Endocrine 1 and 2

Question 1

Risk factors for Metabolic syndrome

Answer 1

Central adiposity- obesity Sedentary lifestyle genetics aging T2 DM Cardiovascular disease Lipid abnormalities

Question 2

clinical presentation of elevated glucose

Answer 2

polyuria polydypsia polyphagia rapid weight loss increased hunger/weight gain recurrent UTIs tingling pain numb extremities

Question 3

Criteria for diagnosis of T2 diabetes?

Answer 3

HbA1c >6.5% Fasting glucose >126 2 hr glucose >200 random glucose test >200

Question 4

Diabetic foot exam?

Answer 4

1/yr or each visit inspect for skin breaks red callused areas pallor dryness, palpate for pedal pulses, cap refill, temp, special test for sensation

Question 5

complications in other organs with poorly controlled diabetes T2?

Answer 5

eye kidney NS Cardiovascular Skin Teeth Genitourinary

Question 6

Clinical presentation of T1DM.

Answer 6

Polydipsia Polyuria Blurry vision Fatigue/Weakness Weight loss with hyperglycemia and ketonemia DKA-initial presentation 20/25%

Question 7

differentiate T1 and T2 diabetes.

Answer 7

T1:

• Presents in childhood
• Insulin secretion is deceased or absent
• Normal insulin sensitivity when controlled
• Insulin dependence permanent
• Pancreatic antibioidies

T2:

• Presents at puberty
• Insulin secretion varies
• Sensitivity decreased
• Dependence is variable
• No antibodies

Question 8

What is severe hyperglycemia and what disorders can come with this?

Answer 8

• Glucose higher than 250 mg/dL
• DKA: (more common type 1) insulin deficiency + glucagon excess leads to gluconeogenesis, glycogenolysis and ketone body formation in liver
• Hyperglycemia hyperosmolar state: (more common type 2) relative insulin deficiency + inadequate fluid intake resulting in severe dehydration
  
  • extra sugar in plasma goes to urine, water followos leading to dehydration, severe electrolye also

Question 9

How do you manage DKA and HHS?

Answer 9

Admit to hospital, generally need IV fluids, insulin and potassium replacememt. DO NOT treat as outpatient.

Question 10

Acute disorders with diabetes- what is Hypoglycemia?

Answer 10

• Most commonly caused by drugs to treat DM
  
  • prevalence of 70% in diabetics
• If patient is confused, altered mental status or siezures Glucose should be checked

Question 11

What are the cholinergic and adrenergic responses to hypoglycemia? If nothing is done about these what are the consequences?

Answer 11

Cholinergic:

• sweat, hunger, parasthesia

Adrenergic:

• palpitations, tremor, anxiety

Hypoglycemic unawareness, serious cardiovascular morbitdity/mortality. The person no longer feels these affects

Question 12

WHat is the most common cause of hypothyroidism in the US?

Answer 12

• Hashimoto’s thyroiditis- autoimmune mediated
• more prevalent in women
• Insidious onset
• may or may not have goiter

Question 13

Hypothyorid symptoms?

Answer 13

• Fatigue
• Weakness
• Dry skin
• Feeling cold
• Constipation
• Weight gain
• Changes in menses
• Puffy hands feet fafce (myxedema)
• Diffuse alopecia
• Hyporeflexia

Question 14

What will the lab results be for a person with Hypothyroidism?

Answer 14

• TSH will be elevated and T4 will be low
  
  • low T4=primary hypothyroidism

Question 15

Management for hypothyroidism?

Answer 15

• Replace hormone with thyroxine (T4)

Question 16

Causes of Hyperthyroidism?

Answer 16

• Graves disease
  
  • most common cause in the US, autoimmune
• Toxic multinodular goider
• Toxic adenomas

Question 17

Graves disesase signs?

Answer 17

• Hyperactivity/irritability
• Heat intolerance
• Palpitations
• Weight loss increased appetite
• Decreased menses

Keys:

• Tachycardia
• Tremor
• Goiter
• Warm moist skin
• Eyelid retraction -exopthalmos
• Hyperreflelxia

Thyroid is diffusely enlarged, firm, not nodular

Question 18

Lab results for hyperthyroidism? Management?

Answer 18

• TSH decreased
• High T4 or T3 (Primary Hyperthyroidism)
• Block thyroid hormone synthesis with anti thyroid drugs
• Remove thyroid tissue with radioiodine ablation or thyroidectomy

Question 19

Types of thyorid masses?

Answer 19

• Goiter: enlarged gland result of biosynthetic defects, iodine deficiency, autoimmune
  
  • leads to increaSed TSH stimulating thyroid growth
• Nodular disease: disordered growth of thyroid cells
  
  • benign or malignant growth
    
    • thyroid cancer most common malignancy of endocrine system
  • Nodules 3-7% by exam and 50% by ultrasound

Question 20

Parathyroid function & regulation?

Answer 20

• Maintain calcium levels in blood and tissues
• Incerased calcium decreases PTH
• Decreased Ca increasess PTH

Question 21

What are two examples of Hormone excess with the parathyroid galnds?

Answer 21

• Primary hyperparathyroidism
• Hereditary syndromes

Question 22

What is primary hyperparathyriodism?

Answer 22

• Autonomously functioning adenomas are 80% of the causes
• hyperplasia
• rarely cancer

Question 23

Primary HPT symptoms?

Answer 23

• Mostly asymptomatic
• Renal stones
• Abnormal bones
• Abdominal moans-pain, N/V, constipation
• Psychic groans- anxiety depression confusion
• Neuromuscular symptoms weakness, easy fatigue, atrophy

Question 24

What is the second most common cause of Primary HPT?

Answer 24

• Hypercalcemia of Malignancy
• usually symptomatic
• Calcium markedly elevated

Question 25

Labs for Primary HPT and management?

Answer 25

* Verify Ca, check PTH, * If abnormally high measure calcium excretion in urine * Check electrolytes twice to ensure elevation wasn't a lab error * Remove PTH glands

Question 26

Hypoparathyroidism?

Answer 26

* Most common occurs after damage or removal of PTH during a neck surgery * autoimmune pth destruction * rarely tissue resistance (psuedohypoparathyroidisim)

Question 27

Hypoparathyroidism signs?

Answer 27

* Uncontrollable painful spasms in face hands arms feet * Pins and needls hands feet around mouth * **Chvostek's sign: tap facial nerve and get facial musle contraction** * **Trousseau's sign: induction of carpal spasm by inflation of sphygmomanometer above systolic for 3 min, results in muscle spasm due to neuromuscular irritablity from hypocalcemia**

Question 28

Hypoparathyrodism labs and management?

Answer 28

* Labs: verify calcium check PTH, if abnormally low measure ca excretion in urine * Use medicatinos and dietary modification to increase calcium, no PTH replacements available

Question 29

Mineralocorticoids?

Answer 29

Regulate sodium and K handling in the kidney affecting BP and fluid volume

Question 30

Role of Glucocorticoids?

Answer 30

Aiding in glucose metabolism inflammatory and immune response to illness or injury and maintenance of BP and cardiac output

Question 31

Regulation of cortisol? disorders?

Answer 31

Hypothalamus-CRH Pituitary- ACTH Adrenal glands-Cortisol * Adrenal insufficiency can be primary or secondary * Excess- cushings disease

Question 32

Adrenal insufficiency?

Answer 32

Primary: * autoimmune destruction of adrenal gland **(Addison's)** * Destruction of gland by infection hemorrhage infiltration, metastases * Genetic diseases cause distinct enzymatic blocks in steroidgenesis Secondary: * Suppression of HPA axis from too much glucocorticoids exogenously given **(most common!)** * Hypothalmus or pituitary failure to release hormones

Question 33

Adrenal insufficiency symptoms in glucocorticod and mineralocorticoid?

Answer 33

Glucocorticoid deficiency: * fatigue * weight loss * hypogloloycemia * postural hypotension * low BP Minieralocorticoid deficiency: * salt craving * low BP and postural * Hyponatremia * Hyerkalemia * Hyperpigmentation (primary ONLY)

Question 34

Labs and management of adrenal insufficiency?

Answer 34

* ACTH stimulation then measure cortisol, if abnormally low measure plasma ACTH renin and aldosterone. * Primary: replace glucorticoids and mineralocorticoids * Secondoary: replace glucocorticoid

Question 35

What is Cushing's syndrome/disease?

Answer 35

* Cushing **Syndrome** =Hypercortisolism, chronic exposure to excess glucocorticoid from any etiology Causes: * ACTH dependent: pituitary adenoma producing too much ACTH resulting in excess cortisol (Cushings **Disease**) could also be ectopic secretion * ACTH independent: adrenocorticol adenoma or carcinoma * Iatrogenic: medical use of glucocorticoids for immunosuppression or treatement of inflammatory disorders **(most common!)**

Question 36

Cushing syndrome signs?

Answer 36

* Weight gain around abdomen * moon face, red cheecks * buffalo hump * purple stria in abdomen and breasts * thin arms and legs * easy bruising, hirituism * weakness * abnormal menses * decreased libido * emotional lability * depression

Question 37

Cushings syndrome labs and management?

Answer 37

* Dexamethasone suppression test and measure cortisol levels * Measure cortisol directly, either 24 hr urinie excretion or midnight plasma cortisol * If high measure plasma ACTH * Remove tumor in adrenal gland, pituitary, etc. * Block cortisol synthesis with meds

Question 38

Mineralocorticoid excess?

Answer 38

Aldosteronism: Conn's syndrome: * Most common-adrenal adenomas

Question 39

hallmark of aldosteroniosm?

Answer 39

HTN with low potassium and normal sodium

Question 40

Management of aldosteronism?

Answer 40

* Measure plasma renin and aldosterone if abnormal measure adrenal glands * Remove unilateral lesions surgically * Block excess aldosterone with mineralocorticoid antagonist

Question 41

Pheochromocytoma?

Answer 41

* Catecholamine producing tumors from symp or parasymp NS. Extremely rare * **Triad of symptoms: palpitations, headache, profuse sweating** * Dominant sign is HTN, usually its episodic * Management: remove turmor, localize turmor, measure catecholamines or metanephrines in urine or plasma

Question 42

Pituitary tumors?

Answer 42

* Usually pituitary adenomas * Common features are headaches and vision loss * Other symptoms depend on what hormone the tumor is ssecreting * Evaluate and manage: * Screen for endocrine functions * remove tumors * block hormone excess * monitor with imaging