Endocrinology Flashcards
treatment of DKA
- admit to ICU/floor depending on pt’s status
- fluid resuscitate (3-4L in 8 hrs) w/ NS & IV insulin
- Na+, K+, phosphate, & glucose must be monitored & repleted q2hrs (change NS to D5NS when glucose <250)
- change IV insulin to subQ sliding scale once anion gap normalizes (improvement of DKA based on anion gap, not glucose levels)
- continue IV insulin for at least 30 min following 1st dose of subQ insulin
presentation of hyperglycemic hyperosmolar nonketotic state (HHNK)
pt acutely ill & dehydrated w/ AMS; usu. precipitated by dehydration, infection, or meds (e.g. beta-blockers, steroids, thiazides)
diagnostic criteria for HHNK
serum glucose >600 mg/dl
serum pH >7.3
serum bicarb >15 mEq/L
anion gap 310 mOsm/kg
treatment of HHNK
fluid resuscitate w/ 4-6L NS w/in 1st 8 hrs; identify precipitating cause & treat; monitor & replete Na+, K+, phosphate, & glucose q2hrs; give IV insulin ONLY if glucose levels remain elevated after sufficient fluid resuscitation
nonproliferative vs. proliferative diabetic retinopathy
nonproliferative: retinal vascular microaneurysms, blot hemorrhages, cotton-wool spots, possibly macular edema
proliferative: neovascularization 2/2 retinal hypoxia
diabetics have increased susceptibility to what?
pseudonomal otitis externa, mucormycosis facial infection, pyelonephritis, emphysematous cholangitis
workup of functional thyroid disease
TSH with reflex T4
- if TSH low, suspect hyperthyroidism; if T4 increased, order radioactive iodine uptake scan
- if TSH high, suspect hypothyroidism; order anti-thyroid peroxidase (anti-TPO) antibody assay
treatment of hyperthyroidism
symptomatic treatment with beta-blockers; propylthiouracil or methimazole to block thyroid hormone synthesis; radioactive 131-I thyroid ablation for more severe cases; thyroidectomy for large goiters, pregnant pts, or obstruction of trachea
- **do NOT give methimazole to pregnant pts–can cause aplasia cutis in fetus
- **pts who have undergone radioactive ablation or thyroidectomy need hormone replacement with levothyroxine
What is thyroid storm?
severe hyperthyroidism characterized by high fever, dehydration, tachycardia, coma, & high-output cardiac failure
what is myxedema coma & how do you treat it?
severe hypothyroidism c/b AMS & hypothermia; t/w IV levothyroxine & IV hydrocortisone
Graves’ disease
2/2 ab directed at TSH receptor; more prevalent in females; hyperthyroidism w/ diffuse, painless goiter, proptosis, pretibial myxedema; diagnosis–low TSH, high free T4, increased radioactive uptake scan, pos thyroid stimulating Ig
subacute thyroiditis
2/2 virus (e.g. mumps, coxsackievirus); p/w hyperthyroidism leading to hypothyroidism, tender thyroid, malaise, URI symptoms, early fever; diagnosis–decreased radioactive uptake scan, high ESR; tx: NSAIDs for pain control, steroids for severe pain, **self-limited
Hashimoto’s thyroiditis
autoimmune, pos anti-TPO ab, hypothyroidism w/ painless thyroid enlargement; t/w levothyroxine
hypercalcemia due to primary hyperparathyroidism
2/2 adenoma or multiglandular disease; p/w fatigue, constipation, polyuria, polydipsia, bone pain, nausea; dx: inc Ca2+ & PTH, low phosphate; tx: parathyroidectomy, hydrate w/ IV fluids, lasix after volume deficit corrected, bisphosphanates for severe hypercalcemia; complications: nephrolithiasis, nephrocalcinosis, osteopenia, osteoporosis, pancreatitis, cardiac valve calcifications
T score in osteoporosis
T score in osteopenia
T score </= -2.5 = osteoporosis
T score of -1 to -2.5 = osteopenia
treatment of osteopenia/osteoporosis
treat when T score is <-1.5 w/ risk factors
drugs of choice: #1: bisphosphonates (alendronate, risedronate, etidronate, ibandronate); #2: teriparatide; #3: SERMs (raloxifene); #4: intranasal calcitonin
***eliminate or treat secondary causes, add weight-bearing exercises & Ca2+/vit D supplementation
workup of hypercortisolism
24-hour urine cortisol (elev diagnostic for Cushing’s); check AM serum ACTH–if 5 pg/ml, administer high-dose dexamethasone suppression test –> if suppressible, Cushing’s disease (e.g. ACTH-secreting pituitary adenoma, confirm w/ pituitary MRI); if not suppressible, ectopic ACTH-producing tumor (e.g. carcinoid tumor, small cell lung ca)
Addison’s disease
primary adrenal insufficiency; elev ACTH w/ low cortisol after ACTH challenge; hyperpigmentation, dehydration, hyperkalemia, & salt craving (plus others that are not specific to primary insufficiency: weakness, anorexia, weight loss, N/V, postural hypotension, diarrhea, abd pain, myalgias/arthralgias); treat with glucocorticoids (hydrocortisone) & mineralocorticoids
presentation & treatment of prolactinoma
sx of mass effect: HA, temporal field visual loss, diplopia, CN III palsy
in women: galactorrhea, amenorrhea
in men: impotence
treat with dopamine agonist (bromocriptine or cabergoline); if medical tx not tolerated or tumor large, transsphenoidal resection followed by irradiation
MEN type 1
parathyroid hyperplasia, pancreatic islet cell tumor, pituitary adenoma
aka Wermer’s syndrome
MEN type 2A
parathyroid hyperplasia, thyroid medullary cancer, pheochromocytoma
aka Sipple’s syndrome
MEN type 2B
thyroid medullary cancer, pheochromocytoma, mucocutaneous neuromas, ganglioneuromatosis of colon, Marfan-like habitus
pheochromocytoma
p/w difficult-to-control HTN, HA, palpitations, sweating; dx: urine or plasma free metanephrines & normetanephrines along w/ CT/MRI; tx: treat preop w/ alpha-blockade (phenoxybenzamine) followed by surgical resection
