Tests And Stuff Flashcards
Primary hyperparathyroidism Labs:
Serum Cal: high
iCal: high
iPTH: high
Serum phosphate: low
S/s of congenital adrenal hyperplasia
Virulization; salt wasting; ambiguous genitalia
Congenital adrenal hyperplasia is caused by what deficiency
21-hydroxylase enzyme (makes cortisol)
DI on physical exam:
Hydronephrosis and larger bladder
Hypoparathyroidism s/s
Laryngospasm/bronchospasm GI Neuro Psych \+chovesteks and trousseau’s sign
Iatrogenic adrenal insufficiency potential causes:
Etodimate
Ketoconazole
Adrenalectomy
RU-486
Common s/s post-parathyroidectomy surgery in hyperparathyroidism
“Hungry bones” and now pts getting waxing and waning hypocalcemia
adrenal insufficiency is comomonly caused by withdrawal from chronic use w/ these medications
Prednisone and dexamethasone (decadron)
Hypoparathyroidism on Labs:
Serum Cal: low
iCal: low
iPTH: low
Serum phosphate: high
Pheochromocytoma etiology
90% adrenal medulla tumors of chromaffin cells
Adrenal insufficiency workups
renal failure Low glucose Hyperkalemia Hyponatremia Metabolic acidosis
Adrenal etiologies with cushings and treatment
1- adrenal adenoma (MC); tx u/l laparoscopic adrenal resection
2 adrenal carcinoma; tx- open laparotomy with exploration
Hypopituitarism workup:
Labs: panhypopituitarism; MRI of pituitary
Hypoparathyroidism etiology
Iatrogenic
Autoimmune destruction
Hypomagnesiemia (reversible)
Central DI tx
DDAVP- synthetic ADH
Diet
Tx for symptomatic primary hyperparathyroidism
Parathyroidectomy
Hypoaldosteronism labs
Hyperkalemia
Hypovolemia
Non-metabolic acidosis
However pt. Asymptomatic presentation
Cushings test to localize the source of acth
ACTH serum level: elevated—>pituitary or ectopic source
(R/o adrenal autonomous secretion)
CRH serum level: elevated—>pituitary source
(R/o ectopic source)
Adrenal insufficiency CT reveals calcified adrenals:
TB
Meds for tx in hyperaldosteronism
CCB and alpha blockade
Nephrogenic DI tx
Diet
Thiazide
Amiloride
Prolactinoma work-up
1- Labs: prolactin, pregnancy test, TSH
2- MRI w/ contrast
Hyporeninemic hypoaldosteronism tx
Thiazide and diet w/ low K
Secondary hyperparathyroidism treatment:
1- reduce phosphate foods
2- phosphate binders: need to be taken w/ meals
Calcium acetate (Phoslo)- CA
Selevamer (Renvela; Renagel): non-ca
Fosrenol (Lanthanum) non-CA, chewable and crushable (peg-tube pts)
3- Vitamin D agent:
Calcitriol (rocaltrol)- IV/oral (SC w/ HD appointments)
-Active form of vitamin D
Doxercalciferol (hectoral)- IV/oral
- metabolized to active form
Paricalcitol (zemplar)- IV/oral
- synthetic vitamin D analog; binds at receptor in kidney
4- Calcimimetic agent: Cinacalcet (Sensipar)
5- Surgical (as last resort): parathyoidectomy
Hypercalcemia treatment:
Mild (<12)
1- hydrate
2- avoid drugs that worsen (lithium and thiazide)
3- avoidance of factors that worsen (bed rest/immobility)
Severe (>12)
1- bisphosphonate IV (zometa) and IV fluids!!
Labs in adrenal insufficiency
Low glucose Hyperkalemia Renal failure Low sodium Metabolic acidosis
Cushing’s syndrome test:
1- dexamethasone test 2- salivary cortisol test 3- random urinary free cortisol test 4- ACTH 5- CRH 6- MRI w/ contrast
Hypoparathyroidism tx
1- IV calcium gluconate—> normal levels Also high oral calcium intake and vitamin D supplements 2- thiazide diuretics 3- recombinant PTH (natpara) —> BBW for osteosarcoma
Hypocalcemia s/s
Parasthesias (oral and hands/feet)
Prolonged QT
Sz
Tetany/muscle spasms
Hyperaldosteronism workup:
- Aldosterone to renin ratio w/ patient standing 2+ hours
- MRI w/ contrast
Hypoaldosteronism MC associated with these diseases
Diabetic nephropathy and chronic tubulointerstitial kidney dz
Pituitary Metasteses cancers and survival length
Metastasize to the posterior pituitary—> diabetes insipidus
~ 6 months
- breast, lung, & GI
MC cause of hyperglycemia in outpatients and MC etiology
Primary hyperparathyroidism
Single autonomous parathyroid adenoma
Diabetes Insipidus workup:
1- 24h urine collection
2- labs:
- ADH
- urine specific gravity (>1.005 is +)
- plasma & urine osmolality (<200 is +)
- serum electrolytes & glucose
3- water deprivation testing to see central vs. nephrogenic
Mc cause of Addison’s dz
Auto abs to adrenal
Prolactinoma Tx:
Aymptomatic: yearly MRI and observation
Symptomatic: Bromocriptine & surgical transphenoidal pituitary adenectomy
Tx of hypocalcemia
Mild: (1.0-1.2)
PO calcium
Calcium gluconate
Calcium chloride (only in central line or w/ emergency)
Severe- IV calcium (<1.0)
W/ symptoms—> 100-300 mg calcium IV over 5-10 minutes w/ continuous infusion at 0.5 mg/kg/hr
W/o symptoms—> 0.5 mg/kg/hr IV infusion (not to exceed 3-4 g over 4 hrs)
Monitor calcium levels Q4-6hours
Cushing’s Dx tests
1- Dexamethasone suppression test- in patient test
- 1 mg at 11p and measure serum cortisol @ 8a—> elevated or normal is likely cushings
2- salivary cortisol levels- easy test; at home
-saliva specimen at 11p—> high cortisol likely Cushing’s
3- random urinary free cortisol level
Cortisol>(3*creatinine) likely Cushing’s
Secondary adrenal dz workup
Screening test: serum cortisol levels (<25mg/dL is +)
Diagnostic: cosynotropin stimulation test (obtain baseline levels of aldosterone and cortisol; give 0.25 mg ACTH and measure aldosterone and cortisol levels—>low/unchanged is +)
MC cause of Diabetes insipidus w/ central etiology:
Idiopathic
- also malignant, surgery, or trauma
MC cause of Diabetes Insipidus w/ Nephrogenic etiology:
Meds: LITHIUM
- also, renal dz, pregnant, osmotic diuresis
MC cause of adrenal insufficiency
Addison’s dz
Primary treatment of cushings:
transphenoidal surgery (high success rate)
Secondary adrenal dz presenting differences:
No salt cravings
All endocrine hormones affected
No hypigmentation
Medical tx w/ ectopic cushings
Ketoconazole
Hypocalcemia w/u
Labs: PTH, mag, creatinine , phosphate, vitamin D metabolites
Secondary hyperparathyroidism Labs picture:
Serum Cal: low
iCal: low
iPTH: high
Serum phosphate: high
Ectopic etiologies in cushings:
Carcinoid tumors: lung/GI (MC)
Neuroendocrine: pancreas; pheo; medullary thyroid cancer
Etiology of hypercalcemia of malignancy
Tumor release of a hormone-related peptide (PTrH) w/ low PTH; BLT and a Kosher Pickle
Dx for pituitary macroadenoma:
1- intitial screening test: random serum IGF-1
(+)—> elevated IGF-1
2- GH supression test:
- oral glucose load is given and GH level drawn at 120 min
- IGF-1 level>1ng/mL= (+) GH excess
3- thin cuts MRI w/ contrast
Tertiary hyperparathyroidism tx
MC w/ total or subtotal parathyroidectomy
Hypoituitarism tx:
1- ACTH= hydrocortisone 2- TSH replacement 3- FSH/LH= - fertility—> Men & women: gonadotropins - no fertility—> M: testosterone W: HRT (est and progest)
Hypercalcemia S/S
Skeletal muscle weakness
Easy fatig
Hypoaldosteronism from Primary adrenal deficiency tx
Fludrocortisone (Florinef)
Tx of choice for macroadenoma
1- transphenoidal microsurgery 2- pharm: - octreotide/lanteotide (somatostatin analog) - bromocriptine - pegvisomant (GH receptor antagonist)
W/u of hypercalcemia
1- confirm hypercalcemia (w/albumin test)
2- Check PTH
—> high: primary hyperparathyroidism
—> low, then require iPTHrP to check malignancy or vitamin D metabolites for granulomatous or vitaminosis
Adrenal insufficiency CT reveals enlarged adrenals:
Metastatic dz
MC cause of hypercalcemia in hospitalized patients
Hypercalcemia of malignancy
Cushings first line Imaging test
MRI w/ contrast
Hypercalcemia of malignancy tx
IV bisphosphonate
FLUIDS
Hyperaldosteronism labs:
Hypokalemia
Hypervolemia
Hypernatremia
Metabolic alkalosis
hyperaldosteronism tx
Adenoma?—> U/L adrenal resection
Hyperplasia?—> aldactone (spironolactone): aldosterone antagonist
Tests for adrenal insufficiency
1- serum cortisol levels (<25 mcg=+)
2- cosyneotropin stimulation test (low or not changing=+)
Hyperaldosteronism etiologies:
Mc women 30-50
1- B/L adrenal hyperplasia (MC)
2- aldosterone producing adenoma
3- sometimes adrenal ca
Pheochromocytoma Dx test
24 hour creatinine urine test
Two pharm treatments for hypothyroidism:
1- levothryoxine (synthroid)
2- liothyronine (cytomel)
Inducers of thyroid pharm tx:
Phenytoin
Tegatrol
Rifampin
Phenobarbital
Inhibitors of levothyroxine
Delivery
Menopause
Oral estrogens
GnRH agonists
