endocrino Flashcards
anticuerpo en graves?
anticuerpo receptor de tirotropina aka anticuerpo anti TSH
diabetes insipidus
problema de secrecion?resistence a ADH
osmolaridad en orina disminuida <300 mOsm
poliuria >3litros al dia
Tratamiento de feocromocitoma?
Fenoxibenzamina primero por un tiempo, despues se inciia con un betabloqueador y despues es que se hace la cx por laparoscopia para remover el tumor
This blood pressure management is especially important before surgery because manipulation of the tumor tissue during its removal may cause high amounts of catecholamines to release into the bloodstream
It is important to administer alpha blockers before beta blockers because beta blockers inhibit the vasodilatory effect of peripheral β2-adrenoceptors. Therefore, beta blockers alone would lead to unopposed α-adrenoceptor stimulation, which causes further vasoconstriction and potentially a hypertensive crisis as a result of ectopic catecholamine release.
tx de crisis hipercalcemica?
primera linea
IV fluid w normal saline +calcitonin/bisfosfonatos/denosumab
sino funciona:
hemodialisis
RET protoncogen +, que se hace?
Prophylactic thyroidectomy is recommended as soon as possible in all patients with known RET mutations
Nearly all patients with MEN 2 develop medullary thyroid cancer, often early in life.
mejor indicador de resolución de episodio de cetoacidosis diabetica?
anion gap
The insulin-deficient state of DKA leads to increased lipolysis, resulting in more free fatty acids. Anion gap metabolic acidosis develops as these free fatty acids become ketones, two of which are unmeasured anions (acetoacetic acid and beta-hydroxybutyric acid), resulting in consumption of serum bicarbonate, which acts as a buffer for the acidic ketones. The acidosis resolves once fluids and insulin therapy are started, halting the process of lipolysis. As the serum bicarbonate rises, the anion gap decreases. Therefore, a normalization in the anion gap (anion gap ≤ 12 mEq/L) is the best indicator for the resolution of DKA. When available, beta-hydroxybutyric acid levels also accurately reflect the state of resolution. Other, less sensitive criteria for the resolution of DKA: glucose < 200 mg/dL plus either venous pH > 7.30 or serum bicarbonate ≥ 15 mEq/L.
tiroiditis de hashimoto. cuales son los anticuerpos y de que aumenta el riesgo?
Anticuerpos antiperoxidasa tiroidea (Anti-TPO)
aumenta riesgo de primary thyroid lymphoma.
hard/painful thyroid+fever+neck/jack pain. diagnostico y imagen?
subacute thyroiditis
reduced uptake in radioiodine scan
Radioiodine uptake is decreased in subacute thyroiditis because the damaged follicular cells are unable to absorb iodine. The reduced uptake is an important feature that differentiates subacute thyroiditis from Graves disease, in which radioiodine uptake is high
ACTH disminuido + cortisol aumentado. Dx y que lo causa? tx?
Primary hypercortisolism. which is typically caused by autonomous overproduction of cortisol by an adrenal tumor (most commonly adrenal adenoma) o exogenous steroids
tx: adrenalectomia. After surgical therapy, patients who develop adrenal insufficiency require lifelong glucocorticoid replacement therapy.
ACTH aumentado + cortisol aumentado. dx?
Cushing disease (ACTH-secreting pituitary adenoma) - Ectopic ACTH secretion
Small cell lung cancer (SCLC) is the most common cause of endogenous hypercortisolism from an ectopic source of ACTH. Other cancers which are less commonly associated with the secretion of ACTH or ACTH-like substances include renal cell cancer, bronchial and pancreatic carcinoid tumors, and medullary thyroid carcinomas.
A corticotropic pituitary adenoma (Cushing disease) would result in secondary hypercortisolism due to increased ACTH production by the tumor. However, ACTH production by corticotropic pituitary adenomas is responsive to suppressive feedback by high doses of dexamethasone, and cortisol levels would decrease.
In a patient who is not on glucocorticoid therapy, serum cortisol levels that remain elevated following a low-dose dexamethasone suppression test are consistent with endogenous hypercortisolism. Elevated serum ACTH levels suggest secondary hypercortisolism, while elevated serum cortisol levels following a high-dose dexamethasone suppression test indicate ectopic ACTH production.
VIPoma
cual es el problema? VIPoma causes relaxation of gastric and intestinal smooth muscle: causes unregulated fluid and electrolyte secretion
VIPoma is characterized by a triad that can be remembered with the mnemonic “WDHA”: Watery DiarrheaHypokalemia Achlorhydria
diarrhea tea colored and liquid
hypokalemia
bone reabsorption: hipercalcemia
inhibits gastric acid secretion
stimulates gluconeogenesis,
leading to achlorhydria/hypochlorhydria, hyperglycemia
face flushing (20% de los pt lo tienen)
dx: ct scan usualmente esta en pancreas
confirmed by a serum VIP level > 75 pg/m
