Endocrinology Flashcards
lab findings in hashimoto’s thyroiditis
high TSH, low T4, and anti-TPO antibodies
lab findings in hashimoto’s thyroiditis
high TSH, low T4, and anti-TPO antibodies
stones, bones, groans, and psychiatric overtones
hypercalcemia
pt complains of HA, weakness, and polyuria; exam reveals HTN and tetany; labs show hypernatremia, hypokalemia, and metabolic alkalosis
primary hyperaldosteronism (due to conn’s syndrome or bilateral adrenal hyperplasia)
pt complains of tachycardia, wild swings in BP, HA, diaphoresis, AMS, and sense of panic
pheochromocytoma
first line of tx for pheo
a-antagonists (phentolamine or phenoxybenzamine) as b-antagonists first will cause unopposed rise in BP
pt w/ hx of lithium use presents w/ copious amounts of dilute urine
nephrogenic DI
tx of central DI
DDAVP
anti-diabetic agent associated w/ lactic acidosis
metformin
pt complains of weakness, N/V, weight loss, and new skin pigmentation. lab shows hyponatremia and hyperkalemia. Dx? Tx?
primary adrenal insufficency (Addison’s dz). tx w/ glucocorticoids, mineralocorticoids, and IVF
goal HA1c for pt w/ DM
less than 7
tx of DKA
IVF, insulin, and electrolyte repletion (ie. K)
why are b-blockers contraindicated in DM?
mask symptoms of hypoglycemia
stones, bones, groans, and psychiatric overtones
hypercalcemia
pt complains of HA, weakness, and polyuria; exam reveals HTN and tetany; labs show hypernatremia, hypokalemia, and metabolic alkalosis
primary hyperaldosteronism (due to conn’s syndrome or bilateral adrenal hyperplasia)
pt complains of tachycardia, wild swings in BP, HA, diaphoresis, AMS, and sense of panic
pheochromocytoma
first line of tx for pheo
a-antagonists (phentolamine or phenoxybenzamine) as b-antagonists first will cause unopposed rise in BP
pt w/ hx of lithium use presents w/ copious amounts of dilute urine
nephrogenic DI
tx of central DI
DDAVP
anti-diabetic agent associated w/ lactic acidosis
metformin
pt complains of weakness, N/V, weight loss, and new skin pigmentation. lab shows hyponatremia and hyperkalemia. Dx? Tx?
primary adrenal insufficency (Addison’s dz). tx w/ glucocorticoids, mineralocorticoids, and IVF
goal HA1c for pt w/ DM
less than 7.0
tx of DKA
IVF, insulin, and electrolyte repletion (ie. K)
why are b-blockers contraindicated in DM?
mask symptoms of hypoglycemia
chronic GI disease can cause vit D def due to malabsorption –> what electrolyte imbalances?
hypocalcemia, hypophosphatemia, and elevated PTH
pt w/ HTN and low renin levels. dx?
primary hyperaldosteronism - elevated aldosterone suppresses renin secretion through feedback inhibition
pt w/ HA, deafness, bone pain + isolated elevated AP, normal calcium, phosphorus, and other liver enzymes
pagets dz of the bones - characterized by increased bone remodeling (increased AP) and abnormal osteoid formation
DKAs effects on K?
“paradoxical hyperK” - DKA is characterized by an osmotic diuresis that reduces total body K stores even though the serum K level may be elevated
proximal muscle weakness can be seen w/ what hormone imbalance?
hyperthyroidism
G6PD def causes hemolytic anemia due to …
oxidative injury to RBCs precipitated by infection or medications
symptom mgmt in hyperthyroidism?
propranolol
diabetic autonomic neuropathy can affect the GU tract causing…
neurogenic bladder –> overflow incontinence (dribbling, poor urinary stream, high post-void residual volume)
pregnant women (increased estrogen) effects on TBG, thyroxine, T3, free T4, and TSH
increased TBG, increased thyroxine and T3, normal free T4, and normal THS
MEN-2 genetic testing
RET proto-oncogene
electrolyte abnormalities associated w/ alcoholics
hypoMg, which causes hypoCa (hypoMg causes decreased release of PTH and PTH resistance)
hypoCa, hyperphosphatemia, and increased PTH indicate…
secondary hyperparathyroidism in chronic renal failure
high serum osmol + low urine osmol (dilute urine)
DI - inability to produce concentrated urine as a result of ADH dysfunction
labs for DI:
water depreivation test…
DDAVP…
water depreivation test shows no increase in urine osmol (distinguishes from primary polydipsia)
DDAVP shows central having decreased urine output and increased urine osmol vs nephrogenic no change
low plasma osmol + high urine osmol > 100 - 150 (concentrate urine)
SIADH - persistent ADH release independent of serum osmol (retention of free water)
OTC med that can cause SIADH
NSAIDs
diabetic neuropathy DOC
TCAs; gabapentin is alternative
tx options for diabetic gastroparesis
prokinetic agents such as metoclopramide, erythromycin, cisapride can sometimes help
tx for pagets
bisphosphonates; calcitonin is usually reserved for pts intolerant to bisphosphonates
differentation of follicular thryoid adenomas vs follicular thyroid cancers
histopath demonstration of invasion of the capsule and blood vessels = cancer
when is FNA of the thyroid recommended?
pts w/ normal or high TSH, cold nodules (hot are usually benign), thyroid cancer family hx, or suspicious thyroid on US
two important causes of hypoglycemia in non-DM pts w/ elevated insulin levels. dx? differentiate?
insulinoma (beta cell tumor) vs surreptitious use of insulin or sulfonylurea.
c-peptide is high in insulinoma vs low in surreptitious use of insulin
