Endocrinology Flashcards
1
Q
DM type I
A
- onset: slow in adults, rapid in children, autoimmune, Finland/Sardinia (by Italy)
- Type 1A: immune mediated, HLA associated, white, no FHx, autoantibody (+)
- Type 1B: idiopathic, AA/Asian, autoantibody (-), FHx
- sxs: 3Ps (polyuria, polydipsia, polyphagia), wt loss, infxn, nocturia, blurry vision
- dx: autoimmune markers, GAD65 autoAbs, islet cell autoAbs, insulin autoAbs, C-peptide low (no active insulin in body)
- tx: insulin pen, vial and basal bolus with carb counting, check gluc at least 4x daily
2
Q
DM type II
A
- insulin resistance: hyperinsulin at first, then hypoinsulinemic
- insulin resistance doesnt change - insulin secretion changes, B-cell decline gradual, def of amylin, def of GLP-1: stops glucagon, satiety, inc insulin release, postprandial gluc increases over time
- RF: first deg relative, age, obesity
- sxs: blurred vision, 3Ps, WIN, Acanthosis nigricans, ketonuria and wt loss (rare), fatigue, pruritus, recurrent candidal vaginitis, blurred vision, poor wound healing
- dx: randome glucose >200 (w/ sxs), fasting >126 (2+ occasions), HbA1C >6.5%, OGTT if fasting 100-125, diabetic dyslipidemia (high TGs, low HDL, altered LDL)
- tx: diet, exercise, wt loss, metformin
- goal of HbA1C = 6-6.5, FBS goal = 100-124, 1-2 PP (<180), screen annually
3
Q
dawn phenomenon and somogyi phenomenon
A
- dawn phenomenon: increased resistance to insulin in the early morning d/t counter-reg hormones
- tx: increase overnight basal insulin, exercise, metformin, TZD
- somogyi phenomenon: rebound fasting hyperglyc following undetected hypoglyc overnight, excess hunger, wt gain, worsening hyperglyc
- tx: dec overnight basal insulin or eat a snack at bedtime
4
Q
hyperthyroidism
A
- associated: afib
- subclinical hyperthyroidsim = low TSH, normal T3/T4
- sxs: anxiety, insomnia, irritability, palps, wt loss, heat intolerance, sweating, D, increased freq, oligomen, tremor, hyperactivity, tremulousness
- signs: moist skin, tachycardia, hyperreflexia, flushed, diaphoretic, wide pulse pressure
- dx: Primary hyperthyroid - TFTs (TSH low, total T3 high, free T4 high)
- autoantibody tests (antithyroid peroxidase Ab, TS-immunoglob
- scintigraphy (thyroid scan) - if etiology unclear after initial labs
- tx: propranolol, methimazole, propylthiouracil (can . use in preg and thyroid storm), RAI tx, thyroidectomy
5
Q
hypothyroid
A
- primary: failure of thyroid to produce sufficient T3 (iatrogenic - prior tx of hyper thyroid, hashimotos)
- secondary: hypothyroid dt pituitary dz, low TSH/free T4
- tertiary: dt hypothal dz (TRH def), low TSH/free T4
- associated: carpal tunnel syndrome
- sxs: constipation, fatigue, lethargy, weakness, wt gain, depression, menorrhagia, cold intolerance, cramps, slow mentation, inability to concentrate, dull expresion, m weakness, arthralgias, hoarseness
- signs: dry, rough skin, coarse hair, palpable enlarged thyroid, brittle nails, puffy face and eyelids, yellowing of skin (carotenemia), decreased DTRs
- dx: thyroid fn tests
- primary: high TSH (most sensitive)
- secondary: low TSH
- tertiary: low TSH
- free T4 low in clinically overt
- Ab testing, CBC (normocytic anemia MC)
- tx: levothyroxine (T4) → effects in 2-4wk →monitor TSH and clinical state periodically
6
Q
Grave’s dz (diffuse toxic goiter)
A
- 80%, metabolically active gland, MCC of hyperthyroidism, mostly younger women with other autoimmune conditions, Autoimmune (thyroid stimulating IgG Ab binds TSH receptors on surface o f thyroid cells triggering synthesis of excess thyroid hormone)
- sxs: pretibial myxedema, exophthalmos (periorbital edema, diplopia, or proptosis), thyroid bruit, diffusely enlarged, symmetric, nontender gland
- dx: measurement of thyroid Abs (anti-TPO high, TSI high), scintigraphy (diffuse uptake)
- tx: antithyroid meds, radioactive iodine preferred, saline eye drops and tight fitting sunglasses, high dose steroids with orbital decompresison surgery and ocular radiation tx for severe exophthalmos
7
Q
thyroid storm
A
- rare, life-threatening complication of thyrotoxicosis, acute exacerbation of hyperthyroidism
- precipitating factors: infxn, DKA, stress (trauma, surgery, illness, labor)
- sxs: marked fever, agitation, psychosis, confusion, nausea, vomiting, diarrhea, signs: tachycardia
- tx: supportive tx, antithyroid agents (PTU q2h, iodine), BB, dexameth (generates peripheral T3 from T4, adrenal support
- high mortality (20%)
8
Q
hashimoto’s thyroiditis
A
- MCC: autoimmune thyroid disorder and MCC hypothyroidism
- MC in F, genetics + FH common, slow decline in thyroid fn
- sxs: puffiness of face and . eyelides: periorbital myxedema, thinning of outer halves of eyebrows, goiter (MC feature) - hard, nonpainful, nontender, multinodular, irregular, asymmetric
- dx: antiperoxidase Abs (90% +), anti thyroglobulin . Ab, antimicrosomal Ab high, irregular I-131 on thyroid scan (not required to DX)
- tx: levothyroxine (T4)
9
Q
primary adrenal insufficiency (addison dz)
A
- chronic adrenocortical insufficiency
- adrenal gland does not produce cort, aldosterone, or sex hormones (retain no sodium), primary adrenal failure from autoimmune adrenalitis
- sxs: hyperpig dt increased ACTH, MSH (POMC), anorexia, abdominal pain, N, V, wt loss, lethargy, confusion, psychosis, weakness, malaise, postural HoTN, dizziness, salt craving
- signs: hypotension (orthostasis)
- dx: electrolytes (hyponat, hyperkalemia, hypoglycemia, hypercalcemia, elevated SCr), low serum cort, high ACTH, low aldo and high renin
- cosyntropin test = definitive (cort will not elevate sufficiently → test also known as astandard ACTH test
- tx: daily oral steroids (hydrocort, prednisone), daily fludrocort (mineralocort)
10
Q
secondary adrenal insufficiency
A
- long-term steroid therapy - most common cause overall, dysfunciton of hypothalamic pituitary . component of HPA axis: only steroid and androgen deficiency present
- sxs: hx of prior use of oral steorids shuts down adrenal axis and causes acute adrenal crisis when stopped (weakness, malaise, postural HoTN, lethargy, confusion, psychosis)
- sings: alabaster pale skin
- dx: electrolytes (hyponat, hyperkalemia, hypoglyc, serum cort low, serum ACTH low, nl aldosterone and renin, ACTH test → cort will not respond at all)
- tx: only daily steroid required
11
Q
addisonian (adrenal) crisis
A
- HoTN refractory to IV fluids or acutely ill pts with chronic steroid use (moon facies, buffalo hump), any stress can precipitate adrenal crisis
- sxs: fatigue, anorexia, generalized aches, weakness, lethargy, abd pain, N, V
- signs: severe HoTN (orthostasis)
- dx: hyponatremia, hyperK, hypoglyc, elevated SCr, metabolic acidosis, acute renal failure, cortisol low, ACTH stim test or cosyntropin test (cort will not elevate sufficiently)
- tx: IV hydrocortisone, fludrocortisone, IV fluids, monitor fluid intake and output, and serum K levels frequently
12
Q
cushing syndrome
A
- excessive exogenous cort, MCC = iatrogenic dt prescribed prenisone, androgen excess absent (exog steroids suppress production by adrenals), second MCC = ACTH secreting adenoma (AKA cushing dz) →bilateral adrenal hyperplasia (androgen excess common)
- sxs: striae, buffalo hump, central obesity, moon facies, lanugo, acne, easy bruising, proximal muscle weakness and wasting, osteoporosis, AVN of fem head, HA, depression, mani
- signs: HTN, DM, menstrual irreg, infertility, Cushing dz only = masculinization
- dx: HD dexamethasome suppression test, midnight serum cortisol, late night salivary cort, urinary free cort, CT or MRI, sustained elevated cort, hypoK, hyperglyc, glucosuria
- tx: if iatrogenic → taper steroids, if ACTH secreting adenoma, transphenoidal resection of tumor, adrenal adenoma → pit radiation, med adrenalectomy, bilateral adrenalectomy, ectopic ACTH production (2/3 SCC from lungs)
13
Q
hyperthyroidism in infants
A
- F>M, MCC in children is graves dz
- sxs: jittery, loose stool, worsening school performance, poor concentration, hyperactivity, fatigue, emotionally labile, nervous, personality disturb, insomnia, weight loss, palps, heat intol, sweating
- signs: tachycardia, tremor, proximal mm weakness, warm skin
- dx: TFTs, TSH low, total T3 high, free T4 high, autoantibody tests (antithyroid peroxidase Ab, TS immunoglobulin)
- tx: sxatic relief (propranolol relieves tachycardia, tremor, sweating, anxiety), anti-thyroid meds (methimazole, PTU)
14
Q
hypothyroidism in infants
A
- severe cretinism (congenital hypothyroid), mental impairment, AAP recommends screening between 2-4d of birth
- sxs: round face, hirsute forehead, large ant/post fontanelle, wide suture, protruding tongue, hoarse cry, distended abd, prolonged jaundice, lethargy, poor weight gain, constipation
- signs: dry skin, hypoactivity, poor feeding, mottling, hypothermia, poor muscle tone, macroglossia, hypertelorism
- dx: TFTs, serum TSH high (most sensitive), free T4 low, Ab testing, CBC (normocytic anemia MC)
- tx: levothyroxine
15
Q
heat and cold intolerance
A
- heat intolerance ddx: hyperthyroidism
- cold intolerance ddx: myxedema (hypothyroidism
- myxedema coma: rare condition, precipitating factors (cold exposure, infxn, trauma, narcotics)
- sxs: depressed state of consciousness, profound hypothermia, resp depression
- tx: supportive tx for BP and breathing, IV thyroxine, IV hydrocortisone
- high mortality rate (50-75%)
- myxedema coma: rare condition, precipitating factors (cold exposure, infxn, trauma, narcotics)
