Endocrinology Flashcards
DIAGNOSIS-MEN ASYMPTOMATIC, WOMEN: CANNOT LACTATE
PROLACTIN DEFICIENCY
DIAGNOSIS-WOMEN: NO OVULATION, AMENORHEIC MEN:NO SPERM,DECREASE HAIR&LABIDO
FHS AND LH DEFICIENCY
DIAGNOSIS-DECREASED FSH,LH FROM LOW GnRH ANOSMIA AND RENAL AGENESIS IN 50%
KALLMAN SYNDROME
DIAGNOSIS-SHORT STATURE, ADULTS FEW SYMPTOMS:CENTRAL OBESITY, INCREASED LDL AND CHOL. REDUCED LEAN MASS
GH DEFICIENCY
DIAGNOSIS- ALL ABOVE SX.
PANHYPOPITUITISM
INITIAL TEST- PANHYPOPITUITISM
HYPONATREMIA, MRI OF PITUITARY
INITIAL TEST- CONFIRM LOW HORMONE PANHYPOPITUITISM WITH LOW TSH, T4 IN BLOOD
DECREASE IN TSH IN RESPONSE TO TRH
INITIAL TEST-CONFIRM LOW HORMONE PANHYPOPITUITISM WITH LOW ACTH AND CORTISOL
COSYNOTROPIN(ACTH)=CORTISOL RISE (ACUTE), CORTICOTROPIN(CRH)=INC.ACTH BUT NO CORTISOL
INITIAL TEST- CONFIRM LOW HORMONE PANHYPOPITUITISM WITH LOW LH, FSH,TEST
NO CONFIRMATORY TEST
TIP- OLDER TESTS FOR PANHYPOPITUITISM
METYRAPONE(CAUSE ACTH LEVEL RISE), INSULIN STIMULATION(CAUSE GH TO RISE)= ABNORMAL SHOULD RESULT OPP.
INITIAL TREAT- PANHYPOPITUITISM
TIP- OXYTOCIN HAS NO DISEASE? TRUE OR FALSE
REPLACE HORMONES: CORTISONE, THYROXINE, TESTOSTERONE/ESTRO,GH
TRUE
P.ASS.-POST- STROKE,TUMOR, TRAUMA HYPOXIA OR INFITRATION OF THE PIT GLAND INFECTION/IFLAM.
P.ASS.-CHRONIC PYELONEPHRITIS, AMYLOIDOSIS, MYELOMA OR SICKLE CELL, HYPERCALCEMIA, HYPOKALEMIA, LI
DIAGNOSIS- POLYURIA AND HYPERNATREMIA (CONFUSION,LETHARGY, SEIZURES /COMA
INITIAL TEST-
INITIAL TREAT-
INITIAL TREAT-
DIABETES INSIPIDUS CENTRAL
DIABETES INSIPIDUS NEPHROGENIC
DIABETES INSIPIDUS
SERUM SODIUM THEN VASOPRESSIN TEST: BETTER IN CENTRAL AND NO CHANGE IN NEPHROGENIC
CENTRAL DI= LONG-TERM VASOPRESSIN (DESMOPRESSIN/ ADH)
NEPHROGENIC DI= TREAT CAUSE:(E.G.HYPOKALEMIA OR HYPERCALCEMIA), HYDROCHLOROTHIAZIDE, AMILORIDE, PROSTAGLANDIN INH (INDOMETHACIN)
P.ASS- PITUTARY ADENOMA, GASTRINOMA OR INSULINOMA OR ECTOPIC GH OR GHRH (LYMPHOMA OR BRONCHIAL CARCINOID)
DIAGNOSIS- INCREASED HAT,RING,SHOE SIZE, CARPAL TUNNEL, ODOR,DEEPVOICE,COLONIC POLYPS,ARTHRALGIAS,HYPERTENSION, CHF, ED
INITIAL TEST- ACROMEGALY
ACC. TEST- ACROMEGALY
INITIAL TREAT- ACROMEGALY
ACROMEGALY
ACROMEGALY
SERUM IGF-1, GLUCOSE (INTOLERANCE), HYPERLIPIDEMIA THEN MRI
GLUCOSE SUPPRESSION TEST
SURGERY (TRANSPHENOIDAL RESEC)OR RADIATION, PHARM:CABERGOLINE(DOPAMINE), OCTREOTIDE OR LANREOTIDE (SOMATOSTATIN), PEGVISOMANT
P.ASS.-INC.GH/TRH(HYPOTHYROIDISM), PIT ADENOMA, PREGNANCY,EXCERISE,RENAL INS.,CHEST STIMULATION, LOW DOPAMINE (DRUGS)
DIAGNOSIS- WOMEM: GALACTORRHEA, AMENORRHEA, INFERTILITY/MEN:ED GYNECOMASTIA
INITIAL TEST- HYPERPROLACINEMIA
INITIAL TREAT- HYPERPROLACTINEMIA
HYPERPROLACTINEMIA
ANTIPSYCHOTICS, METHYLDOPA, METOCLOPROMIDE, OPIOIDS, TRICYCLICS, VERAPAMIL
SERUM PROLACTIN, TFT, PREGNANCY TEST, BUN/CR, LFT THEN MRI(PROBABLE TUMOR)
DOPAMINE AGONIST(CABERGOLINE/BROMOCRIPTINE), TRANSPHENOIDAL SURGERY, RADIATION (RARE)
TIP- DRUGS THAT INCREASE PROLACTIN
DIAGNOSIS- BODILY ROCESSES BEING SLOWED DOWN
INITIAL TEST-
INITIAL TREAT-
HYPOTHYROIDISM
LAB: TSH, T4/T3
IF DOUBLE TSH; THEN= THYROXINE
TIP- COMMON CAUSE OF HYPOTHYROID=HASHIMOTO, DIET, AMIODARONE
TIP- IF TSH IS HIGH BUT NOT DOUBLE RUN? IF POSITIVE THEN WHAT?=ANTITHYROID PEROXIDASE/ANTITHYROGLOBULIN ANTIBODIES THEN TREAT WITH THYROXINE
DIAGNOSIS-EYE PROPTOSIS AND SKIN, HYPERTHYROID, ELEVATED RAID
DIAGNOSIS- TENDER THYROID, HYPERTHYROID
DIAGNOSIS- NONTENDER THYROID, HYPERTHYROID
DIAGNOSIS- INVOLUTED GLAND (NOT PALPABLE), HYPERTHYROID
DIAGNOSIS- HIGH TSH AND HYPERTHYROID
GRAVES
SUBACUTE THYROIDITIS
PAINLESS SILENT THYROIDITIS
EXOGENOUS THYROID HORMONE USE
PITUITARY ADENOMA
INITIAL TEST- PITUITARY ADENOMA INITIAL TREAT- GRAVES INITIAL TREAT-SUBACUTE THYROIDITIS INITIAL TREAT-PAINLESS HYPERTHYRIOD INITIAL TREAT- EXOGENOUS THYROID USE INITIAL TREAT- PITUITARY ADENOMA TIP- METHIMAZOLE VS PROPYLTHIOURACIL
MRI RADIOACTIVE IODINE ASPIRIN NONE STOP USE SURGERY METHIMAZOLE
DIAGNOSIS- ANXIETY, PALPITATIONS, FEVER DIARRHEA
INTIAL TREAT- ACUTE HYPERTHYROID
INITIAL TREAT- GRAVES OPHTHALMOPATHY
TIP- AE INCEDIBLY COMMON 5% WOMEN 1% MEN/95% BENIGN (ADENOMA,COLLOID NODULE, CYST)
INITIAL TEST- THYROID NODULE
INITIAL TREAT- THYROID NODULE (FOLICULAR MEDULARY PAPILARY)
TIP-PRIMARY CAUSE OF HYPERCALCEMIA THEN
TIP- OTHER CAUSES OF HYPERCALCEMIA
ACUTE HYPERTHYROID(THYROID STORM)
PROPANOLOL, THIOUREA, IODINATED CONTRAST MATERIAL, STEROIDS, RADIOACTIVE IODINE
STEROIDS THEN RADIATION THEN SURGERY
THYROID NODULE
TSH/T4 AFTER NORMAL TSH FINE-NEEDLE ASPIRATE BIOPSY
SURGERY EXCISION
PRIMARY HYPERPARATHYROIDISM (PTH) THEN ECTOPIC PTH (CANCER)
HIGH VIT D, SARCOIDOSIS OR OTHER GRANULOMA, THIAZIDE, HYPERTHYROIDISM*,METASTASIS TO BONE AND MM
DIAGNOSIS- ACUTE CONFUSION, STUPOR, LETHARGY AND CONSTIPATION, SHORT QT, HBP,OSTEOPOROSIS*,NEPHROLITHIASIS,DI,RENAL INSUF
INITIAL TREAT-
HYPERCALCEMIA
ACUTE HYPERCALCEMIA= HIGH VOL. SALINE, BISPHOSPHONATES + TEMP. CALCITONIN
DIAGNOSIS- HYPERCALCEMIA, PEPTIC ULCER, MUSCLE WEAKNESS, ANOREXIA, OSTEOPOROSIS
INITIAL TEST-
INITIAL TREAT-
HYPERPARATHYROIDISM
PTH LEVELS, LOW PHOSPHATE LEVELS, HIGH CHLORIDE LEVEL, EKG: SHORT QT, ELEVATED BUN/CR, ALK PHOS. THEN SONOGRAPHY OR NUCLEAR SCANNING
SURGERY (REMOVE AFECTED GLANDS) CINACALCET WHEN SURGERY NOT POSSIBLE
TIP- SOLITARY ADENOMA 80%, HYPERPLASIA 15-20%, PARATHYROID MALIGNANCY 1%= HYPERPARATHYROIDISM
DIAGNOSIS- CHVOSTECK SIGN, CARPOPEDAL SPASM,PERIORAL NUMBNESS, MENTAL IRRITATBILITY, SEIZURES, TETANY
INTIAL TEST-
INITIAL TREAT-
HYPOCALCEMIA
EKG:PROLONGED QT, SLIT LAMP SHOWS CATARACTS
SEVERE: IV CALCIUM AND VIT D, MILD: ORAL CALCIUM AND VIT D
TIP- MAIN CAUSES OF HYPOCALCEMIA=HYPOPARATHYROIDISM(THYROIDECTEM) HYPOMAGNESEMIA(HELPS SEC. PTH), RENAL FAILURE
TIP- OTHER CAUSES OF HYPOCALCEMIA=VIT D, GENETIC, FAT MALABSORPTION AND LOW ALBUMIN .1 DECREASES .8 IN CALCIUM
DIAGNOSIS-FAT REDISTRIBUTION, SKIN: STRIAE, EASY BRUISING, THIN SKIN, OSTEOPOROSIS,
DIAGNOSIS- HYPERTENSION, MENSTRUAL DISORDER, ED,BAD COGNITION,POLYURIA(HYPERGLYCEMIA)
INITIAL TEST- 1-2-3
INITIAL TREAT-
CUSHING SYNDROME
CUSHING SYNDROME
FIND HIGH CORT.:#1—-24 HOUR URINE CORTISOL, IF NOT POSSIBLE 1MG OVERNIGHT DEXAMETHASONE SUPPRESSION TEST-#2—FIND CAUSE: ACTH TESTING (NARROWS IT TO TWO) AND CUSHING DISEASE IS SUPPRESSED WITH DEX(NARROW TO ONE), MRI OR PETROSAL ACTH-#3—-FIND P.ASS: HYPERGLYCEMIA, HYPERLIPIDEMIA, HYPOKALEMIA, METABOLIC ALKOLOSIS, LEUKICYTOSIS
SURGERY
TIP- LOW CALCIUM= TWITCHY AND HYPER; HIGH CALCIUM-SLOW AND LETHARGIC
TIP- ETIOLOGY: CUSHING DISEASE»>ADRENAL HYPER>ECTOPIC ACTH>UNKNOWN ACTH SOURCE
TIP- FALSE POSSITIVE FOR 1MG DEXAMETHASONE SUPPRESSION TEST= DEPRESSION, ALCOHOLISM, OBESITY
TIP- ANTI-INSULIN HORMONES?
GH, CORTISOL, GLUCAGON
TIP- INCIDENTALOMA ARE 5% COMMON TEST FOR:
METANEPHRINES, RENIN, ALDOSTERONE, SUPPRESSION TEST
DIAGNOSIS- WEAKNESS, FATIGUE, ALTERED MENTAL STATUS, NAUSEA, VOMITING, ANOREXIA, HYPOTENSION, HYPNATREMIA, HYPERKALEMIA
INITIAL TEST:
INITIAL TREAT:
HYPOADRENALISM (CHRONIC: HYPERPIGMENTATION)
COSYNTROPIN (ACTH) TEST (NORMAL: RISE IN CORTISOL AFTER) OR LESS SP. TEST FOR PRIMARY OR SECONDARY: ACTH HIGH OR LO W SERUM:HYPOGLYCEMIA,HYPERKALEMIA, MET ACIDOSIS, HYPONATREMIA, HIGH BUN.
HYDROCORTISONE AND FLUDROCORTISONE( GOOD ALDOSTERONE EFFECT)
TIP: ETIOLOGY OF HYPOADRENALISM (ADDISON)
TIP: ETIOLOGY OF ACUTE HYPOADRENALISM
TIP- EOSINOPHILIA IS FOUND IN HYPOADRENALISM? TRUE OR FALSE
TIP- IN ACUTE ADRENAL INSUFFICIENCY ALWAYS?
80% AUTOIMMUNE THEN INFECTION(TB), ADRENOLEUKODYSTROPHY, MET. CANCER
ACUTE:HEMORRHAGE, SURGERY, HYPOTENSION REMOVE CHRONIC HIGH DOSE STERIODS
TRUE
TREAT AND TEST AFTER HX AND GEN. LABS
DIAGNOSIS- UNDER AGE 30 OR OVER 60, HYPERTENSION( PHARM: DOES NOT WORK), HYPOKALEMIA
INITIAL TEST-
ACC. TEST-
INITIAL TREAT-
HYPERALDOSTERONE, CONNS SYNDROME
HIGH ALDOSTERONE=RATIO: ADOSTERONE TO PLASMA RENIN (HIGH RENIN EXCLUDES PRIMARY HYPERALD.)
PRIMARY ADENOMA=VENOUS BLOOD DRAIN: HIGH ALDOSTERONE LEVEL THEN SERUM:K,ADOSTERONE, RENIN THEN CT
HYPERADRENALISM= SURGERY ( UNILATERAL ADENOMA) OR EPLERENONE OR SPIRONOLACTONE(BILATERAL HYPERPLASIA)
TIP- ETIOLOGY- OR HIGH ALDOSTERONE
SOLITARY ADENOMA OR HYPERPLASIA
TIP- NEVER START WITH SCAN IN ENDOCRINOLOGY? TRUE OR TRUE
TRUE
DIAGNOSIS- EPISODIC HYPERTENSION, HEADACHE, SWEATING, PALPITATIONS TREMOR
INITIAL TEST-
INITIAL TREAT-
PHEOCHROMOCYTOMA
24 HOUR URINE FREE METANEPHRINES COLLECTION (VANILLYLMANDELIC ACID LESS SENSITIVE)THEN CT OR MRI THEN MIBG(NUCLEAR ISOTOPE)
PHENOXYBENZAMINE, CCB AND BETA BLOCKERS THEN SURGERY
DIAGNOSIS: GLUCOSE: >125MG/DL TWICE, YOUNG, POLYURIA-PHAGIA-DIPSIA
DM 1
DIAGNOSIS- GLUCOSE: >125MG/DL TWICE, ADULT, OBESITY, POLY:URIA-PHAGIA-DIPSIA
DM 2
INITIAL TEST- DM
INITIAL TREAT- 1-2-3
GLUCOSE (TWICE: >125 FASTING) GLUCOSE (SINGLE: >200 NON-FASTING) HIGH GLUCOSE (TOLERANCE TESTING) HBA1C >6.5% (ALSO CONTROL)
1.(DIET, EXERCISE, WEIGHT LOSS)
- ORAL HYPOGLYCEMIC: METFORMIN>INCRETINS>SULFONYLUREAS/GLINIDES (NO CHF)>GLITAZONES>PRAMLINTIDE(AMYLN)>ALPHA GLU INH
TRUE
3. INSULIN: LONG ACTING (GLARGINE OR NPH) + SHORT ACTING: (LISPRO, ASPART,GLULISINE AND SOMETIMES REGULAR)
TIP: INSULIN-ONSET-PEAK-DURATION: FOR SHORT AND LONG ACTING=
SHORT: 1-15MIN(30-60REG)-1 HR(2HR REG)-3-4HR(6-8HRS REG)
LONG: 1-2HR(2-4NPH)-NO PEAK(6-7NPH)-24HRS(10-20NPH)
TIP: REVIEW PHARM NAMES
DIAGNOSIS-ABDOMINAL PAIN, HYPERVENTILATION,DEC. MENTAL STATE,METABOLIC ACID,HYPERKALEMIA,INC ANION
INITIAL TREAT-
INTIAL TEST-
DKA
LARGE VOLUME SALINE + INSULIN THEN POTASSIUM WHEN GLUCOSE IS APPROACHING NORMAL
BICARB (VERY LITTLE CAN KILL YOU)
TIP- DM CONTROL
TIP- DM COMPLICATIONS-1-2-3-4-5 AND TX
PNEUMO VACCINE, EYE EXAM YEARLY, LIPIDS, BP (>130/80), ACEi FOR MICROALBUMINURIA OR BP, FOOT EXAM AND ASPIRIN
CARDIO:(MI,STROKE,CHF, LIPIDS)
RENAL: MICROABLBUMINURIA 30-300MG PER 24HRS
GI: PARESIS(METOCLOPROMIDE AND ERYTHROMYCIN)
EYE: RETINOPATHY
NEUROPATHY:(DAMAGE TO VASONERVORUM-TX:PREGABALIN,GABAPENTIN OR TRICYCLICS)
