple endocrine neoplasia (MEN): MEN1 MEN2
- Autoimmune: Grave’s
Causes of Hypofunction Dysfunction
- Autoimmune: Hashimoto, Type 1 DM, Addisons
- Nutritional Deficiency
- Hormone mutations
- Enzyme defects
Causes of Hormone Resistance Dysfunction
- Signaling pathway: Type 2 DM, Leptin resistance
- Receptor mutations
Testing for Hypothyroidism Graves Thyroid Nodules and Neoplasia Hyperparathyroidism
Hypothyroidism: TSH, confirm with free T4
Graves: TSH, free T4
Thyroid Nodules and Neoplasia: biopsy
Hyperparathyroidism: Serum Ca, PTH if Ca elevated
Hyperthyroidism and HPI
-Weight loss
-Anxiety
-Heat Intolerance (feels hot)
-Palpitations
-Tremor
-increased appetite
-Exophtalmos & proptosis (graves)
-
Potential Causes of Hyperthyroidism
- Graves
- Toxic multinodular goiter
- Subacute (de Quervain’s) thyroiditis
- Initial phase of Hashimoto
- Jod-Basedow phenomenon: due to high I2 intake, Amiodarone, radiocontrast_
- Amiodarone-induced
- “Subclinical”
Hyperthyroid differentials
- anxiety
- Cancer
- Exopthalmos due to orbital tumor
- Acute psych disorders
- High estrogen states
Hypothyroid HPI
- Fatigue
- weight gain
- Cold intolerance
- Impaired memory
- Depressed
- diminished sweating
Hypothyroid Causes
- Hashimoto
- I2 deficiency
- Severe illness
- Drugs: Lithium, amiodarone
Hypothyroidism Differentials
- Depression
- Chronic Fatigue Syndrome
- Heart failure
- Anemia
Parathyroid (classical primary hyperparathyroidism)
- NO effect on metabolism
- Classical primary hyperparathyroidism
- Increased Ca and PTH
- “Bones, Stones, Abdominal Moans, Psychic Groans”
- Decreased bone density, kidney stones, abdominal pain, depressed, fatigued
PTH and Ca
Kidney
-1-alpha hydroxylase converts to active Vit D
Intestine
-Vit D increases amount of Ca absorbed
- When Ca serum low–>Increase PTH–>Increase Ca reabsorb into bone, kidney, intestine
2 Tests for Hypocalcemia
- Trousseau’s Sign: spasm when inflating blood pressure cuff
- Chvostek’s Sign: contraction of facial muscle when tapping on the nerve
Signs of Excess PTH
- hypercalcemia
- bone disease
- Proximal renal tubular acidosis
- Hyperuricemia and gout
Clinical Signs of HyperCalcemia
- Muscle weakness
- Bone pain
- Polyuria & Polydipsia
- Nephrogenic Diabetes Insipidus
- Nausea, vomitting
- Bradycardia
- Hypertension
- Confusion
Primary Hyperparathyroidism Symptoms and Causes
Symptoms
-Associated with Nephrolithiasis and bone disease
-anorexia, nausea, constipation, polydipsia, polyuria
Causes
-PT adenoma, hyperplasia, carcinoma, MEN, chronic renal failure
Differentials Of HPTH
- Hypercalcemia of malignancy
- Vit D intoxication
- Hyperthyroidism
- FHH
Hypoparathyroidism: Hypocalcemia Causes and Symptoms
Causes -gland removal -hypoparathyroidism Symptoms: Neuropsych: seizures, dementia, anxiety Neuromuscular: paresthesia round mouth/fingers, muscle stiffness CV: CHF, hypotension Autonomic: Bronchospasm Other: Cataracts, dry coarse skin, hyperpigmentation
Cushings Syndrome Cause and presentation
Cause: overproduction of cortisol or ingestion of exogenous Presents: HTN, Central Obesity, Weakness, Ecchymosis, Hirsutism, Depression, Striae SIGNS: -moon shaped face -striae: purple streaks -Buffallo hump -Fatty tissue in abdomen -hirsutism in women
Differential of Cushings
- Chronic alcoholism
- DM
- Depression
- Obesity due to other causes
- Primary hyperaldosteronism
Adrenal Insufficiency Causes
Primary (Addisons) -Autoimmune -Surgical removal -Infection -Hemorrhage Secondary -Pituitary failure -exogenous sterioids
