Endocrinology Flashcards
Nelson syndrome
rapid enlargement of pituitary adenoma after removal of both adrenal glands for Cushing’s disease; characterized by bitemporal hemianopsia and hyperpigmentation
Dx. nelson’s syndrome
MRI - suprasellar extension of pituitary adenoma
labs - very high plasma ACTH levels
tx. nelsons syndrome
surgery and/or pituitary radiation
lab findings in non-functioning pituitary adenoma
- hypogonadism - low levels of FSH and LH
2. serum alpha subunit levels are elevated
preferred therapy for nonfunctioning pituitary adenoma
trans-sphenoidal surgery
tx. prolactin-secreting adenomas
DA agonists ex. cabergoline
what dyslipidemia is common in HIV pt
triglyceridemia
assoc. with elevated LDL and TC & decreased HDL
tx. of hypertriglyceridemia in HIV pt on antiretroviral therapy
if TG> 500 -> fibrate medication (gemfibrozil)
if TG < 500, can use a statin
amiodarone effects on thyroid
decreased conversion from T4 to T3 = decreased T3 and increased T4 levels
- may also cause hypothyroidism and thyrotoxicosis due to high iodine content
diagnoses of DM
- two FPG > 126
- one random glucose > 200 with symptoms
- abnormal OGTT
- HbA1c > 6.5%
pt with type 2 DM that is not adequately controlled with metformin - next step?
add sulfonylurea
S/E of metformin
lactic acidosis
contraindications of metformin
renal insufficiency (Cr > 1.4, CCl < 50) use of contrast agents --> ARF alcohol abuse CHF liver disease
what should you do in pt on metformin about to have a contrast procedure done?
- stop metformin 1 d prior
2. if high risk for RF, give NaHCO3 or NS before procedure, adequately hydrate
s/e of sulfonylrureas
hypoglycemia
SIADH
DPP-IV inhibitors
sitagliptin, saxigliptin
- increase insulin release and block glucagon
C/I to rosiglitazone/pioglitazone
CHF
insulin secretagogues
nateglinide, repaglinide
- short acting
- cause hypoglycemia
GLP analogs
exenatide, liraglutide
- decrease gastric motility (increase feeling of fullness)
- increase satiety
- promote weight loss
s/e exenatide or liraglutide
NV
dyspepsia
sensation of fullness/bloating
best test to determine severity of DKA
serum bicarb
also: ph < 7.3 or anion gap high
effect of glucose on Na levels
high glucose artificially drops Na levels
which hyperlipidemia drug is C/I in diabetes
niacin - worsens glucose intolerance
Tx. diabetic neuropathy
gabapentin
pregabalin
Tx. diabetic gastroparesis
erythromycin or metoclopramide
lab findings in TSH secreting adenoma
elevated TSH and T3/T4
increased serum alpha subunit levels
TH resistance syndrome
elevated TSH and T3/T4
symptoms of hypothyroidism
increased RAIU
Graves disease
goiter
tsh secreting adenoma
decreased RAIU
subacute/painless thyroiditis
iatrogenic/factitious disorder
Grave’s opthalmopathy
Tx. does not affect the ocular findings
if severe, may lead to compression of the optic N. with visual field deficits
what intervention may decrease severity of graves ophthalmopathy
smoking - increases severity
Tx. Grave’s disease
PTU or MTZ acutely, then RAI to ablate the gland