MTB and important from FA 2 Flashcards
Panhypopituitarism - diagnostic tests - sodium
hyponatremia: common in 2ry hypothyroidism and isloated glucocorticoid underproduction
Panhypopituitarism - diagnostic tests - some older, less useful tests (only name them)
- Metyrapone: inhibits 11-beta hydroxylase –> decrease the output of the adrenal gland (normally increases ACTH
- Insulin stimulation –> normally increases GH
Panhypopituitarism - specific diagnostic test for TSH: standard blood test and confirmation
standard blood test: low tsh and thyoxine levels
abnormality confirmed with: decreased TSH response to TRH
Panhypopituitarism - specific diagnostic test for ACTH: standard blood test and confirmation
standard blood test: low ACTH + cortisol levels
abnormality confirmed with: 1. elevated baseline cortisol excludes pituitary insufficiency
2. No response with CRH
3. Normal respone to cosyntropin stimulation of the adrenal in recent disease, but not in chronic disease because of adrenal atrophy
Panhypopituitarism - specific diagnostic test for LH/FSH: standard blood test and confirmation
standard blood test: low LH, FSH and Testosterone levels
abnormality confirmed with: no confirmatory test
- maybe: no menstruation following administration of medroxyprogesterone
Panhypopituitarism - specific diagnostic test for GH: standard blood test and confirmation
standard blood test: Low GH levels (non helpful since GH is pulsatile and maximum at night)
abnormality confirmed with: 1. No response to arginin infusion 2. No response to GHRH
Panhypopituitarism - specific diagnostic test for prolactin: standard blood test and confirmation
standard blood test: low prolactin levels (not helpful)
abnormality confirmed with: no response to TRH
nephrogenic DI (NDI) - etiology
- few kidney diseases such as chronic pyelonephritis, amyloidosis, myeloma, or sickle cell anema disease will damage enough to inhibit ADH effect
- Hypercalcemia
- Hypokalemia
- drugs (lithium, demeclocycline)
The difference between central + nephrogenic DI is deermined by
respone to vasopressin (desmopressin)
(VASOPRESSIN STIMULATION TEST):
in central: urine volume will decrease and urine osm increase
in nephrogenic: no effect
nephrogenic DI - treatment
- trying to correct the UNDERLYING CAUSE
- hydrochlorothiazide
- amiloride
- prostagladin inhibitors such as NSAID
Laron syndrome - mechanism
Dwarfism: defective growth hormone receptor –> decreased linear growth
Laron syndrome - clinical feature
- short height
- small head circumference
- facies with saddle nose and prominent forehead
- delayed skeletale maturation
- small genitalia
methimazole and propylthiouracil -toxicity
- skin rash 2. agranulocytosis 3. aplastic anemia
4. hepatotoxicity (propylthiouracil) 5. teratogen (methimazol)
cinacalcet - mechanism of action / SE
sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ –> decreases PTH
SE: hypocalcemia
cinacalcet - clinical use
hypercalcemia due to 1ry or 2ry hyperparathyroidims
ADH antagonists
- demeclocycline
- conivaptan
- tolvaptan
demeclocycline - toxicity
- nephrogenic diabetes insibidus
- photosensitivity
- Abnormalities of bone and teeth
GH as a drug - clinical use
- GH deficiency
2. Turner syndrome
Oxytocin - clinical use
- stimulates labor
- uterine contraction
- milk let down
- controls uterin hemorrhage
octreotide - clinical use
- acromegaly 2. carcinoid syndrome 3. gastrinoma
4. glucagonoma 5. esophangeal varices (acute bleed) 6. VIPoma
Glucocorticoid drug without the typical name (prednisone, beclomethasone etc)
TRIAMCINOLONE
type 1 vs type 2 diabetes mellitus - genetic predisposition
type 1: weak (50% concordance in identical twins), polygenic
type 2: relatively strong (90% concordance in identical twins), polygenic
type 1 vs type 2 diabetes mellitus - association with HLA system
type 1: yes (HLA-DR3 and HLA-DR4)
type 2: No
normal glucose level
70-120 mg/dL
Diabetes is diagnosed as
AT LEAST ONE OF:
- Two fasting glucose measurements greater than 125
- single random glucose level above 200 mg/dl + symptoms
- above 200 2h after 76g oral gl load
- Hemogl A1c greater than 6.5 (BEST TO FOLLW RESPONSE TO THERAPY)
Diabetic ketoacidosis (DKA) - complications
- life treatening mucormycosis (Rhizopus infection)
- cerebral edema
- cardiac arrhythmia
- HF
most accurate measure of the severity of DKA
Serum biocarbonate -
Health maintenance - all patients with DM should receive ….
- Pneumococcal vaccine
- yearly eye exam (proliferative retinopathy - laser)
- statins if LDL above 100 mg/dl
- ACEi or ARB if BP greater than 140/90 or microalbuminuria
- Aspirin if age above 30
- foot exam (neuropathy + ulcers) (once a year)
- annually check for microalbuminuria
- once a year check for lipids
Cardiovascular complications of DM
increased risk of MI, stroke and CHF from premature atherosclererotic disease (that’s why the goal of BP is below 140/90, lower than in general population, and the LDL goal is less than 100 mg/dl)
complications of DM - kidneys
- diabetes leads to microalbuminuria early in the disease
- dipstick for urine becomes trace posotive at 300 mg of protein per 24 h (micro means 30-300 mg)
- Patietnts should be screen annually for microalbuminuria and started on an ACEi or ARB
complications of DM - GI / treatment
gastroparesis –> metoclopramide and erythromycin
DM - urine test?
In patients more than 10 years old who have had diabetes for more than 3 years, a urine microalbumin analysis will help assess kidney function. This should be checked annually.
initial treatment of hyperthyroidism in pregnancy
B-BLOCKERS:
Treatment should not be continued for a long duration given a low but serious risk of hypoglycemia, respiratory depression, and fetal growth restriction. Regarding definitive treatment for hyperthyroidism, this is dependent on gestational age. PTU is preferred over methimazole in the first trimester, but methimazole is recommended for all pregnant patients in the second or third trimester.
The best test that would establish REANAL artery stenosis
either MRA, CTA, or Doppler ultrasound.
metformin vs a-gycosidase inhibitors - flatulence
only a-gycosidase inhibitors
stop alcohol - decreases the risk of DM2
no
An impaired fasting glucose level
is one over than 100 mg/dL but lower than 126 mg/dL. Patients with glucose impairment who are overweight should be followed annually for the development of diabetes mellitus
Somogyi effect.
hyperglycemia following hypoglycemia in DM
If the dose of NPH insulin given at night causes the morning glucose level to be too low, then the body may release stress hormones in response, causing hyperglycemia. To correct for this effect, decrease insulin at night.
false HbA1c in DM
HbA1c must be interpreted with caution in patients with conditions that extend (iron, vitamin B12 or folate deficiency) or decrease (hemolytic conditions) the RBC lifespan.
extend –> increases HbA1c
decrease –> decreases HbA1c
The feared complications of hypocalcemia are
laryngospasm and QT prolongation.
metastatic tumor that causes CDI
very rare
Breast ca by far the MC
IGF measuring in acromegaly patients
for screening and and monitoring of treatment
thyroid nodule - RF for ca
men, cold, bhoarseness, over 60 or less than 30 years old, fast growth, painless
hypoglycemia - types
- reactive
- iatrogenic
- insulinoma
- fasting
- alcohol –> serum ethanol over than 45 mg/dl
- pituitary/adrenal insuficiency –> cortisol replacement
thyroid nodule treatment
- benign small cystic –> observe
- benign solid –> surgerym radioabl, T4 to decrease the risk of conversion
- malignant –> surgery and ablation
- radiation with local extension + chemo for metastasis
Familial hypocalciuric hypercalcemia
AD, defective Ca2+ sensing receptor –> hypercalcemia, hypocalciuria, mild hypermagnememia
distinguish with 1ry hyperthyr by checking urinary calcium
amiodarone-induced thyrotoxicosis
two types of amiodarone-induced thyrotoxicosis.
1. increased synthesis of thyroid hormone
2. excess release of T4 and T3 due to a destructive thyroiditis.
it can cause both hyper and hypothyroidism
clinical manifestations of amiodarone-induced hyperthyroidism are often masked because of amiodarone’s β-blocking activity
primary adrenal insufficiency in AIDS
CMV or TB adrenalitis
Acromegaly - snore
it can cause sleep apnea
metastatic tumor that causes CDI
very rare
Breast ca by far the MC
