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Hyper parathyroid

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%


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




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


Hypocalcemia periodic paralysis



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

Attila fib
Dec libido



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

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
Cardiac disease
Resp distress
Cold exposure
Drug use



Different types


Most common thyroid Dz


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

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


Tx: octreptodr and lanreotide
Dopamine agonists
Like cabergoline

Transsphenoid surgery good for very small tumors



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

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



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


too little cortisol
Addison's dz

autoimmune destruction of cortisol tissue

s/s: fatigue, weight loss, hyperpigmenation, hypotension , hyperkalemia,

dx: low sodium, high potassium, low BS, AM cortisol ( high is diagnostic)

tx: steroids
prednisone 2-40 mg po QD
hydrocortison 50-100 mg q 6 hour IV




cause HTN
tx; adregenric blocker or remove adrenal medulla


too high aldosterism ( coon's)

s/s: HTN, hypokalemia, mm weakness, dec renin

tx: aldosterone antagonist


Diabetes mellitus

- they are everywhere
dx; A1C > 6.5 %
FPG> 126 mg/ dl
2 hour plasma glucose > 200 mg / dl during GTT

sxs: hyperglycemia, random glucose > 200 mg/ dl

s/s: polyuria, polydipis, polyphagia, infection, weakness, lethargy numbness
RF: age, sedentary, ethnic groups, fix, gestation dm

FPG: 100-125
2 hour post glucose test > 140

A1c 5.7-6.4 %

screening: no RF- start 45 y/o and continue every 3 years
BMI > 35 - screening at age 35

T2DM- by the time they are diagnosed, they have had insulin resistance for the past 5-10 years
-damage is already is done


hyperglycemia -other causes

drugs ( steroids)
-beta blockers
-oral contraception


type 1

DKA- very sick
seen in kids
seen in illness
- fruity breath

s/s: rapid n/v, thirst, abd pain, sob

admit- mental staus, VS, aBg, plasma glucose

every 2 hours: electrolyte, U waves on ECG

tx; insulin and fluids and K

using insulin: start drip 1-2 units per hour
-gluse falls faster than ph can accommodate



- s/s: confusion, seizures, or coma
sever; AMC

cause: missed meals and snacks, insulin done error, exercise, drugs
too much ETOH

tx: D50 syringe, glucose gel, need to carry glucagon injection


Gestational DM

-risk for fetal developentand size

- inc risk for develop DM later in life

- screen all pregnant women 24-28 weeks

tx: glucoscan 4 x daly
diet education
insulin when diet not effective
start insulin when glucose> 95


chronic complications of DM

microvascular--> intensive control prevents progresosn

-eye disease- retinopathy


macrovacualr - use ASA or statin


diabete retinopathy

leading cause of blindness
-seen by opthalmo once a year


diabete neuropathy

autonomic dysfunciton- gastroparesis,urinary retention, impotence, fecal incontinence

silent MI


diabetes nephropathy

creatine 3-4- pt do poorly an do dialysis

- screen for early sign an check micro albumin


poor immune function

vaginitis, periodontiti, UTI

gram negative pneumonia
infected ulcers
gram negative ulcers


somogyi effect and dawn phenomena

too much evening insulin dose then BS drops too low --> signs of hypoglycemia will be hidden

glucagon kick in and glucose goes up in the AM ( don't given more insulin)


DM health maintenance

stop smoking
blood pressure: 140/80
Dilated eye exam annual
foot exam: every time

lab tests: lipids under control and monitor HA1c


Tx in DM

Type 1: insulin

Type 2: diet and exercise,
start on metformin
second dryg: sulfonurea, incretin class
insulin if no glycemic control, severe hyperglycemia fasting BG> 240

new drugs: nice b/c less and SE but not effective


hyperlipidemia screening

starts at age 25 in right risk miles, 35 in females

- do fasting

repeat every 3 years


metabolic syndrome

HDL 135/ 85
elevated triglycerides . 150
waist circumference> 35 F? 40 M

tx: LSM, activity for 30 mintues/ daily
reduce sat fats, trans fat, cholesterol

no real benefit from drugs


who should we treat?

- look at overall risk of CAD--> tx
start statin

if 10 year > 7.5 -treat
5.0-7.5- low does states

in DM- moderate statin therapy

SE statin: myopathy
switch among stating
trial of Co-enzyme Q10
alternate day dosing