Endocrinology Flashcards
Factors affecting HbA1c (besides glycemia)
Increase A1c:
- ethnicity (higher in Black, Native, Latino, Asian)
- iron deficiency
- B12 deficiency
- alcoholism
- CKD
- Chronic opioid use
Decrease A1c:
- Supplemental Fe, B12, vit C, vit E
- ASA
- Hemoglobinopathy
- Chronic liver disease
- CKD
- antiretroviral
Diabetes Dx criteria
8h fasting glucose >7
Random glucose >11
2h 75g OGTT >11
HbA1c >6.5
If asymptomatic, repeat test on another day to confirm Dx.
(if random BG, confirm with another modality)
Transplant options for T1DM
Pancreas transplant
Pancreas islet allotransplant
ESRD: kidney transplant
Typical distribution of basal and bolus insulin
40% basal
60% bolus (20% per meal)
Meds for vascular protection in DM (and their indications)
Statin
- macrovascular disease
- OR age 40+
- OR age 30+ and DM >15 years
- OR microvascular disease
- OR according to lipid guidelines
ACEI/ARB
- CVD
- OR microvascular complications
- OR age 55+ and additional factor (albuminuria, retinopathy, LVH, etc.)
ASA
- Only if CVD (not primary prevention)
Cardiorenal benefits of SGLT2 and GLP1
SGLT2:
CKD, HF (kidney failure, heart failure)
GLP1:
ASCVD and risk factors (smoking, obesity, HTN, lipids)
Diabetes meds to hold or not to hold during illness
Metformin: hold
SGLT2: hold
DPP4: don’t hold
GLP1: don’t hold
Secretagogues: hold
Side effects and adverse events of SGLT2i’s
Euglycemic DKA
Hypotension, OHT
AKI
Urosepsis/UTI
Mycotic infections
Fractures
Dapagliflozin contraindicated in bladder cancer
Side effects and adverse events of GLP1’s
N/V
Pancreatitis
Pancreatic cancer (Seems this isn’t real…)
Contraindicated if Hx or fam Hx of thyroid Ca or MEN2
Side effects of metformin
GI symptoms
decreased vit B12
What is Kussmaul breathing
Deep, rapid breathing.
Occurs in metabolic acidosis, especially DKA.
Typical glucose values in DKA and HHS
DKA: 14+ (pts on SGLT2 can have euglycemic DKA)
HHS: 34+
Investigations for pts with DKA/HHS
Glucose
Creat
AG: Na - Cl - HCO3
OG: 2NA + 2K + BUN + glucose
Beta-hydroxybutyrate
Blood gas
Serum + urine ketones
Assess for causes and complications:
Lipase
CBC
Urine and blood cultures
CXR
ECG (risk of K changes)
Management of DKA/HHS
Hydration: start with NS, then D5-1/2NS or D5W later.
IV insulin: start at 0.1 u/kg/h.
(after starting NS and ensuring K >3.3)
K: up to 40mmol/L, depending on K.
Causes of / conditions associated with hyperPTH
Meds: thiazides, lithium
Radiation, radioactive iodine
MEN (1 and 2a)
Neonatal severe hyperPTH
Familial hypocalciuric hypercalcemia (FHH)
Familial hyperPTH
Hypercalcemia symptoms
Stones (nephrolithiasis)
Bones (bone pain, fragility fractures)
Groans (N/V, constipation, PUD, pancreatitis)
Psych overtones (lethargy, depression, psychosis, coma)
Also:
Cardiac (short QT, ventricular arrhythmia)
Gout, pseudogout
Treatment for hyperPTH
Primary hyperPTH
- Parathyroidectomy
- For hyperCa: volume, loop diuretic, zoledronate
For FHH (familial hypocalciuric hypocalcemia)
- no parathyroidectomy
Risk factors for hyperthyroidism
goiter
T1DM
Autoimmune disorder
Family Hx
Meds: amiodarone, lithium, iodine
Causes of hyperthyroidism (algorithm)
Low TSH, high/normal fT4+T3:
- Measure radioiodine
-> low uptake: thyroiditis, ectopic T4 (metastatic thyroid cancer, ovarian tumours), exogenous T4
-> high uptake: Graves (diffuse), toxic multinodular goiter (multiple), toxic adenoma (single hot spot)
High TSH, high T4+T3: 2ary hyperthyroidism
- MRI to assess for TSH-secreting pituitary adenoma
Treatment for primary hyperthyroidism
Betablockers (e.g. propranolol)
Methimazole (Tapazole) x 12-18 mo then taper
Propylthiouracil (2nd line)
Radioactive iodine (single treatment)
Subtotal thyroidectomy (Tx of choice in pregnant/young)
Signs and symptoms of thyroid storm
Fever
CNS (agitation, psychosis, seizure, coma)
Tachycardia, Afib
CHF
GI (N/V/D, pain, jaundice)
Treatment of thyroid storm
Methimazole (reduce thyroid synthesis)
K iodide (inhibit hormone release)
Propranolol (reduce HR)
Support circulation (steroids, fluids, O2, cooling)
Causes of hypothyroidism
Primary:
- Hashimoto
- Postpartum thyroiditis
- Meds: amiodarone, lithium, iodine
- Radioactive iodine, radiation
- Surgery, trauma
- Cancer
- Agenesis/dysgenesis
Central:
- Pituitary adenoma
- Pituitary damage (surgery, trauma)
- Pituitary infiltration (TB, sarcoid, granulomatous)
When to check T3 hormone
To r/o T3 thyrotoxicosis
(in pt with undetectable TSH and normal fT4)
Non-thyroid lab abnormalities due to hypothyroidism
HypoNa
Macrocytic anemia
Increased lipids
Elevated CK
When to treat subclinical hypothyroidism
Elevated TPO antibodies
Goitre
Pregnancy
Strong family Hx of autoimmune disease
TSH >10 (or >20) and/or symptomatic
What is subacute granulomatous thyroiditis
Often preceded by URTI
Thyroid pain / painful goitre
Hyperthyroid, then hypothyroid, then self-resolves
