Endocrinology & Metabolism Flashcards
Diabetes, Hyperthyroidism, Hypothyroidism, Osteoporosis
What are the 4 most common cause of unintentional weight loss (general)?
- Malignancy
- chronic infections
- GI disorders
- psychiatric conditions
How is unintentional weight loss evaluated?
(Labs & Imaging orders)
- Labs: CBC, CMP, thyroid panel
- Imaging: CXR, abdominal CT (if malignancy suspected)
What are complications of unintentional weight loss?
Malnutrition, functional decline.
DM is diagnosed when HbA1c is greater than… OR Fasting Glucose is greater than…
- 6.5%
- 126 mg/dL
(prenatal uses OGTT and is dx with glucose > 200 mg/dL)
First Line Tx for DM
lifestyle always! then Metformin
What are the complications of DM?
- Microvascular → Retinopathy, Nephropathy, Neuropathy
- Macrovascular → Coronary Artery Disease (CAD), Stroke
When does screening for DM begin?
45 y/o
(sooner if obese, family hx, HTN or PCOS)
Diabetic Retinopathy → Fundoscopic exam shows …
cotton-wool spots, hemorrhages
(microvascular vessel damage)
Diabetic Neuropathy →… (3)
- Stocking-glove pattern
- gastroparesis
- foot ulcers
What are the macrovascular (Large vessel damage) changes/complications of DM?
- Heart → CAD, MI (DM = equivalent to CAD risk!)
- Brain → Stroke (2-4x increased risk in diabetics)
- Peripheral Vascular Disease → Claudication, gangrene, amputation risk
Metformin (Biguanide) → Decreases hepatic glucose production, NO hypoglycemia. What is the life-threatening side effect to look out for?
auses lactic acidosis (avoid in CKD)
(weight neutral, contraindicated in CDK)
What are the two classes of diabetes meds that promote weight loss?
SGLT2 inhibitors (Empagliflozin) & GLP-1 agonists (Liraglutide)→ SGLT2 causes glucose loss in urine, GLP-1 slows gastric emptying & suppresses appetite
What diabetes drug class increases insulin secretion and causes hypoglycemia?
Sulfonylureas (Glipizide, Glyburide) → Stimulates pancreas, but causes hypoglycemia & weight gain
Which diabetes medication should be avoided in CHF due to fluid retention?
Thiazolidinediones (Pioglitazone) → Increases insulin sensitivity, but causes edema & CHF exacerbation.
(remember PPAR-g in the “glitter-zone”)
What is the best oral diabetes medication for patients with CKD?
DPP-4 inhibitors (Sitagliptin) → Less potent, but safe in kidney disease.
What is the main difference between DKA & HHS?
- DKA a/w Type 1, ketones & acidosis
- HHS a/w Type 2, very high glucose, no ketones, no acidosis
(tx both w/fluids. DKA: give insulin and K+)
How do you treat DKA?
IV Fluids → Insulin → Potassium replacement (watch for hypokalemia!)
(HHS is just treated w/fluids)
Why is potassium replacement critical in DKA treatment?
Insulin drives K+ into cells, causing life-threatening hypokalemia if not replaced.
(DKA tx = IV Fluids → Insulin → Potassium replacement)
When do you start insulin in Type 2 Diabetes (4)?
- A1c >10%
- maxed-out orals
- symptomatic weight loss
- hospitalizationan
(remember how mad dad’s doctor was when his A1c was 12%?!)
What are the 4 types of insulin and their use?
- Rapid-acting (Lispro, Aspart) → Mealtime insulin
- Short-acting (Regular) → DKA (IV), inpatient use
- Intermediate-acting (NPH) → Twice-daily basal insulin
- Long-acting (Glargine, Detemir) → Once-daily basal insulin
What is the insulin protocol for DKA treatment (4)?
- IV Regular Insulin (First-line)
- Switch to subQ Basal Insulin once anion gap closes
- Always check & replace K+ before giving insulin
- If glucose <200 but still acidotic → Add dextrose & continue insulin
How do you differentiate causes of hyperthyroidism using the radioactive iodine uptake (RAIU) test?
- ↑ Utake (Diffuse) → Graves’ Disease
- ↑ Uptake (Nodular) → Toxic Adenoma or Multinodular Goiter
- ↓ Uptake → Thyroiditis, Exogenous Thyroid Hormone Use
HypERthyroidism/GravEs Diz is caused by… Abs..
HypOthyroidism/HashimOtOs diz is caused by… Abs.
HypERthyroidism/GravEs = TSH receptor Abs
HypOthyroidism/HashimOtOs = Anti-TPO Abs
(TSH ticklers, TPO destrOyers)
When is Methimazole used for hyperthyroidism
1st-line, except in 1st trimester pregnancy (use PTU instead, PTU also used for thyroid storm)
(definitive tx: radioactive iodine ablation OR thyroidectomy)
When is PTU used in hyperthyroidism?
1st trimester pregnancy & thyroid storm
Thyroid Storm sx
(Myxedema Crisis is the opposite = Severe hypOthyroidism)
- Fever
- Tachycardia
- AMS
- HTN Crisis
(Tx= PTU, Beta-blockers, IV Steroids)
Tx for thyroid storm (3)
- PTU (also used in 1st trimester of pregnancy)
- Beta-blockers
- IV Steroids
(Thyroid Storm sx = Fever, Tachycardia, AMS, HTN Crisis)
3 complications of hyperthyroidism
- thyroid storm
- A-Fib (high-output HF risk!)
- osteoporosis (chronic hyperthyroidism = increased bone turnover)
Myxedema Crisis (Severe Hypothyroidism) sx (3)
(don’t confuse w/pretibial myxedema which is a hypErthyroid sx)
- Hypothermia
- Hypotension
- Bradycardia
(ICU Treatment)
When do you do screening for Hashimotos (2 groups)?
- All Women >60
- Younger if risk factors (Family history, autoimmune disease, previous radiation, pregnancy, lithium use, amiodarone use)
difference between myopathy in hypOthyroidism/HashimOto and hypErthyroidism/GravEs?
HypOthyroid/HashimOto = mucle edema/myoedema and increased CK
(both have muscle weakness)
DEXA scan T-score less than … = Osteoporosis
(and/or fragility fx)
≤ -2.5
(bone mineral density is used for screening in asymptomatic patients)
Labs to rule out secondary causes of osteoporosis (4)
- Vitamin D deficiency (25-hydroxyvitamin D level)
- Hyperparathyroidism (PTH level)
- Hyperthyroidism (TSH)
- Multiple myeloma (serum protein electrophoresis if suspicious)
1st-line agents that tx osteoporosis (T score < 2.5)
- Zoledronic acid
- Risedronate
- Alendronate
3 Rx AE of bisphosphonates?
- Esophagitis (must take and stay upright for 30 min to avoid)
- Atypical fractures
- Osteonecrosis of the jaw
Rx for Osteoporosis in pateints w/established CKD
Denosumab (RANKL inhibitor)
Indication for Teriparatide (PTH analog)
T-score < -3.5 or multiple fractures
(severe osteoporosis)
When is Raloxifene (Selective Estrogen Receptor Modulator - SERM) indicated?
for postmenopausal women who can’t take bisphosphonates
(can’t take them if GI issues, CKD. Used b/c this group of patients is at risk for breast cancer)
