Endocrinology Flashcards
Diagnostic criteria for DM
- Random plasma glucose of > 200 with symptoms
- Glucose >126 after 8 hr fasting
- Glucose > 200, 2 hrs after 75 g GGT
- A1C > 6.5%
USPSTF recommends screening —– for T2DM.
Overweight or obese individuals age 40-70 or those who are symptomatic
C/I to metformin
GFR <30
C/I to Rosiglitazone or pioglitazone
NYHA class 3-4, bladder cancer or osteoporosis
C/I to exenatide, liraglutide, albiglutide
gastroparesis(causes delayed gastric emptying), CrCl <30, hx of Medullary thyroid cancer
C/I to SGLT-2 inhibitors(-flozins)
renal or liver failure
Most chronic complications of DM start — years after disease onset.
5
Most common functional pituitary adenoma?
prolactinomas
You find a pituitary mass incidentally on MRI. What should you do next?
Check: Prolactin, IGF-1, 24 hr urine cortisol, ACTH, TSH, LH, FSH & Testosterone. If all normal just monitor. If + then treat condition
Pituitary adenoma compressing the optic chiasm will result in ——(pattern of vision loss)
bitemporal hemianopia
Diabetes Insipidus is caused by low —-.
ADH = inability to concentrate urine.
Central Diabetes Insipidus vs Nephrogenic DI
Central = decrease ADH release from pituitary 2/2 trauma, genetic or idiopathic Nephrogenic = resistance to ADH most often due to Lithium or another med
In Diabetes Insipidus urine osmolality will be —, serum osmolality will be —, Na will be — & ADH will be —.
Low urine osm, high serum osm, high Na, Low ADH
**per truleson you dnt need a high Na for DI, just someone whos drinking gallons and gallons of water a day.
Treatment for central vs nephrogenic DI
Central = desmopressin(DDAVP) Nephrogenic = stop rx
Causes of SIADH
CNS(tumors, hemorrhage, stroke, infarct), Pulm( pneumonia, cystic fibrosis, Asthma), Tumors(small cell carcinoma of the lungs is the most common), Drugs(commonly: carbamazepine, SSRIs, vincristine, haloperidol, amitriptyline, amiodarone)
SIADH is a —volemic —osmolar —natremia.
euvolemic hypoosmolar hyponatremia
First line treatment for GH excess
transphenoidal resection – carries 80% risk of hypopituitarism or DI
First line treatment for prolactinoma
bromocriptine or cabergoline or stop offending rx.
**if cannot be controlled with rx may be transsphenoidal resection
Dopamines effect on prolactin?
inhibits
Tumors associated with MEN1
Pancreatic(insulinoma, gastrinoma), Parathyroid, Pituitary tumors
Tumors associated with MEN2A
Mendullary thyroid cancer(calcitonin secreting), pheochromocytoma, parathyroid hyperplasia
Tumors associated with MEN2B
Medullary thyroid cancer, mucosal neuromas, pheochromocytoma
You check a TSH and its elevated so you check a T3/T4 & its also elevated. Whats the next step?
RAI - could be parathyroid secreting TSH adenoma
Causes of increased RAI uptake?
Graves(diffuse), active nodule(single focus)
Causes of decreased RAI uptake?
exogenous thyroid hormone, thyroiditis
Which vitamin suppliment can cause false +/- readings for TSH?
Biotin
Which labs need to be monitored for a patient on methimazole or PTU? why?
CBC looking for agranulocytosis
Most common type of thyroid cancer? Prognosis? whats it produce?
Papillary - excellent prognosis, secrete Thyroglobulin
What are the two most aggressive thyroid cancers? Which one is worse?
anaplastic > follicular
which thyroid cancer is most likely to mets to bone, lungs & brain?
Follicular
**often retains ability to make TH = “functioning thyroid cancer”
Which thyroid cancer secrets calcitonin?
medullary = associated with MEN2B
Nodule on thyroid US with low TSH. Next steps?
RAI uptake - FNA all cold nodules as these are more likely cancer!
DO NOT FNA hot nodule
Hypocalcemia due to hypoparathyroidism will have what P & PTH levels?
elevated P, Low PTH
Hypocalcemia due to CKD will have what P & PTH levels?
elevated P, elevated PTH
Hypocalcemia due to Vit D deficiency will have what P & PTH levels?
low P, elevated PTH
Hypocalcemia due to low Mag will have what P & PTH levels?
low P, low PTH
Paget Disease labs + imaging
- *elevated alk phos, normal GGT & other liver enzymes, Ca & P often normal.
- *XR shows increase bone denisty, Bone scintigraphy showed increase uptake due to increased bone osteoclast activity
X
X
Most common cause of adrenal insufficiency in the US
Addisons disease
Which type of anemia would falsely elevate A1c?
Iron deficiency anemia -smaller red blood cells stay around longer
- a1c will also be increased with hypertriglyceridemia, splenectomy, renal failure, aplastic anemia
Pioglitazone improves outcomes of those with…
CVA and non fatal MI
3 medications Approved for use and diabetes in children
MetForman, liraglutide and insulin
- Other medications are used they’re just not officially approved
Which ethnicity do you see the highest rate of diabetes?
Native Americans
Pt with DKA. When do u switch to 1/2 NS + dextrose w/K?
Glucose around 250
Best indicator for successful healing of diabetic foot ulcer?
Distal pulses
Things that effect thyroid supplimentation…
Desiccated thyroid(poor quality), T3 alone(poor quality studies), iron, sulcrafate, anticonvulsant, grapefruit, amiodarone, lithium, SSRI, retinoids
Things that ca effect T4 to T3 conversion
OCPs, steroids, chemotherapy, lithium, SSRIs, Fenelton, IV contrast, theophylline, beta blockers, Florida, opioids, estrogen, Stress, Asian, alcohol use, fasting, radiation, some vegetables in excess, low ferritin, soy, pesticides, hemachromatosis, smoking and kidney disease
Patient finds a thyroid nodule. What’s the first test u run?
TSH then US
Goal TSH in pregnancy?
<3
When should you check TSH after postpartum thyroiditis & why?
Check TSH two months after toxic phase to look for hypothyroidism. If hypothyroid go ahead and treat with Synthroid however this medication can Often be weaned off after 6 to 12 months
