Medicine (Endocrine Disease) Flashcards
What are the two thyroid hormones, which is more active?
-T3 and T4
-T3 more active (T4 converts to T3 in liver/kidney)
-T3 must be in unbound form to be active
What is hyperthyroidism?
-A condition in which the thyroid gland is overactive, excessive amounts of thyroid hormone exposed to body tissues
What is the most common etiologies of hyperthyroidism?
-Graves disease
-Multinodular diffuse goiter
How does hyperparathyroidism present?
-Warm skin
-Sweating
-Tachycardia
-Palpitations
-Exophthalmos
-Heat intolerance
What is Graves disease?
-Autoimmune condition which results in hyperstimulation of TSH receptors
What is thyroid storm?
-Acute exacerbation of hyperthyroidism that is life threatening
-Patient induced into a hypermetabolic state caused by excessive release of thyroid hormones (dysrhythmias, MI, CHF, hyperthermia, high systolic/low diastolic pressure)
-Can be caused from surgical stress or illness
-Treat with supportive measures (cooling blanket, IV fluid, electrolyte correction), propranolol, sodium iodide
What is your patient management for hyperthyroidism patients.
-Consult with endocrinologist for optimization (ideally euthyroid state)
-Avoid ketamine, epinephrine, atropine, ephedrine
-Takes 8 weeks for anti-hyperthyroidism medications to take effect
What is hypothyroidism?
-Condition where thyroid gland has decreased production (myxedema)
What are the symptoms of hypothyroidism?
-Reduced metabolic activity, cold intolerance, weight gain
What are etiologies of hypothyroidism?
-Primary: Hashimoto’s thyroiditis, iodine deficiency
-Secondary: Hypothalmic or pituitary disease
What is hashimoto’s thyroiditis?
-Most common cause of hypothyroidism, autoimmune process of destruction of the thyroid gland
What is myxedema?
-Decompensated hypothyroidism characterized by hypoglycemia, hypercapnia, hypoventilation, hypotension, delirium
-Medical emergency
-Treated with IV doses of T3, T4
What is the patient management for hypothyroidism?
-Consult with endocrinologist for euthryoid state
-Consider increasing NPO time
-More prone to hypotension
-More sensitivity to anesthetic drugs
What is diabetes mellitus?
-A metabolic disorder which results in a defect in insulin secretion, action or both resulting in hyperglycemia
What is type I DM?
-Impaired production of insulin (insulin dependent diabetes)
-Autoimmune destruction of beta islet cells in pancreas
What is type II DM?
-Altered number and affinity of peripheral insulin receptors. May have decreased secretions as well.
What is the function of insulin?
-Increase uptake of glucose by cells
-Increase glycogen synthesis, decrease gluconeogenesis.
How is DM diagnosed?
-Fasting glucose >126 on 2+ occasions
-HgB A1C 6.5 or greater
-Non fasting glucose >200 with symptoms
-Glucose tolerance test
What are sequelae or DM?
-Peripheral neuropathy
-CAD
-Diabetic nephropathy
-Diabetic retinopathy
-
How does insulin work and what are the types used to treat?
-Promotes uptake of glucose into muscle, adipose and liver tissue
-Fast acting: lispro, aspart
-Short acting: Regular
-Intermediate: NPH, lente
-Prolonged acting: Glargine, levemir
What is metformin?
-Biguanide
-Decrease hepatic gluconeogenesis and decrease intestinal glucose absorption
-Risk of lactic acidosis
What is glipizide?
-Sulfonylurea
-Stimulate beta cell to produce insulin
-Risk of hypoglycemia
What is ozempic?
-GLP-1 agonist (exantide)
-Synthetic glucagon like peptide that stimulates insulin secretion and decreases glucagon synthesis
What is Januvia?
-DPP4 inhibitor
-GLP1 works better when DPP4 is inhibited
What is DKA?
-Metabolic condition secondary to insulin shortage.
-Hyperglycemia, ketonemia, and anion gap metabolic acidosis
How is DKA treated?
-Fluid rehydration
-Insulin gtt
-Manage hyperkalemia
-Bicarb
Why are diabetic patients more susceptible to post-op infections?
-Impaired chemotaxis and phagocytosis by monocytes and neutrophils
What is the function of the adrenal gland?
-Produces glucocorticoids, mineralcorticoids and androgens
-Produces norepinephrine and epinephrine
What is Cushing’s syndrome?
-Disease of excessive free plasma glucocorticoids
-Most common from chronic use of steroids
-S/s: Buffalo hump, weight gain, obesity, depression, muscle weakness, osteopenia
What is Addison’s Disease?
-Disorder of insufficient adrenocortical synthesis and secretion of glucocorticoids and mineralcorticoids
-Weakness, anorexia, arthralgia, hyperpigmentation, hypotension, hyponatremia/hyperkalemia
What is your patient management of Addison’s disease?
-Pre-op antibiotics
-Discuss with patient’s endocrinologist regarding stress dose of steroids to avoid adrenal crisis
-Check serum potassium pre-op
What is your patient management of Cushing’s syndrome?
-Concern for obesity (OSA, GERD)
-Concern for glucose intolerance (may need sliding scale glycemic control)
-Frail patient (osteoporosis)
What is adrenal crisis?
-A life threatening physiologic state brought about by major physical stress
-Severe circulatory collapse and hypotension not responsive to vasopressors
What are the causes of hyperparathyroidism?
-Primary: Adenoma or enlargement of the parathyroid gland
-Secondary: Hypocalcemia leading to excessive PTH
What are maxillofacial manifestations of hyperparathyroidism?
-Browns tumor (giant cell lesion)
-Loose teeth, altered eruption, root malformation
-Sialolithiasis
What are the causes of hypoparathyroidism?
-Surgically removed parathyroid gland, autoimmune process, DiGeorge’s syndrome
What are the manifestations of hypoparathyroidism?
-Enamel hypoplasia, malformed roots, missing teeth, paraesthesia of lip/tongue, muscle spasms
What happens with hypercalcemia/hypocalcemia (cardiac)?
Hypercalcemia: Short QT
Hypocalcemia: Long QT
