Endocrinology Flashcards
Panhypopituitarism
Compression or damage of the pituitary gland.
Caused by tumors, cancers, adenomas, cysts, meningiomas, craniopharyngionas, or lymphoma
Panhypopituitarism causes
hemochromatosis sarcoidosis histiocytosis X infection with fungi, TB, parasites Autoimmune and lymphocytic infiltration damages gland
Prolactin def presentation
male: no symptoms
female: patient cannot lactate normally after childbirth
LH and FSH deficiency presentation
decreased libido, decreased axillary, pubic, body hair
men: no testosterone or sperm & erectile dysfunction
women: unable to ovulate or menstruate normally and become amenorrheric
GH deficiency presentation
children: dwarfism
Kallman syndrome
decreased FSH, LH, GnRH
and anosmia
Diabetes Insipidus
decreased in the amount of ADH from pituitary (central DI) or its effect on kidney (nephrogenic DI)
Central Diabetes Insipidus
Damage to the brain
Nephrogenic Diabetes Insipidus
Chronic pyelonephritis Amyloidosis Myeloma Sickle cell disease Lithium Hypercalcemia or hypokalemia inhibits ADH effects
Central DI Tx
Vasopressin
Nephrogenic DI Tx
Correct the cause (hypokalemia or hypercalcemia)
HCTZ, NSAIDs, amiloride
Acromegaly
soft tissue overgrowth throughout the body
increased hat, ring, and shoe size carpal tunnel body odor deep voice colonic polyps arthralgias hypertension Cardiomegaly, CHF, erectile dysfunction
Acromegaly
pts are hyperglycemic, glucose intolerant, hyperlipidemia
Best initial test: IGF
Most accurate test: glucose suppression test
MIR: after lab values
Acromegaly treatment
transphenoidal resection of pituitary
Meds:
cabergoline (dopamine agonists inhibit GH release)
octreotide or lanreotide (somatostatins inhibit GH)
Pevisomant
Hyperprolactinemia
pregnancy, chest wall stimulation, cutting pituitary stalk, antipsych, TCA, SSRI, methyldopa, metoclopromide, opioids,
Cosecretion with GH, hypothyroidism with pathologically high TRH levels
Hyperpolactinemia tests
Thyroid function tests
Pregnancy tests
BUN/creatinine
Liver function tests
Hyperprolactinemia treatment
Dopamine agonists
cabergoline is better than bromocriptine
Hypothyroidism
Bradycardia, constipation, weight gain, fatigue lethargy, coma, decreased reflexes, cold intolerance, hypothermia (hair loss, edema)
Hyperthyroidism
Tachycardia, palpitations, arrhythmia, diarrhea, weight loss, anxiety, nervousness, restlessness, hyperreflexia, heat intolerance, fever
Hypothyroid tests
treatment?
T4 and TSH
synthroid
Hyperthyroidism all have
elevated T4 levels
TSH level in hyperthyroidism is
elevated in pituitary adenoma
inhibited in other forms
Graves Ophthalmopathy
Tx: with steroids
decompressive surgery
Subacture thyroiditis tx
painful nodular
treat with aspirin
Pitutary adenoma
tx
surgery
Thyroid storm
Propanolol Thiourea drugs Iodinated contrast material Steroids Radioactive iodine
Normal TSH/T4 levels but thyroid nodule is present
FNA
Hypercalcemia causes
Vitamin D intox Sarcoidosis and other granulmatous disease thiazide diuretics hyperthyroidism metastases to bone and multiple myeloma
Hypercalcemia most common cause
Primary Hyperparathyroidism
confusion, stupor, lethargy, SHORT QT
constipation
Hypercalcemia
Hypercalcemia Treatment
- saline hydration at high volume
- bisphosponates: pamidronate, zoledronic acid
- calcitonin
Primary hyperparathyroidism
solitary adenoma most common
hyperplasia of all 4 glands
parathyroid malignancy
Low phosphate
short QT on EKG
elevated BUN and creatinine
Alk phos elevated from effect of PTH on bone
Hyperparathyroidism
high calcium and high PTH
Hypocalcemia presentation
twitchy, hyperexcitable
Hypercalcemia presentation
lethargic, slow
Neural hyper excitability is found in
hypocalcemia chvostek sign carpopedal spasm perioral numbness mental irritability seizures trousseau sign
Hypocalcemia EKG
prolonged QT
may cause ventricular tachycardia
Cushing disease
pituitary overproduction of ACTH
Cushing syndrome
ectopic production of ACTH
Moon face, truncal obesity, buffalo hump, thin extremities, increased abdominal fat, striae, easy bruising, decreased wound dealing, increased sodium reabsorption in kidney
Hypercortisolism
Before you get a CT in hypercortisol you need to
establish where the source is
Cortisol is an anti-insulin stress hormone which means you will find what on lab?
hyperglycemia
hyperlipidemia
Adrenal incidentaloma found now what?
metanephrines of blood/urine to exclude pheo
renin and aldosterone levels to exclude hyperaldosteronism
1 mg overnight dexamethasone suppression test
Addison’s disease
chronic hypoadrenalism Autoimmune destruction infection Adrenoleukodystrophy metastatic cancer to adrenal gland
Adrenal crisis
acute adrenal insufficiency
weakness, fatigue, altered mental status, nausea, vomiting, anorexia, hypotension, hyperpigmentation from chronic adrenal insufficiency
Hypoadrenalism presentation
acute hypoadrenalism also shows hypotension, fever, confusion, and coma
hypoadrenalism
labs
hypoglycemia, hyperkalemia, metabolic acidosis, hyponatremia, high BUN
eosinophilia is common in hypoadrenalism
Hypoadrenalism Treatment
replace Steroids with hydrocortisone
fludrocortisone (high in aldosterone like effect)
Primary hyperaldosteronism
presentation/labs/cause
High BP and low K
usually caused by solitary adenoma
primary hyperaldosterone treatment
laproscopic if unilateral
eplerenone or spironolactone if bilateral
Pheochromocytoma definition
Autonomous overproduction of catecholamines despite high BP
Pheochromocytoma presentation
episodic HTN
headache
sweating
palpitations and tremors
Pheochromocytoma best test?
Plasma catecholamines
confirm with 24 hr urine metanephrines and catecholamines (more accurate than VMA level)
Pheochromocytoma Tx?
phenoxybenzamine
propranolol
Calcium channel blocker
laproscopic removal
Diabetes mellitus
persistently increased fasting blood glucose levels> 125 on at least 2 separate occasions
Type 1 DM
What the bananas is this?
the pancreas is broken return to sender. momma gave you a terrible pancreas NO INSULIN FOR YOU!
Type 2 DM
What the bananas is this?
your tissues have issues and don’t wanna take the insulin.
Polyuria, polyphagia, polydipsia
DM
Type 1 is thin people
Type 2 is obese individuals
Diagnostic test for DM
NAME THEM
2 FBG >125 mg/dL
one reading of >200 mg/dL
abnormal oral glucose tolerance testing
hemoglobin A1C >6.5%
Name your diabetes drugs
metformin, sulfonylureas DPPI Glitazones Nateglinide and repaglinide Incretins
Metformin
blocks gluconeogenesis
Sulfonylureas
increase insulin release from pancrease and causes weight gain
Dipeptidyl peptidase inhibitors
sitagliptin, saxagliptin, linagliptin
increase insulin
decrease glucagon
Thiazoladinediones
Rosiglitazone, pioglitazone
increase fluid overload
Nateglinide and repaglinide
stimulates insulin release
similar to sulfonylreas
Incretins
Exenatide liraglutide
raise insulin
decrease glucagon levels
decreased gatric motility
Alpha glucosidase inhibitors
acarbose, miglitol
block glucose absorption in bowel
cause flatus, diarrhea, and abdominal pain
Pramlitide
decreases gastric emptying
decreases glucagon levels
decreases appetitie
Diabetic Ketoacidosis occurs more frequently in who?
type 1 diabetics
Hyperventilation altered mental status metabolic acidosis with increased anion gap hyperkalemia in blood increased anion gap on blood testing serum positive for ketones
DKA
see a high glucose level too!
when bicarb corrects they can leave the ICU
Treatment of DKA
Saline and insulin
replace potassium
correct the underlying issue: noncompliance with medications, infection, any serious illness
All diabetics should?
feet check
proteins in urine (+) give ARB/ACEi
BP
Gastroparesis Tx:
metoclopramide or erythromycin
Non-proliferative retinopathy treatment
tighter control of glucose
Proliferative retinopathy treatment
treat with photocoagulation
Neuropathy treatment
gabapentin
pregabalin
TCA
