Endocrinology Flashcards
Hallmark findings or pheocromocytoma
Palpitations
Diaphoresis
Headache
Cranial nerve palsy found in diabetics
Cranial nerve III palsy (the pupil remains normal size)
Types of diabetic retinopathy
1) non-proliferative: microaneurysms leading to cotton wool spots , flame hemorrhage
2) proliferating: neovascularization
3) maculopathy: macular edema with central vision loss
Kidney bx finding in diabetic nephropathy
Kimmelsteal- Wilson modular glomerulosclerosis!!
Pink hyaline material (protein leakage )
Proteinuria
*ACE inhibitors for management
Who should be screened for diabetes
- ALL adults over 45 q3 years
- any obese adult with 1 additional risk factor
DM diagnosis
Fasting glucose >126
Random glucose >200
A1c 6.5%
** on two occasions
Metformin MOA, SE
- decreases hepatic glucose production
* lactic acidosis, GI upset, macrocytic anemia (b12 deficiency)
Sulfonylureas MOA, SE
Stimulates pancreatic beta cells to produce insulin no matter the glucose levels
-weight gain and hypoglycemia
Meglitinides MOA, SE
Stimulates beta cell insulin production but is glucose dependent
-weight gain and hypoglycemia
Thiazolidinediones MOA, SE
Increase insulin sensitivity peripherally at the adipose muscle tissues
- fluid retention/edema
- MI (more with rosiglitizone)
GLP-1 agonist MOA, SE
Mimic incretin to stimulate insulin secretion and delays gastric emptying
- pancreatitis
- CI in someone with gastroporesis
SGLT-2 inhibitor MOA, SE
Increases urinary glucose excretion
-thirst, UTI
Rapid acting insulin
- lispro, aspart
* work in 5-15 minutes, give at mealtime
Short acting insulin
Regular insulin
-works in 30min-1hr, give before meal
Intermediate acting insulin
NPH, lente
- works about half the day or overnight
Long acting insulin
Glargine(Lantus),Detemir
Works 24 hours
*cant be mixed in same syringe as other insulin
Dawn phenomenon Managemeny
Early morning hyperglycemia, treat this by giving a bolus of NPH (intermediate) and no snacks before bed
Somogyi effect
Nighttime hypoglycemia that is followed by a rebound hyperglycemia
*to treat, prevent the hypoglycemia by encouraging a nighttime snack and not giving as much insulin at night
What is the most common trigger for DKA
Infection
What kind of pH change will you see in DKA
High anion gap metabolic acidosis (ketonemia)
Kussmaul’s respirations
Deep continuous respiration’s in an attempt to blow off CO2 , seen in acidosis
1st line treatment in someone just diagnosed with DMT2
DIET and exercises.
- Carbs 50-60%
- Protein 15-20%
- Unsaturated fats 10%
Best treatment for diabetic neuropathy?
Gabapentin
Arrythmia associated with thyroid storm
a-fib
treatment for thyroid storm
- PTU or mithimozole (prevents conversion)
- BB (slow you down)
- IV glucocorticoids (prevents concersion)
MC cause of adrenal insufficiency
abrupt discontinuation of corticosteroids
Lab findings in acute adrenal insufficiency
hyponatremia, hyperkalemia, hypoglycemia, refractory hypotension
pathophis of Graves dz
autoimmune process where patient makes TSH receptor antibodies…therefore TSH is “low” resulting in clinical hyperthyroid.
***MC cause of hyperthyroid
Physical exam findings specific to Graves dz
- thyroid bruits
- Opthalmopathy (lid lag, proptosis, exophthalmos)
- Pretibial Myxedema (nonpitting, edematous pink/brown plaques)
**diffuse radioactive iodine uptake
Treatment of Grave’s dz
- radioactive iodine to destroy thyroid (then give thyroid replacement)
- PTU, methimazole
- BB
What is silent thyroiditis
autoimmune process where thyroid first enlarges causing thyroidtoxicosis, THEN changes to hypothyroid state over a year.
***treat with ASA , most return to normal on their own.
Medications that can precipitate hypothyroidism
amiodorone
lithium
alpha interferon
Are hot or cold thyroid nodules highly suspicious for malignancy?
cold
What level of thyroid hormone do most people with thyroid cancer present in
euthyroid
What is the most common type of thyroid cancer?
Papillary (80%) , least aggressive with best prognosis, young females , DISTANT METS UNCOMMON
What are the 4 types of thyroid concer
- papillary, only local mets, good prog.
- follicular, distant mets, good prog
- medulary,MEN2 association, secrete calcitonin
- anaplastic , older men, rapid growth to invade trachea, most die in 1 yr and need tracheostomy
MEN2 syndrome is made up of what diagnoses
- hyperparathyroid
- medullary thyroid cancer
- pheochromocytoma
MEN1 syndrome is made up of what diagnoses
- hyperparathyroid
- pituitary tumur
- Pancreatic tumor
2 MC causes of hypoparathyroidism
post surgical removal, autoimmune destruction
Treatment of symptomatic hypercalcemia
IV fluids and lasix (loop diuretics increase renal calcium excretion)
Addisions dz.. what is it and what causes it?
adrenal gland destruction leading to low cortisol and aldosterone levels. some causes are :
- autoimmune
- infection (TB, HIV)
- metastatic cancer
clinical manifestations of primary addisons disease
hyperpigmentation, hypotension, hyperkalemia, hyponatremiametabolic acidosis , loss of sex hormones
What is the screening test for adrenal insufficiency
ACTH stimulation test… no rise in cortisol after injection
What is the best test to differentiate primary vs secondary adrenal insufficiency
CRH stimulation test
- if test causes a list in ACTH then you know it is PRIMARY
- if the test doesn’t cause a rise in ACTH then you know it is SECONDARY (there is a problem with the pituitary itsself )
Treatment of adrenal insufficiency
if primary (addison’s) then give glucocorticoid and mineralocorticoid
if secondary adrenal insufficiency then only give glucocorticoid
What is the most common cause of cushing syndrome
long term steroid use
What is cushion’s dz?
cushing syndrome caused by a PITUITARY adenoma secreting ACTH
What is a pheochromocytoma?
catacholamine secreting adrenal tumor
*diagnosed by 24 hr urine catecholamines with elevated metanephrine and vanillylmandelic acid
Pheocromocytoma treatment
Adrenalectomy
**need alpha blockade with PHEnoxybenzamine or PHEntolamine x2 weeks pre-surgery
BB post surgery
What is the cause of acromegaly and how do you test for it?
It is caused by a pituitary adenoma secreting growth hormone (somatotropinoma)
*diagnosed by a high level of IGF (insulin like growth factor)
what is de Quervain’s thyroiditis
MC post viral inflammatory reaction resulting in painfully tender thyroid with clinical hyperthyroid
- Elevated ESR , no thyroid antibodies
- Treat with ASA
