nephrology Flashcards
rx used for gastroparesis
prokinetic metoclopromide, erythromycin, cisapride
elevate T4 and low TSH + TPO Ab
Hashimotos thyroiditis, sx tx with Propranolol
Medullary thyroid cancer with elevated calcitonin. What more to check?
Could be part of MEN type 2a or 2b, associated with pheo so check urine catecholamines
Wt loss, tachycardia, tremor, lid retraction
Thyrotoxicosis - jacks up cardiac system with increased HR, HTN, pulse pressure and output
3 types of thyroiditis
chronic autoimmune, painless, subacute
Diffuse goiter, + TPO antibody, variable radioiodine uptake
Chronic autoimmune thyroiditis/Hashimoto
Hyperthyroid, painful/tender goiter, elevated ESR and CRP, low radioiodine uptake
Subacute thyroiditis
Cabergoline, Bromocriptine
Tx of prolactinoma
Why check serum protein electrophoresis (SPEP) in hypercalcemia
Would be + in MM
Hyperaldosteronism leads to hypo_____
HIGH aldosterone = HYPO kalemia
Aldosterone SAVES SODIUM, PASSES POTASSIU
chronic fatigue, weakness, weight loss, hypotension, hyperpigmentation/vitiligo, hyponatremia, and hyperkalemia with a low-normal cortisol level
primary adrenal insufficiency/ Addison disease
A girl comes in for a near syncopal event and is found to be hypotensive with hyperpigmentation in palmar creases. Labs show low sodium and high potassium. What test should you do to confirm the diagnosis?
Likely primary adrenal insufficiency/addison disease - ACTH test
Test for acromegaly
IGF-1
Tx for hyperprolactinemia
Dopamine agonist - Cabergoline or Bromocriptine
Suspect hypothyroidism, what is the most likely causes
Haushimoto Thyroiditis
5 causes of HYPERthyroidism
Graves disease Subacute thyroiditis Painless "silent" thyroiditis Exogenous thyroid hormone use Pituitary adenoma
Hyperthyroidism + proptosis and myxedema + elevated uptake or RAI
GRAVES DISEASE
Hyperthyroidism + tender thyroid
Subacute thyroiditis
MEN1
Pituitary Adenomas
Primary Hyperparathyroidism
Pancreatic/gastrointestinal neuroendocrine tumors
Symptoms of primary hyperparathyroidism
hypercalcemia - polyuria, kidney stones, decreased bone density
Types of Pancreatic/GI neuroendocrine tumors in MEN1
Gastrinoma
Insulinoma
VIPoma
Glucagonoma
A woman with known chronic hypotension and hyperpigmented skin comes in with abdominal pain, shock, fever, AMS
Acute adrenal crisis in PAI
Hyperthyroid sx + tender thyroid + postviral + low radioiodine uptake
Subacute thyroiditis
Why increase levo dose in women on estrogen containing BC, HRT, or pregnant?
Estrogen increases TBG decreasing the effective amount of thyroid
Irregular menses + hirsutism + weight gain
PCOS - weight loss, birth control, clomid
Fatigue, delayed reflexes, myalgias, proximal muscle weakness, elevated serum CK and ESR
hypothyroid myopathy
Pt has hypercalcemia - what lab to follow?
PTH to determine if hypercalcemia is PTH dependent or independent
Acute or severe illness + fall in total and free T3 levels with normal T4 and TSH
Euthyroid sick syndrome, “low T3 syndrome”
Medullary thyroid cancer, pheochromocytoma, marfanoid habitus, mucosal neuromas
MEN 2B
Are pts with chronic lymphocytic Hashimoto thyroiditis at increased risk for Thyroid lymphoma?
Yep
HTN, mild hypernatremia, metabolic alkalosis, suppressed plasma renin activity, +/- hypokalemia
primary hyperaldosteronism - hypokalemia sometimes doesn’t present until diuretic use
proximal muscle weakness, muscle atrophy, hyper/hypothyroid symptoms
thyroid myopathy
List two rxs that can be used for tx of hyperaldosteronism
eplerenone and spironolactone - block the effects of aldosterone
A pt has cushinoid appearance and has been using glucocorticoids chronically for years. Is it likely that this person has HPA disturbance with resultant central adrenal insufficiency?
Yes - measure morning cortisol (low) and ACTH (low)
What do you expect ACTH and Aldosterone to be in central vs primary adrenal insufficiency?
central = low ACTH and normal Aldosterone primary = high ACTH and low Aldosterone
Low K, high Na, high HCO3, high Aldo, low renin
primary hyperaldosteronism
Does hyperaldosteronism lead to metabolic alkalosis
yes
how to differentiate large vs small nerve injury in DM
small = positive symptoms like pain, paresthesias, allodynia large = negative symptoms like numbness, loss of proprioception and vibration, diminished ankle reflexes
test to differentiate central vs peripheral DI
demospressin after water restriction
3 different tests to use in initial evalution of Cushing syndrome
confirm hypercortizolism:
late-night salvary cortisol assay
24 hr urine free cortisol measurement
overnight low-dose dexamethasone test
