Endo Flashcards
Hyper parathyroid
Pathophys
Glands site back of thyroid and secrete pth and incr calcium
Stimulates kidneys to transform calcium and incr gi absorption of calcium
Benign adenomas cause 85%
Parathyroid gland hyperplasia causes 15%
Cancer 3%
F>m
S/sx:
Mild elevated calcium _> no sx
Severe hypercalcemia –> thirst anorexia n/v htn depressed dtr
Kidney stones, pain in bones, abd cramps, moans
Dx: cmp
Serum calcium > 10.5 and Phos 55
Elevated calcium with low pth indicates cancer
Very high pth and calcium parathyroid cancer
Imaging like ct and Mri for surgery planning
Screening: familial benign hupercalciuric hypercalcemia with 24 hour for calcium and creatinine before treating
Tx: no sxs hyper parathyroid : stay active, avoid bed rest , and drink lots of fluids
Avoid diuretics large doses of vitamin a and vit d and antacids with calcium
Monitor serum calcium and albumin levels , kidney function , urinary calcium and bone density
Bisphosphonates and IV hydration
Parathyroidectomy
Hypoparathyroidism
Causes: s/p parathyroidextomy, thyroidectomy , autoimmune , heavy metal, hypo magnesium ( alcoholics)
S/sx: tetany cargo pedal spasms muscle or abd cramps, parsthesias
Teeth nail and hair defects
Chvostek sign twitching of eyes mouth or nose muscles by tapping the facial nerve
Dx; decreased pth and adjusted serum calcium and incr phosphate level
Tx: correct hypocalcemia with calcium and vitamin d
Mag supplementation
Emergency tx for tetany; slow IV calcium
Thyroid storm
Rare life threatening
Extreme hyperthyroidism
Causes: rai therapy and pregnancy
S/sx: high fever, tachy, agitation? Sweating, tremor, instability, delirium, vomiting
Tx: icu
PTU - check lfts
IV sodium iodide
IV hydrocortisone
Propanalol
Hypocalcemia periodic paralysis
Hyperthyroidism
Types
Thyrotixicosis: too much t4 and t3 with low tsh
Graves : 80% of hyperthyroidism
Other causes; toxic multimodalar thyroid, hashimoto thyroiditis, pituitary tumor, pregger, too much iodine in diet, amiodarone
S/sx:wt loss, anxiety,tachycardia , menorah his, brittle nails, heat intolerance
Dx: high t3 and t4 and low tsh
Tx; beta blockers to control sxs
Propylthiouracil and methimazole
pTU for preggers
SE: arthritis lupus aplastic anemia thrombocytopenia and
MMi se serum sickness, cholestaric jaundice, alopecia and nephrotic syndrome
Check tsh 4-6 weeks after tx
Radioactive tx;?older pts or fail pTU or Mmi
Thyroidectomy : large obstructing glands, malignant modules, or preggers
Graves Dz
Pathophys: autoimmune attacking tsh receptors
Diffuse symmetric goiter
May coincide with thyroid cancer
Hyperthyroid sxs plus Eye changes ( lid lag, upper eyelid tetraction, protrusion/ bulging of eyes)
Dx: hyperthyroid labs Plus perioxidase antibodies and thyroglobulin antibodies
Radioactive uptake: shows increased uptake
Tx same as hyperthyroid
Complications Attila fib Osteoporosis Dec libido Gynecomastia
Hypothyroidism
Second most common endocrine disorder in us
Pathophys: autoimmune
Ab against tsh receptors antiperoxidase and and thyroglobulin
Associate with pernicious anemia , RA, sle
Causes: primary form- autoimmune thyroid like Hashimoto’s thyroiditis and end stage graves Dz
Other causes: gland shrinkage
Surgical thyroidectomy
Low iodine in diet
Lymphoma
Secondary : cancer to pituitary or hypothalamic
S/sx; weakness, dry hair, lethargy, slow speech, cold intolerance, constipation, depression
Large thyroid
Myxedema in tibia
Inc Risk for high cholesterol and cad
Dx: tsh
Normal or low normal free t4 and tsh is euthyroid
Low free and high tsh is primary hypothyroid
Low t4 and low or normal tsh means secondary hypothyroidism
Check anti thyroid peroxidase and anti thyroglobulin ab
Tx: synththroid replaces t4
Adjust dose every 4-6 weeks based on tsh values
Myxedema crisis
Severe hypothyroidism
S/sx: obtundation
And coma
Tx: icu
Thyroxine bolus
And hydration
Causes: injury Sepsis Cardiac disease Resp distress Cold exposure Drug use
Thyroiditis
Different types
Hashimoto’s
Most common thyroid Dz
F>m
S/sx: diffuse large thyroid with small nodules
Thyroid nodules
Most are a symptomatic
Only 5% are malignant
Types: follicular adenoma is most common type
Work up;
If low tsh –> hyperthyroidism and radionuclide thyroid scan
Cold nodules–> surgery
Hot nodules –> are functional
Us most sensitive test
Suspicious lesions–> fna
All nodules need to be monitored
Replace t4 to decr size
Thyroid cancer
Common in women
Worse px in men
Px depends on staging
Types:
Papillary ; most common least aggressive
Causes: genetic mutation or translocation
Follicular: mets to lungs brain and liver
Anaplastic: 1% elderly and deadly
Medullary: causes
RF: childhood rad tx to head and neck
Family hx
Gardner syndrome
men type 2
Presentation/ tx
Painless neck swelling and palpable firm nodule
Us done
Raiu - assessing risk for malignancy
Pet -check for mets
Tx: surgical resection
rai ablation for residual dz
T4 replacement for life
Too much growth hormone
Causes; benign pituitary adenoma
- ectopic tumors and MEN type 1
S/sx: gigantism prior to close of epiphyses - very rare
Acromegaly : long hands,feet, jaw, and int organs in adults
Adults have inc risk for dm htn and cad
Dx: screening with random IGF -1
If normal for age r/o acromegaly
If 5x /-> adenoma
And 1 hour glucose test
Mri
Tx: octreptodr and lanreotide
Dopamine agonists
Like cabergoline
Transsphenoid surgery good for very small tumors
Dwarfism
Achondroplastic dwarfs: most commo type of short limb dwarfs
Causes; failure to ossify cartilage
Ht: 4’4 male
- short limbs, long narrow trunks
, large heads
Delayed motor milestones
Intelligence is normal
Labs: mutation in the FGGR3
Tx: ortho surgery
Use of gh controversial
Diabetes insipidis
Insipid–> tasteless
Causes: deficicieny of or resistance of vasopressin
Primary DI: genetic or sporadic
Secondary DI: tumors , encephalopathy, surgery, head trauma, infection
Types: 4 types
S/sx: polydypsia, polyuria, and dilute urine
In
Intense thirst
Crave ice water
Large volume polyuria
Dx: serum osmolality is high
Urine osmolality is low
Bun low
Mir of pituitary
Tx; desmopressin acetate for central DI and DI associated
Mild cases no tx just hydration
Px is good
Diabetes mellitus
I
elevated cortisol
iatrogen Cushings syndrome - leads to adrenal insuffiecy at time of stress
medical emergency
treat with high dose steroids
ACTH screening adenoma of pituiary= cushion’s disease
s/s: too much cortisone’
buffalo hump, easy bruising, ,central obesity
lab: overnight low dos test or 24 hour urine
measure ACTH- distinguish and adrenal production of cortisol
if high ACTH: pituitary adenoma or ectopic( lung caner)–> high dose dex test
- pituitary adenoma- response
- ectopic source–> not response
tx: taper stoics,
pituiarty adenoma: surgery
adrenal adenoma or carcinoma: adrenalectomy
