Endocrinology Flashcards
Complications of DM are many. They include:
- Neuropathy- +/- cranial nerve III palsy
- Retinopathy- Nonproliferative microaneurysms are the earliest change, also hard exudates and cotton wool spots
- Nephropathy- leads to microalbuminuria (Kidney bx- KIMMELSTIEL-WILSON, nodular glomerulosclerosis)
- Tx= ACEI, low Na+ diet - Macrovascular- atherosclerosis (CAD, PVD, stroke)
- Increased infection risk- b/c of vascular insufficiency and immunosuppression from hyperglycemia
___ is the MC cause of ESRD. ___ is the 2nd MC cause.
DM is MC cause!!
HTN is 2nd MC cause
Dx of HYPOglycemia can be made when a random blood sugar is between __ and __.
50-60mg/dL- Sx occur at 60
___ is the treatment for mild HYPOglycemia.
Fast acting carb- fruit juice or hard candy
___ is the treatment for someone who is severe/unconscious due to HYPOglycemia.
IV bolus of D50 or inject glucagon SQ
How to diagnose DM:
- Fasting blood glucose ≥ 126 (fasting 8 hours on 2 occasions, GOLD STANDARD)
- 2hr Glucose Tolerance Test ≥ 200 (3hr GTT is GOLD STANDARD IN GESTATIONAL DM)
- Hemoglobin A1c ≥ 6.5%
- Random Blood Glucose ≥ 200
DM Screening:
- ADA: all adults > 45y or ANY adult with BMI > 25 and 1 additional RF
- USPSTF: any 40-70y that is overweight or obese
______ is preferred for glucose control in gestational DM.
Insulin
Glucose control goals:
- Hgb A1c < 7% (check Q3 months if not controlled)
- Pre-prandial glucose goal 80-130
- Post-prandial glucose goal < 180
*Lipids: LDL < 100; HDL > 40; TG < 150
____ should be prescribed if mircoalbuminuria is present.
ACEI
Lactic acidosis, Macrocytic anemia, and GI complaints are common ADRs associated with what diabetes drug?
Metformin (Glucophage)
*Should be stopped 24hours before iodine contrast!!
Glipizide, Glyburide, and Glimepiride are in what class of diabetes medications?
Sulfonylureas
What are 2 unique ADRs associated with sulfonylureas?
- HYPOGLYCEMIA
- WEIGHT GAIN
Pioglitazone (Actos) and Rosiglitazone (Avandia) are in what class of diabetes medications?
Thiazolidinediones
- Increase risk of bladder cancer with Pioglitazone
- *Cardiotoxicity with Rosiglitazone
Exenatide and Liraglutide are injectables and are in what class of diabetes medications?
GLP-1 Agonists
- Delay gastric emptying
- *CI if hx of gastroparesis
Sitagliptin and Linagliptin are in what class of DM medications?
DPP-4 inhibitors
Canagliflozin, Empagliflozin, and Dapagliflozin are in what class of DM medications?
SGLT-2 Inhibitors
*Increases urinary glucose excretion
What class of DM meds is associated with possible UTIs?
SGLT-2 inhibitors
Name 2 rapid insulins:
Humalog (Lispro) and Novolog (Aspart)
*Give at same time as meal
Name 2 intermediate insulins:
Humulin N and Novolin N (NPH)
*Covers insulin for half day or OVERNIGHT (often given at bedtime)
Name 2 long acting insulins:
Levemir (Detemir) and Lantus (Glargine)
- Covers insulin for 1 full day
- *Glargine causes FEWER HYPOglycemic episodes :)
Normal glucose until rise in serum glucose between 2-8am is known as:
Dawn phenomenon
*Tx= Bedtime injection of NPH
Nocturnal HYPOglycemia followed by rebound HYPERglycemia is known as:
Somogyi effect
*Tx= Decreasing nighttime NPH dose or give bedtime snack
DKA and Hyperosmolar Hyperglycemia are direct responses to stressful triggers such as:
Infxn, infarction, noncompliance w/ insulin/dosage change, undiagnosed diabetics
*Cortisol is a stress hormone that increases glucose. patients cannot meet the demand of increased insulin requirements in response to hyperglycemia
Hyperglycemia is higher in ____ (DKA/HHS).
HHS
Younger patients with DM1 are more likely to get ___ (DkA/HHS) and older patients with DM2 are more likely to get ____ (DKA/HHS).
Younger- DKA
Older- HHS (Higher mortality!)
High anion gap metabolic acidosis and ketonemia is associated with ___ (DKA/HHS).
DKA
What electrolyte is also depleted in DKA?
POTASSIUM
MC cause of HHS is ____.
Infection (with decreased fluid intake)
Plasma glucose in HHS is usually > ____.
600
Decreasing arterial pH and serum bicarb are associated with what?
DKA
What is the critical first step in managing DKA/HHS?
IV FLUIDS!
*Isotonic NS until hypotension resolves then D51/2NS when glucose levels reach 250 (to prevent hypoglycemia from insulin therapy)
What are the treatments used for DKA/HHS after IV fluids?
- Insulin (regular)
- Potassium (first verify renal output)
- Bicarb- ONLY IN SEVERE ACIDOSIS
* Tx goals= Closing anion gap in DKA and Normal mental status in HHS
Deficiency in all 3 zones of the adrenal cortex is a form of Adrenal Insufficiency known as:
Addison’s Disease
- Etiology:
- Autoimmune is MC in industrialized nations
- Infxn is MC worldwide: TB, HIV
- KETOCONAZOLE is also a culprit
Pituitary failure of ACTH secretion w/ ALDOSTERONE INTACT due to RAA is seen in what diagnosis?
Secondary Adrenal Insufficiency
*Tertiary- Hypothalamic disease: very rare!
Lots of symptoms related to lack of cortisol associated w/ adrenal insufficiency such as:
see p. 136 of study guide!
*HYPOGLYCEMIA common in Secondary
Decreased aldosterone, seen w/ Addison’s, can cause a drop in _____ (what electrolyte?) and rise in ______ (what electrolyte?).
Drop in sodium- HYPONATREMIA
Rise in potassium- HYPERKALEMIA
*Also hypogylcemia due to low cortisol levels!
Primary/Addison’s has ___ (high/low) ACTH levels and ____ (high/low) cortisol levels.
HIGH ACTH
LOW CORTISOL
Treatment of Adrenal Insufficiency…
Glucocorticoids + Mineralcorticoids (only gluco in secondary)
*HYDROCORTISONE (glucocorticoid) is 1st line!!!
Treatment of Adrenal Insufficiency…
Glucocorticoids + Mineralcorticoids (only gluco in secondary)
*HYDROCORTISONE (glucocorticoid) is 1st line!!!
The MC cause of and Adrenal Crisis is ____.
Abrupt withdrawal of glucocorticoids
S&S of an Adrenal Crisis are:
Shock- HYPOtension and HYPOvolemia
*Dx- Labs- HYPOnatremia, HYPERkalemia, HYPOglycemia, low cortisol levels
Treatment for Adrenal Crisis involves:
- IV Fluids
- Glucocorticoids- IV Hydrocortisone or Dexamethasone
- Reversal of electrolyte disorders
- Fludrocortisone
S&S of Cushing’s Syndrome and Disease are:
Central obesity, moon face, buffalo hump, wasting of extremities, HTN, weight gain, androgen excess (hirsutism, oily skin, acne, increased libido)
___ is the MC cause of Cushing’s Syndrome.
Long-term high dose corticosteroid use
Low-dose dexamethasone suppression test AND
24hr urinary free cortisol levels (most reliable) are used to screen for what?
Cushing’s
*No suppression of cortisol levels in low-dose suppression test if you have Cushing’s
- *In HIGH-dose suppression test:
- Suppression= Cushing’s Dz
- No suppression= adrenal or ectopic ACTH-producing tumor
What is the treatment of choice for Cushing’s?
Transsphenoidal surgery or radiation
*KETOCONAZOLE can be used in inoperable patients
Causes of Cushings…
70%= benign pituitary adenoma or hyperplasia
Otherwise Ectopic ACTH secreting tumors or Adrenal tumor
____ is the most specific test for Hyperthyroidism.
Thyroid-stimulating immunoglobulins (Ab)
also TFT and RAIU- increased diffuse uptake
What is the treatment for HYPERthyroidism?
- Radioactive Iodine
- Methimazole or PPU (or BB)
- Thyroidectomy
Toxic Multinodular Goiters are MC in elderly and treated with:
Radioactive Iodine or Surgery
_____ is the same as TMG + dyspnea, dysphagia, stridor, hoarseness from laryngeal compression.
Toxic Adenoma
*Tx= same as TMG
Hyperthyroid symptoms + bilateral hemianopsia is associated with what diagnosis?
TSH secreting pituitary adenoma
*Tx- transsphenoidal surgery
_____ is the MC cause of HYPOthyroidism.
Hashimoto’s
*Tx- Synthroid
What 2 medications are associated with medication-induced HYPOthyroidism?
Amiodarone and Lithium
____ is the MC agent involved in acute thyroiditis.
S. Aureus
- Pt. usually ill and febrile
- *TFT: euthyroid
Riedel’s Thyroiditis…
Fibrous thyroid, with firm, “woody” nodule. May be hypothyroid.
A painful, tender neck with clinical HYPERthyroidism following a viral infection is associated with _____ thyroiditis.
de Quervain’s
*Increased ESR is HALLMARK
MC cause of HYPOthyroidism worldwide is ____ deficiency.
Iodine deficiency
You should monitor TSH levels at ___ weeks when initiating synthroid changes.
6
*Slow, small increases in patients >50y and patients with cardiovascular dz due to increased metabolic rate
