Endocrinology Flashcards
1
Q
DDX for palpitations
A
Hyperthyroidism Thyroid storm Hypoglycemia Anemia Electrolyte disorders Cardiac disease Alcohol withdrawal
2
Q
DDX for tremors
A
Hypoglycemia
Hyperthyroidism
Thyroid storm
3
Q
Primary hyperparathyroidism
A
Excess (inappropriate) PTH production
Most common type
4
Q
Most common cause of primary hyperparathyroidism
A
Parathyroid adenoma
5
Q
Primary hyperparathyroidism occurs in 20% of pts taking _______
A
Lithium
6
Q
Secondary hyperparathyroidism
A
Increased PTH due to hypocalcemia or vitamin D deficiency
7
Q
Most common cause of secondary hyperparathyroidism
A
Chronic kidney failure - kidneys convert vitamin D to its usable form
8
Q
Tertiary hyperparathyroidism
A
Prolonged PTH stimulation after secondary hypothyroidism, leading to autonomous PTH production
9
Q
Signs/Symptoms of hypercalcemia
A
Stones Bones Abdominal groans Psychic moans Decreased DTRs
10
Q
Diagnosis of hyperparathyroidism
A
Hypercalcemia Elevated PTH Decreased phosphate Increased 24 hour calcium excretion, increased vitamin D Imaging studies for parathyroid adenoma Osteopenia on DEXA
11
Q
Management of hyperparathyroidism
A
Acute - saline, calcitonin, bisphosphonates
Definitive - Parathyroidectomy - remove overactive (if all 4, remove 3.5 glands)
12
Q
Most common cause of hyperthyroidism
A
Grave’s disease - autoimmune disease that leads to TSH receptor antibodies
13
Q
Signs/Symptoms of hyperthyroidism
A
Anxiety Heat intolerance Menstrual irregularities Weight loss Palpitations Tachycardia Hyperdefecation
14
Q
Specific signs/symptoms for grave’s disease
A
Eye (proptosis, chemosis, lid retraction) Skin abnormalities (pretibial myxedema)
15
Q
Diagnosis of hyperthyroidism
A
- R/o pregnancy if menstrual irregularities
- Low TSH, high T4
- Radioactive iodine uptake (will show decreased uptake in all forms except graves - elevated)
16
Q
Treatment of thyroid storm
A
PTU or methimazole
Beta blockers
High dose corticosteroids
17
Q
Treatment of grave’s disease
A
Beta blockers
PTU or methimazole
Definitive tx: radioactive iodine
Steroids for ophthalmopathy
18
Q
Treatment for grave’s in pregnant pts
A
PTU first trimester
Switch to methimazole after
19
Q
S/E of methimazole
A
Leukopenia/agranulocytosis
20
Q
S/E of PTU
A
hepatotoxicity
21
Q
Most common cause of acute thyroiditis
A
Staph aureus
22
Q
Signs/symptoms of acute thyroiditis
A
Painful, fluctuant thyroid.
Usually very ill, febrile
23
Q
Diagnosis of acute thyroiditis
A
Increased WBC w/ left shift
Usually euthyroid
24
Q
Tx of acute thyroiditis
A
Abx, drainage if abscess present
25
Adrenal insufficiency secondary to autoimmune destruction (most common cause)
Addison's Disease
26
Signs/Symptoms of Addison's disease
Fatigue, weakness, anorexia, nausea, weight loss
Hyperpigmentation
Hypotension, hyponatremia, hypoglycemia, hyperkalemia, metabolic acidosis
27
Cause of hyperpigmentation in adrenal insufficiency
Long-standing elevated ACTH levels
28
Diagnosis of adrenal insufficiency/Addison's
1. Low cortisol levels (<3)(measure early morning)
2. ACTH stimulation test
3. ACTH level - increased levels = primary, decreased levels = secondary
29
ACTH stimulation test
Addison's disease
Give pt ACTH (cosyntropin) if cortisol levels do not rise, adrenal insufficiency is confirmed
Once low cortisol has been confirmed, draw ACTH level
30
Increased levels of ACTH with adrenal insufficiency
```
Primary insufficiency (adrenal problem)
CT of adrenal gland. Will also see elevated renin and decreased aldosterone
```
31
Decreased levels of ACTH with adrenal insufficiency
Secondary (pituitary problem) or tertiary insufficiency (hypothalamus).
MRI of the brain.
Renin and aldosterone levels will be unaffected
32
Treatment of primary adrenal insufficiency
Hydrocortisone and fludrocortisone
33
Treatment of secondary adrenal insufficiency
Hydrocortisone
34
Adrenal Crisis: presentation and tx
1. Present with shock, n/v, abd pain, ams
| 2. Volume repletion and high dose IV glucocorticoid administration
35
Diabetes insipidus is caused by:
1. ADH (vasopressin) deficiency (central) - MC
| 2. Insensitivity to ADH (neprhogenic) - inability of kidneys to concentrate urine
36
Signs/symptoms of diabetes insipidus
1. Polyuria (up to 20 L/day)
2. Polydipsia
3. Nocturia
4. Hypernatremia (if severe)
37
Diagnosis of diabetes insipidus
1. Fluid deprivation test
| 2. Desmopressin (ADH) stimulation test
38
Fluid deprivation test for diabetes insipidus
Establishes diagnosis
Normal response - progressive urine concentration
DI: continued production of dilute urine (low s.g. < 1.005)
39
Desmopressin (ADH) stimulation test
Differentiates nephrogenic from central DI
Administer ADH
1. Central: reduction in urine output indicating a response to ADH
2. Nephrogenic: continued production of dilute urine (no response to ADH)
40
Management of central DI
Desmopressin/DDAVP
| Intranasal, injection or oral form
41
Management of nephrogenic DI
Na+/protein restriction
| Hydrochlorothiazide, indomethacin
42
Results of insulin deficiency and counterregulatory hormonal excess in diabetes as a direct response to stressful triggers
DKA
| Hyperosmolar hyperglycemic syndrome (HHS)
43
Stressful triggers that can cause DKA/HHS
Infection (MC)
Infarction
Noncompliance with insulin/dosage change
Undiagnosed diabetes
44
DKA and HHS differ in:
DKA has presence of ketoacidosis
| Severity of hyperglycemia (higher in HHS)
45
Signs/Symptoms of DKA
Hyperglycemia, abdominal pain, hypotension
| Thirst, polyuria, polydipsia, nocturia, weakness, fatigue
46
Signs/Symptoms of HHS:
Hyperglycemia, mental status changes, hypotension
| Thirst, polyuria, polydipsia, nocturia, weakness, fatigue
47
DKA specific physical exam
Ketotic breath
| Kussmaul's respirations
48
Kussmaul's respirations
Deep continuous respirations as lung attempts to blow off excess CO2 to reduce acidemia
49
Diagnosis of DKA
1. Plasma glucose > 250
2. pH < 7.30
3. Bicarb < 18
4. Ketones (urine/serum)
50
Diagnosis of HHS
1. Plasma glucose > 600
2. > 7.30
3. Bicarb > 15
4. Small ketones
51
Management of DKA/HHS
1. IV Fluids
2. Insulin
3. Potassium (verify renal output) if potassium low/normal
4. Bicarb if severe
52
IV fluids for management of DKA/HHS
1. Give 0.9% NS until hypotension resolves, then 0.45% NS
| 2. When glucose reaches 250, switch to D5 0.45% NS to prevent hypoglycemia from insulin
53
Treatment goals of DKA
Close anion gap
54
Treatment goals of HHS
Normal mental status
55
Autoimmune destruction of the pancreatic beta cells, which will result in insulin dependence
Type 1 DM
56
Characterized by insulin resistance related to obesity
Type 2 DM
57
Main distinction b/w type 1 and type 2 diabetes
Presence of antibodies
58
Risk factors for DM type II
```
> 45 y/o
BMI > 25
DM in 1st degree relative
Sedentary lifestyle
Gestational DM
Hx of child delivery > 9 lb
Dyslipidemia
HTN
PCOS
```
59
Signs/Symptoms of DM
1. Polyuria
2. Polydipsia
3. Fatigue
60
Screening options for DM
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
61
Diabetic follow up care
1. Yearly eye exam to screen for retinopathy
2. Yearly urine microalbumin screening
3. LDL > 100 (statin first line)
4. BP > 140/90 (ACE/ARB first line)
5. Yearly comprehensive foot exam
6. ASA for prevention if 10 year risk . 10% and > 30 y/o
62
Increased pituitary ACTH secretion leading to cortisol excess
Cushing's Disease
63
Signs/Symptoms of Cushing's Disease
1. Redistribution of fat - moon face, buffalo hump, supraclavicular fat pads
2. Catabolism (breakdown of protein) - thin extremities, skin atrophy
3. Hypertension
4. Mental - depression, mania, psychosis
5. Androgen excess - hirsutism, oily skin, acne, amenorrhea
64
Most common cause of cushing syndrome
Exogenous - long-term high dose corticosteroid therapy
65
Endogenous causes of cushing's disease
1. Benign pituitary adenoma or hyperplasia (secretes ACTH)
| 2. Adrenal tumor - cortisol-secreting adrenal adenoma (or rarely carcinoma)
66
Diagnosis of cushing's disease
1. Low-dose dexamethasone suppression test
2. 24 hour urinary free cortisol levels
3. salivary cortisol levels
67
Low-dose dexamethasone suppression test
Cushing's disease
| Normal response is cortical suppression. No suppression = cushing's disease
68
24 hour urinary free cortisol levels
Cushing's disease
| Increased urinary cortisol = cushing's syndrome
69
Salivary cortisol levels
Cushing's disease
Increased cortisol in cushing's syndrome
usually performed at night
70
Decreased ACTH with cushing's syndrome
Adrenal tumor
71
Management of cushing's disease
Pituitary - transsphenoidal surgery
Adrenal - tumor removal
Iatrogenic steroid therapy - gradual steroid taper
72
Most common etiology of hypothyroidism
Hashimoto's thyroiditis
73
Signs/Symptoms of hypothyroidism
1. Constipation
2. Weight gain
3. Fatigue
4. Decreased reflexes (on relaxation phase)
5. Cold intolerance
6. Menstrual irregularities
7. Hair loss
74
Diagnosis of hypothyroidism
Elevated TSH, decreased T4
| Hashimotos: thyroid peroxidase antibodies
75
Treatment for hypothyroidism
Levothyroxine - take fasting and wait 4 hours before taking iron or calcium supplements
