Endocrinology Flashcards
Type II Diabetes meds
Metformin—> best initial medical therapy
- works by blocking gluconeogenesis
CI:
- renal insufficiency
- use of contrast agents
-sulfonylurea s/e
Hypoglycemia
SIADH
Risoglitazone ( thiazidinedione) work by increasing peripheral insulin sensitivity, is CI with CHF
Insulin secretagogues, like nateglinide and repaglinide are short acting and can cause hypoglycemia
GLP Analogue/Incretins (exenatide, liragluyide)—> slow Gastric emptying and promote weight loss
SGLT inhibitor like empagliflozin lead to UTIs
Type I diabetes
Best initial test
What to order
Why high AG?
Serum bicarbonate
B hydroxybutyrate is elevate marking the acidic state. Acetone and acetoacetate elevates too
Order CBC, bmp, abg, and fluids
Then order iV insulin
Diabetes complications
HTN Proliferative retinopathy Neuropathy ED Nephropathy—>Ur microalbumin Lipid mgmt Gastroparesis
The 4 forms of hyperthyroidism
Graves: elevated RAIU. And treat with radioactive iodine ablation
Silent: low RAIU and no treatment
Subacute: low RAIU and treat with aspirin
Pituitary adenoma: elevated RAIU and treat with surgery
Graves’ disease findings
Opthalmopathy
Dermopathy just below the knee
Oncolysis
RAIU elevated
Treat with Ptu or MMA then radioactive iodine to ablate the gland
- propranolol
Silent thyrtoiditis
Autoimmune to anti thyroglobulin and thyroid perkxidase
Nontender gland that is leaking
RAIU normal unlike graves
Subacute
Viral etiology
Tender gland
RAIU low
Thx: Aspirin
Pituitary adenoma
Only cause of hyperthyroidism with elevated tsh
Thyroid storm
Tx is kinda like graves. - iodine
- PTU Or mma
- propranolol
But add
- decamethasone
Solitary thyroid nodule
Always do Fine needle aspiration!
Wrong answer are… ultrasound and radioactive iodine scan or sample the gland
Hypercalcemia
Causes
Sx
Dx
Tx when to remove the parathyroid gland?
Causes:
Sarcoid Malignancy Vit D intoxication Thiazides Histo Berylliosis (. Ceramics, fluorescent light bulns, electronics)
Sx:
Stones, bones, moans and groans
Dx:
High PTH
High Ca
TE: surgical removal
When: - stones bones moans and groans - renal insufficiency > 12.5 calcium - markedly elevated UrCa
Acute Severe hypercalcemia
Features
Tx
Confusion Constipation Short QT Renal insufficiency, ATN, kidney stones Polyuria And polydpsia
Tx Hydration Bisphosphonates ( palendronate) Diuretics- but only After! Hydration Calcitonin Steroids- if granulama
Hypocalcemia
Causes
Dx
Tx
Surgical removal of pth glands Vit D def Malabsorption Hypo Mg Hyper pth Pseudohypoparathyroidism: - short 4th finger; round face, MR
Dx testing:
- seizures - prolong QT
- chvosteks and trousseau sign
Tx:
Replace Ca
Hypercortisolism
Features
Dx
Tx
- Truncalb obesity…- -. Easy bruising and stria
- HTN
- muscle wasting
- hirsutism
Dx: hyperglycemia And hyperlipidemia Met alkalosis Osteoporosis - high wbc
Do a 1 mg dexamethadone suppression test . Normally, a person will suppress the cortisol in the morning
Then do a 24 go urine cortisol(. Best initial test)
Then ACTH
If high= pituitary adenoma Or ectopic acth
If low ACTH—> adrenal in origin. Scan it and remove
Then high dose dexametgadone suppression test
Suppression —-> pituitary adenoma
MRI or ct then petrosal vein sampling!!!
No suppression•> ectopic acth or cancer—> scan the chest
Addison’s disease
Adrenal insufficiency. Do not produce enough cortisol so HYPOGLYCEMIA and NEUTROPENIC or aldosterone which normally absorbs Na and excretes K and H so hyperK and hypoNa with mild met acidosis
Dx Cosyntropin stimukation test… measure cortisol before and after the test - CT scan of adrenals Tx: steroid replacement ( hydrocort) - - prednisone—> stables. Nonhypotensi
Hyper aldosteronism
Think opposite of Addison
Htn+ hypoK+ low renin= hyperaldosteronism
With met alkalosis
Dx: - low renin - HTN - elevated aldosterone despite! Salt loading with NS Confirm with CT of adrenal
So
Solitary Adenoma —< resection
Hyperplasia—> spirinolactone
Pheochromocytoma
Beyt initial:
- plasma and urinary catecholamines
- plasma metanephrine and VMA levels
Most Accurate:
CT of adrenal
Metastatic —> MIBG scan
Tx: phenoxybenzine then propranolol then surgery
CAH common features
Elevated ACTH
Low aldosterone and cortisol
Tx
- prednisone
21 hydroxylase def
- virilization
And
Hypotension
Dx with :
17 hydroxyprogesterone
11 hydroxylase def
- viriluzation but
HYPERTENSION
17 hydroxylase def
- NO virilization
And
HYPERTENSION
HTN because of 11- decoycorticosterone
Prolactinoma
Exclude these causes
Dx
Tx
Exclude:
- pregnancy
- metoclopromide, phenothiazines, TCAs
- hypothyroidism
- nipple stimulation, stress, exercise
Dx:
MRI of the brain
Tx:
Bromocriptine or cabergoline
Surgery if meds does help
Acromegaly
Features
Best initial test
Most accurate test
Tx
Diabetes HTN And cardiomegaly Colonic polyps Amennorhea Joint problems
Best initial test IGF1
Most accurate test GH suppression with glucose
Tx
- transphenoid resection
- octreotide
- bromocriptine or cabergoline
- pegvisomant- gh antagonist
Primary vs secondary amenorrhea
Primary is due to a genetic defect
- Turners or testicular feminization!!!!- she is socially a female and has breasts but no cervix, tubes, ovaries or the top third of the vagina. Let alone a penis.
Secondary
- due to pregnancy, exercise, extreme weight loss or hyperprolactemia or…
PCOS.
Tx
metformin
Virilization —> spirinolactone
Klinefelters
47XXY
Very High FSH and LH but no testerone.
Tx testosterone
Kallmans syndrome
Anosmia with hypoglnadism
So…
Low GnRH, FSH and LH
