Endocrine

Question 1

Lab values Hypothyroid vs Hyperthyroid

Answer 1

Hypo –> Low T4

Hyper–> High T4

TSH is opposite

Question 2

Symptoms Hypothyroid vs Hyperthyroid

Answer 2

Hypo –> Cold lizard (fatigue, weight gain, cold intolerance, depression)

Hyper –> Hot rabbit (palpitations, heat intolerance, sweating, anxiety)

Question 3

Hypothyroid causes

Answer 3

Hashimoto’s

Subacute thyroiditis

Iodine deficiency

Question 4

DM Diagnosis

Random glucose =
Fasting glucose =
Two-hour glucose =
Hemoglobin A1c (HbA1c) =

Answer 4

Random glucose > 200 mg/dL
Fasting glucose > 126 mg/dL
Two-hour glucose > 200 mg/dL (75 gm)
Hemoglobin A1c (HbA1c) > 6.5

Question 5

DM Complications

DKA can occur in ..?

HONK can occur in …?

Answer 5

DKA = DM1

HONK = DM2

Question 6

HHNS

Hyperosmolar Hyperglycemic Non-Ketotic State

• Symptoms
• Lab values
• Management
• Why are DM2 uniquely affected?
• How long does it take to develop?
• How long does it take to resolve?

Answer 6

• Polyuria, weakness, dec LOC, blurred vision, HA, seizures (same as DKA except no fruity breath, no kausmal resp)
• Glucose >600, Serum osmolarity >320, hypokalemia, Metabolic acidosis uncommon
• Fluid resucitate (avg 9L dehydrated), replete K+, slowly give insulin to prevent worsened hypokalemia
• Because DM2 still have a little circulating insulin there is no ketosis
• Devlops and resolves gradually over several days

Question 7

DKA

• Symptoms
• Lab values
• Management
• Why are DM2 uniquely affected?
• How long does it take to develop?
• How long does it take to resolve?

Answer 7

• Fruity breath, Kausmall breathing (shallow/rapid), dehydration, dec LOC, weakness, abdominal pain, n/v
• Glucose >250, Anion-gap metabolic acidosis, ketonemia, hyperkalemia, hypernatremia
• Fluid resucitate (avg 9L dehydrated), replete K+, slowly give insulin to prevent worsened hypokalemia
• Because DM1 have no circulating insulin there is glucagon release and ketosis
• Devlops and resolves rapidly in several hours

Question 8

Adrenal Insufficiency

• Symptoms
• Initial lab values
• ACTH level
• Etiology
• Management
• Anesthesia concerns

Answer 8

• Hypotension, Weakness, Salt craving
• Hyponatremia (bc absent aldosterone), Hypoglycemia (bc absent cortisol), low AM cortisol, Hypercalcemia, Hyperkalemia (bc absent aldosterone)
• ACTH
  
  • High: Primary Adrenal Insuffienciey
  • Low: Secondary Adrenal Insufficiency
• Primary Adrenal Insufficiency = Addison’s
  
  • Autoimmune, infection, malignancy
• Secondary Adrenal Insufficiency = Pituitary problem (ie some pituitary adenomas and Sheehan’s post pregnancy pitiutary necrosis)
• Tertiarty Adrenal Insufficiency = Hypothalamus problem (exogenous steroids)
• Management: give mineralocorticoid and glucocorticoid
• Anesthesia concerns: Adrenal crisis when body needs cortisol in response to stress but can’t get it. Death can occur.

Question 9

Hypercortisolemia = Cushings syndrome

• Most common cause
• Second most common cause
• Symptoms
• How to determine Cushing Disease vs Ectopic ACTH
• Management

Answer 9

• Most common is chronic exogenous glucocorticoids
• Second most common is Cushing’s Disease (pituitary adenoma)
• Symptoms: truncal fat, round face, buffalo hump, hypertension, hyperglycemia
• High dose Dex suppresion test (see picture). Cushing disease shows supressed ACTH. Ectopic ACTH adenoma shows unsupressed ACTH.
• Cushing Diseae = Remove pituitary adenoma
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