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EOR Family Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Autoimmune destruction of the pancreatic beta cells, which will result in insulin dependence. Pts usually diagnosed in adolescence

A

Type I diabetes

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2
Q

Classically, DKA is seen with Type _ diabetes more often

A

type 1

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3
Q

Characterized by insulin resistance related to obesity. May occur at any age.

A

Type 2

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4
Q

Main distinction between type 1 and type 2 diabetes is that type 2 will not have:

A

Antibodies

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5
Q

Risk Factors for Type 2 Diabetes:

A
  1. > 45 y/o
  2. BMI . 25
  3. Diabetes mellitus in 1st degree relative
  4. Sedentary lifestyle
  5. Gestational DM
  6. Hx of delivery of child > 9 lbs
  7. Dyslipidemia
  8. HTN
  9. PCOS
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6
Q

Signs/Symptoms of diabetes

A

Polyuria, polydipsia, fatigue

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7
Q

More likely to present with a thin pt who is losing weight

A

Type 1 diabetes

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8
Q

More likely to present with obesity and acanthosis nigricans

A

Type 2 diabetes

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9
Q

Screening for diabetes

A

Screening should be done as part of cardiovascular risk assessment in adults aged 40-70 y/o with BMI > 25 years every 3 years

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10
Q

Screening Options for diabetes

A
  1. Two fasting glucose levels > 126
  2. One glucose level > 200 with symptoms
  3. HgA1c > 6.5%
  4. Positive 2 hour oral glucose tolerance test
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11
Q

Diagnosis for type 1 diabetes specifically

A

Positive antibodies

Low c-peptide, low insulin, elevated glucose

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12
Q

Diagnosis for type 2 diabetes specifically

A

No antibodies

Normal to increased c-peptide, normal to increased insulin, elevated glucose

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13
Q

Management of diabetes

A

HgA1c is drawn every 3-6 mo to evaluate management.
Goal HgA1c < 7%
May be drawn every 3 mo if not controlled, every 6 mo if well controlled

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14
Q

Treatment for Type 1 Diabetes

A

Insulin is mainstay. Should receive basal insulin (glargine or detemir) followed by pre-meal insulin

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15
Q

Four types of insulin

A

Rapid Acting
Fast Acting
Intermediate
Long Acting

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16
Q

Treatment for Type 2 Diabetes

A

Counseling on weight loss, exercise, and proper nutrition
First line - metformin
Second line - Sulfonylureas (glipizide, glimepiride)

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17
Q

If a pt has starting HgA1c > 9%

A

Want to start with insulin

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18
Q

Diabetes medications that cause weight gain and hypoglycemia

A

Insulin and sulfonylureas

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19
Q

Other second line options for diabetes (type 2)

A
  1. Pioglitazone
  2. DPP-4 Inhibitors
  3. Meglitinides
  4. GLP-1 agonists
    5- Alpha-glucosidase inhibitors
  5. SGLT2 inhibitors
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20
Q

Diabetic follow up care:

A
  1. Yearly eye exam to screen for retinopathy
  2. Yearly microalbumin screening
  3. Yearly comprehensive foot exam
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21
Q

Diabetic with LDL > 100

A

Statin first line

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22
Q

Diabetic with BP > 140/90

A

ACE/ARB first line

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23
Q

Adrenal insufficiency secondary to autoimmune destruction

A

Addison’s disease

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24
Q

Fatigue, weakness, anorexia, nausea, weight loss, hyperpigmentation

A

Addison’s disease

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25
Q

Cause of hyperpigmentation in addison’s disease

A

Long-standing elevated ACTH levels

26
Q

Other symptoms of addison’s disease

A 
Hypotension
Hyponatremia
Hypoglycemia
Hyperkalemia
Metabolic acidosis
27
Q

1st step in diagnosis of adrenal insufficiency

A

Low cortisol levels (< 3) - measure early morning (normally highest in the AM)

28
Q

Most specific test for adrenal insufficiency

A

ACTH stimulation test

Give pt ACTH, if cortisol levels do not rise, adrenal insufficiency is confirmed

29
Q

Increased levels of ACTH in adrenal insufficiency

A 
Adrenal problem (primary)
CT of adrenal gland
30
Q

Decreased levels of ACTH in adrenal insufficiency

A

Pituitary problem (secondary)
OR hypothalamus problem (tertiary)
MRI of the brain

31
Q

Treatment of primary adrenal insufficiency dz

A

Hydrocortisone and fludrocortisone

32
Q

Treatment of secondary adrenal insufficiency dz

A

hydrocortisone

33
Q

Occurs under major stress, infection, trauma, pituitary apoplexy or acute withdrawal of chronic steroids

A

Adrenal crisis

34
Q

Treatment for adrenal crisis

A

Volume repletion

High dose IV glucocorticoid

35
Q

Pathophysiology behind cushing’s disease

A

Pituitary increased ACTH secretion causing high levels of cortisol release

36
Q

Signs/Symptoms of cushing’s disease

A
  1. Redistribution of fat
  2. Catabolism (breakdown of protein)
  3. Hypertension, acanthosis nigricans
  4. mental
  5. Androgen excess
37
Q

Redistribution of fat in cushing’s disease

A

Central (trunk) obesity, moon facies, buffalo hump, supraclavicular fat pads

38
Q

Catabolism (breakdown of protein) in cushing’s disease

A

Wasting of extremities (thin extremities, proximal muscle weakness), skin atrophy (easy bruising, striae), increased infections, hyperpigmentation

39
Q

Mental symptoms of cushing’s disease

A

Depression, mania, psychosis

40
Q

Androgen excess in cushing’s disease

A

Hirsutism, oily skin, acneiform rash, increased libido, virilization, amenorrhea

41
Q

Most common cause of cushing’s disease

A

Exogenous - long-term high dose corticosteroid therapy

42
Q

Diagnosis of cushing’s disease

A
  1. Low-dose dexamethasone suppression test
  2. 24 hour urinary free cortisol levels
  3. salivary cortisol levels
43
Q

Low-dose dexamethasone suppression test for cushing’s disease

A

Normal response is cortisol suppression

No cortisol suppression = Cushing’s syndrome

44
Q

24 hour urinary free cortisol level test for cushing’s disease

A

Most reliable index of cortisol secretion

Increased urinary cortisol = cushing’s syndrome

45
Q

Salivary cortisol level test for cushing’s disease

A

Increased cortisol is Cushing’s syndrome

Usually performed at night

46
Q

Management for cushing’s disease

A

Transsphenoidal surgery (pituitary)

47
Q

Management for iatrogenic cushing’s disease

A

Gradual steroid taper (to prevent Addisonian crisis)

48
Q

Most common cause of hyperthyroidism

A

Grave’s disease - autoimmune disease that leads to TSH receptor antibodies

49
Q

Signs/Symptoms of hyperthyroidism

A 
Heat intolerance
Menstrual irregularities
Weight loss
Palpitations
Hyperdefecation
Anxiety
Tachycardia
50
Q

Grave’s disease specific symptoms

A 
Eye proptosis, chemosis, lid retraction
Skin abnormalities (pretibial myxedema)
51
Q

Diagnostic Testing for Hyperthyroidism

A
  1. R/o pregnancy first if menstrual irregularities are present
  2. Suppressed TSH, high T4
  3. Radioactive iodine will show decreased uptake (except Graves)
52
Q

Treatment of thyroid storm

A

PTU or methimazole, beta blockers, high dose corticosteroids

53
Q

Treatment of Grave’s disease

A 
Beta blockers
PTU or Methimazole
Definitive: radioactive ablation
Steroids for ophthalmopathy
PTU for first trimester
54
Q

S/E of PTU

A

Hepatotoxicity

55
Q

Most common etiology of hypothyroidism

A

Hashimoto’s Thyroiditis (autoimmune disease)

56
Q

Most common etiology worldwide of hypothyroidism

A

Iodine deficiency

57
Q

Signs/Symptoms of hypothyroidism

A 
Constipation
Weight gain
Fatigue
Decreased reflexes (on the relaxation phase)
Cold intolerance
Menstrual irregularities
Hair loss
58
Q

Diagnosis of hypothyroidism

A

High TSH and low T4

59
Q

Diagnosis of hypothyroidism specifically hashimoto’s’

A

Thyroid peroxidase antibodies

60
Q

Treatment for hypothyroidism

A

Levothyroxine

61
Q

Instructions for levothyroxine

A

Take fasting, wait 4 hours before taking iron or calcium supplements

EOR Family Medicine (14 decks)

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