Endocrinology Flashcards
CC: Amenorrhea
PE:Hirsutism and body acne. Serum testosterone on upper limit.
DX and Meds?
PCOS
Metformin will improve menses
Encourage exercise, weight loss
May use low dose oral contraceptives; NOT HIGH dose
SIADH
Presentation?
Meds that can cause it?
Hyponatremia + low serum osmolality and high urine osmolality
Meds that can cause it: SSRI - Sertraline (Zoloft)
Patient with Turners
- Presentation?
- Diagnoisis?
- Web neck, short stature, low hair line, no signs of pubertal dev
- Do Karyotyping!
50 y/o male with elevated BP and Hypokalemia in spite of oral potassium supplement
DX?
Test?
Hyperaldosteronism
- resistant HTN
- Hypokalemia
Order an Aldosterone suppression test; if abnormal
Order a peripheral aldosterone concentration and peripheral renin activity
Patient with Panhypopituitarism due to pituitary tumor will undergo surgery
Perioperative meds?
Hydrocortisone q 8 hrs due to adrenal insufficency
Low TSH, HIGH T4, T3, elevated Radioactive iodine uptake scan
DX?
Graves
Patient on testosterone replacement
What to monitor
Hematocrit due to erythrocytosis
Cause of Osteoporosis in Men?
- MM
- AIDS
- Hyperparathyroidism
- Hypotestosteronism
Addisons -
Presentation?
Low Na, high K
HYPERPIGMENTATION!
Complications of Hypoparathyroidism?
Hypocalcemia, Heart failure, tetany and seizures
DM medication that causes weight loss?
How?
GLP-1 receptor agonist like Exenatide (Byetta)
Increase insulin secretion causing dec in Glucagon decreasing gastric emptying
Patient with Pre diabetes.
What medication can you use to decrease the risk of of developing DM?
Thiazolidinediones( Actos)
Metformin
Alpha Glucosidase inhibitors(Acarbose)
Orlistat
*US diabetic prevention program outcomes study
65 y/o female with 1.5 cm thyroid nodule.
What test to order?
- TSH
- If TSH is low –> radionucleotide scan
- If TSH is high or normal –> US –> FNAB
- If nodule is large and firm –> FNAB
30 y/o F , 3 months post party me
Recent URTI now with neck pain, anxiety and palpitation
T4 high and TSH low
DX?
Sub acute thyroiditis – painful, followed by URTI
- give NSAIDS or corticosteroids
Lab test results for 2nd hyperparathyroidism?
Tx?
Low vitamin D and high alkaline phosphatase with normal calcium
Vit D supplementation
1-25 Dihydroxy vitamin D (calcitriol) only on renal failure
A1C goal of an elderly in nursing home?
Between 8-9%
59 y/o F with HTN on HTCZ and amlodipine
BMP showed high Ca
Hx of Stones
After stopping HCTZ, what lab to order
Rpt BMP with iCa
Order Vit d level if PTH is low
Order 25 hr urine calcium if PTH is normal or high
When is TSH unreliable for patient with Hypothyroidism
If the hypothyroidism in due to pituitary disease –> Secondary centrally mediated hypothyroidism
32 Male with type 1 DM
With tender, scaly lesion on the shin
Reddish brown plaque with well defined boarders with yellowish deposits on the center
DX?
Necrobiosis - seen in 0.3% with DM
Adverse reaction of Pioglitazone? (Actos)
Fluid retention causing weight gain and edema
42 y/o with ELEVATED BP even on 3 meds
Lab test?
Aldosterone: renin ratio –> screen for primary aldosteronism; elevated aldosterone in suppressed renin levels
