Endocrinology Flashcards
↓ cortisol, ↑ ACTH and no increase in cortisol level after the ACTH stimulation test
↓ aldosterone and high plasma renin activity
Primary Adrenal insufficiency (addison’s disease)
↓ cortisol and ↓ ACTH, an increase in cortisol after ACTH administration
No increase in ACTH after a CRH injection
Secondary adrenal insufficiency (insufficient ACTH production_
secondary adrenal insufficiency is caused by…
pituitary macroadenoma
↓ cortisol and ↓ ACTH, an increase in cortisol after ACTH administration, but no aldosterone deficiency
ACTH levels increase after CRH injection
Tertiary adrenal insufficiency
decreased cortisol, normal aldosterone
What is the most common cause of tertiary adrenal insufficiency?
sudden withdrawal of glucocordicoids after cushings
fatigue, weight loss, and recurrent nausea and vomiting.
appears weak and has skin that appears abnormally tan.
blood pressure is 90/70.
hyponatremia and hyperkalemia
Addison’s disease (primary adrenal insufficiency)
primary cause of addison’s?
autoimmune destruction of adrenal cortex
Dx of addison’s?
high dose cosyntropin stimulation test
little to no increase in cortisol
Lab findings in addisons?
low sodium, low 8am cortisol
high ACTH, high potassium
Tx of addison’s?
PO hydrocortisone
Initial diagnostic for cushings?
24 hour urinary free cortisol
Dx for cushings?
dexamethasone suppression test - NO SUPPRESSION = CUSHING’s Syndrome
Cushings DISEASE cause…
pituitary adenoma (causes excess ACTH)
Normal glucose until 2-8 am when it rises. Results from decreased insulin sensitivity and a nightly surge of counter-regulatory hormones during nighttime fasting
dawn phenomenon
Nocturnal hypoglycemia followed by rebound hyperglycemia due to a surge in growth hormone
somogyi effect
3 Abs suggestive of T1DM
Insulin, GAD65, IA-2 Abs
Which T2DM Medication? (2)
stimulates pancreatic beta-cell insulin release (insulin secretagogue)
Sulfonylureas and meglitinides
Which T2DM Medication?
increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells
TZDs (glitazones)
C/I for TZDs…
CHF, liver disease, increase MI risk
Which T2DM Medication?
Delays intestinal glucose absorption
alpha-glucosidase inhibitors (acarbose, miglitol)
Which T2DM Medication?
lowers blood sugar by mimicking incretin - causes insulin secretion and decreased glucagon and delays gastric emptying
GLP-1 agonists (glutide)
Which T2DM medication?
dipetpidylpetase inhibition - inhibits degradation of GLP-1 so more circulating GLP-1
DPP-4 inhibitors
Gaves antibodies…
anti-thyrotropin Abs
Which hyperthyroid drug during pregnancy?
PTU
Abs in hashimoto’s…
antithyroid peroxidase Abs
antithyroglobulin Abs
