Endocrinology Flashcards
Addison’s disease is?
Primary adrenal insufficiency
How do labs look for Addison’s Disease?
Increased ACTH
Decrease cortisol
Hyponatremia
Hyperkalemia
What is the MC cause of Addison’s?
autoimmune destruction
What is the MC cause Addison’s worldwide?
TB, HIV
What labs are seen in Secondary adrenal insufficiency?
Decrease ACTH
Decrease cortisol
Cause of secondary adrenal insufficiency?
pituitary macroadenoma or central nervous system tumor
No increase in ACTH after CRH injection is what?
Secondary adrenal insufficiency
No increase in cortisol level after ACTH stimulation test is what?
Primary adrenal insufficiency (Addison’s Disease)
What does the labs for tertiary adrenal insufficiency look like?
decrease cortisol
normal aldosterone
ACTH levels increase after CRH injection
Tertiary adrenal insufficiency
What is the MC cause of tertiary adrenal insufficiency?
sudden withdrawal of glucocorticoid therapy
What is the mechanism of Addison’s disease?
destruction of adrenal cortex resulting in loss of cortisol production
What is the screening test for Addison’s disease?
High dose ACTH (cosyntropin) stimulation test
What is the treatment for Addison’s disease?
Glucocorticoids + Mineralocorticoid (Hydrocortisone + Fludrocortisone)
What is the treatment of 2ndry adrenal insufficiency?
Glucocorticoids (Hydrocortisone 1st line, Prednisone, Dexamethasone)
What is the treatment for Adrenal (Addisonian) Crisis?
IV fluids, IV hydrocortisone, glucose,
What symptoms are seen in Addison’s?
Hyperpigmentation, Orthostatic hypotension (syncope, dizziness), hyponatremia, hyperkalemia, metabolic acidosis, hypoglycemia, decrease sex hormones in women (loss of libido, amenorrhea, loss of hair)
Mechanism of Cushing Syndrome?
s/s due to prolonged exposure to excess cortisol
What are symptoms seen in Cushing?
buffalo hump, moon facies, pigmented striae, obesity, hypertension, hypokalema
Diagnosis of Cushing?
Dexamethasone supression test
Suppression of cortisol =
Cushing’s disease
No suppression=
Cushing’s syndrome
Treatment for Cushing disease?
Transsphenoidal surgery
What two medications can be used if a adrenal tumor can’t be removed?
Ketoconazole or Metyrapone
4 Medications that cause Addison’s?
Ketocanzole, Rifampin, Phenytoin, Barbiturates
What causes Type I DM?
Autoimmune
Whom do Type I DM occur in?
young people before school age or near puberty
What is Dawn Phenomenon?
normal glucose until rise of serum glucose between 2am-8am. Results from decreased insulin sensitivity and nightly sure of counter regulatory hormones
What is Somogyi effect?
Nocturnal hypoglycemia followed by rebound hyperglycemia due to surge in growth hormone
What is insulin waning?
progressive rise in glucose form bed to morning
What are the symptoms of Diabetic Ketoacidosis?
fruity breath, weight loss, rapid respirations, hypotension
What is the treatment for DKA?
Large volume IV fluids (normal saline), Insulin IV pump
A random glucose of what is dx for DM?
200mg/dl w/ classic symptoms
A fasting glucose of what is dx for DM?
> 126 mg/l on more than one occasion
A HGB A1c represents of what is dx for DM?
6.5% or higher
What is the treatment of Type I DM?
Dietary control + insulin
What is the A1C goal of Type I DM?
< 7
What is the BP goal for DM?
<140/90
All DM pts 40-75 should take a?
statin
What are the 4 diagnostic criteria for DM?
Random glucose > 200
Fasting glucose > 126
2 postprandial glucose > 200
HgA1c >6.5%
How does Metformin work?
decreases hepatic glucose production and increases peripheral glucose uptake
What is the side effect of Metformin?
lactic acidosis
What is the mechanism of Sulfonylureas?
stimulates pancreatic beta-cell insulin release
What is the side effect of Sulfonylureas?
hypoglycemia and weight gain
What is the mechanism of Thiazolidinediones?
increases insulin sensitivity in peripheral receptor site adipose and muscle
What is the sde of Thiazolidinediones?
fluid retention and edema
What labs are seen in hyperthyroidism?
Decrease TSH
Increase free T4 or T3
Sometimes radioactive iodine uptake
What is the initial dx used for hyperthyroidism?
TSH
What test is used after TSH to confirm hyperthyroidism?
Radioactive iodine uptake
What is used to treat cardiac symptoms of Graves disease?
beta blockers (atenolol)
What are the two antithyroid drugs used to treat Graves disease?
Methimazole and Proylthiouracil (PTU)
What med is used in preggo with Graves?
PTU
What symptoms are seen in Graves?
heat intolerance, weight loss despite increased appetite, exopthalmos, nervousness, sweating, pretibial myxedema, goiter with a bruit
What are the labs in hypothyroidism?
Increase TSH
Decrease free T4
What is the most common cause of hypothyroidism?
Hashimoto’s thyroiditis
Hashimoto’s is confirmed by what?
Antithyroid peroxidase (TPO) antibodies
What two other associations are seen with Hashimoto’s?
Anemia and high cholesterol
Treatment for Hashimoto’s?
Thyroid replacement hormone therapy (Oral T4) L-thyroxine
What is the preferred txt for Hashimoto’s?
Oral T4 L-thyroxine, Levoxyl, Synthroid
What are complications of Hashimoto’s?
Hashimoto encephalopathy, goiter, heart failure, depression decreased libido, myxedema
What symptoms make up the Thyroid storm?
Fever, tachycardia, delirium
What disease has discrete areas of high uptake?
Toxic multinodular
What antibodies are seen in Graves?
Anti-thyrotropin antibodies
Thyroidectomy mostly likely complication is?
recurrent laryngeal nerve (hoarseness)
What is the recommendation for PTU?
given only in the FIRST TRIMESTER! switch to methimazole for the rest of pregnancy
What is the sde of PTU?
liver damage
What are the symptoms of Hashimoto’s?
cold intolerance, fatigue, constipation, depression, weight gain, bradycardia
