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Flashcards in Endocrine Deck (70):
1

define Diabetic Ketoacidosis (DKA)

Glucose is not available for the body to use as energy, so instead, fat is used for fuel, producing
byproducts - ketones.

2

most common Precipitating factor of DKA

infection, missing insulin, or unknown

3

Dehydration, Acetone smell on breath, Abdominal tenderness, Tachycardia/hypotension/shock, AMS, Kussmaul respirations and Coffee ground emesis

DKA

4

dx of DKA

Glucose level >250mg/dL
● Bicarbonate

5

management of DKA

1. fluids to dilute sugars
2. give potassium
3. know that sodium will be falsely low

6

role of insulin in DKA

Start 0.1 units/kg/hr IV drip. don't worry about returning glucose to a normal level, instead focus on stoping DKA

7

Drugs can cause glucose intolerance

Glucocorticoids, anti-hypertensives

8

how do you dx DM?

two different accounts of fasting glucose >126, or random glucose >200 + symptoms or A1C >6.5

9

is DKA an acid or base disorder

acidosis

10

complications of DKA therapy

hypoglycemia, cerebral edema!!!!!

11

Sulfonylureas

Squeeze-stimulate pancreas to release more insulin

12

Biguanides

(bite) suppress hepatic gluconeogenesis

13

Thiazolidenediones (TZDs)

Increases sensitivity to insulin

14

Glipizide®, Glyburide®

sulfonylureas

15

Actos®, Avandia®

Thiazolidenediones

16

Metformin®

Biguanides

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SE of sulfonylureas / Glipizide®, Glyburide®

hypoglycemia

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SE of biguanides / Metformin

GI issues and Can cause lactic acidosis

19

SE of Thiazolidenediones ( actos and Avandia)

hepatitis & edema

20

Incretins:

Hormones released by small intestine enteroendocrine cells in response to dietary glucose, delays gastric emptying.

21

names of incretins (they end in TIDE)

GLP-1 analogs [GLP-1 receptor agonists]):
Albiglutide (advantage: once-weekly dosing)
Exenatide (synthetic version of exendin-4 found in Gila monster saliva!; extended release version is also once-weekly dosing)
Liraglutide (advantage: once-daily dosing)

22

Main disadvantage of incretins

must be administered by subcutaneous injection and cause GI SE

23


● Main risks:

pancreatitis, thyroid C-cell tumors

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when are incretins used

incretin mimetics are recommended as potential 2nd
line treatment options to add to metformin (or other agents, including insulin) in
patients not achieving glycemic goals

25

we can block the enzyme that breaks down incretins using;

“DPP-4 inhibitors”

26

gliptins):
o Sitagliptin
o Saxagliptin
o Linagliptin
what are these?

DPP-4 inhibitors

27

Sodium-glucose linked transporter (SGLT): effect

proximal tubule of the kidney

28

Dapagliflozin
o Canagliflozin
o Empagliflozin
what are these

Sodium glucose linked transporter, add on has 2nd of 3rd therapy with metformin

29

medications that contribute to hypercholesterolemia

thiazides, glucocorticoids, beta blockers

30

ANY condition that results in excess thyroid hormone

Thyrotoxicosis (ex: Graves disease, toxic goiter, thyroiditis, medication ingestion)

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Thyroid Storm

A life-threatening condition that develops from untreated thyrotoxicosis induced by trauma or infection

32

test findings for hyperthyroid

Low TSH
● Usually elevated free T3 and/or T4

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fine tremor, hypereflexia, Proptosis/Pretibial myxedema
○ Lid Lag

Graves (autoimmune)

34

treatment of hyperthyroidism

Propylthiouracil/Methimazole : Blocks new hormone synthesis & Iodides: SSKI (saturated solution of potassium iodide) Blocks release of preformed hormone, must give PKU first then give iodide.

● Blunt systemic effects (medications) Beta-blocker: Propranolol (stops the conversion of T4 to T3)

○ Glucocorticoids: Prevent conversion of T4 to T3

● Prevent decompensation
○ Aggressive IV fluids
○ Dextrose containing solution (high metabolic demand)
○ Cooling blankets, ice packs
○ Acetaminophen
DON'T GIVE ASPIRIN (increases release of thyroid hormone)

35

painful causes of hypothyroidism

Subacute thyroiditis
○ de Quervain’s
○ Pain may radiate to ear
○ Viral and self-limited

Bacterial thyroiditis
tx with antibiotics

36

Thyroid Nodules management

FNA only 5% are cancerous

37

most common thyroid cancer

papillary

38

how do you dx

Hyperparathyroidism

get PTH level

39

treatment of hyperparathyroidism

Surgery
● Treat hypercalcemia
○ IV Fluids
○ Lasix (after fluids)
○ Bisphosphonates
○ Calcitonin (short lived)
○ Steroids

40

hypoparathyroidism due to no parathyroid glands

DiGeorge syndrome

41

tx for hypoparathyroidism

Calcium
● Vitamin D

42

most common cause of Adrenocortical Insufficiency

autoimmune

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crisis Adrenocortical Insufficiency is induced due to???

infection, stress

44

Orthostatic hypotension & Hyperpigmentation

addison's dz

45

Obesity, hypertension, increased thirst
● Proximal muscle weakness is clue
● Pigmented abdominal striae
● Oligomenorrhea, amenorrhea, erectile dysfunction
● Impaired would healing, fractures
● Psychiatric symptoms

cushing dz ( looks like too much steroid)

46

dx of cushing

1. High urine cortisol
2. Overnight dexamethasone suppression test - will have high cortisol

47

difference between cushing syndrome and disease

Disease: only high dexamethasone suppression test will decrease ACTH
Syndrome: if its an adrenal tumor, low dexamethasone suppression test will decrease ACTH

48

Acromegaly/Gigantism due to too much

growth hormone (pituitary tumor)

49

Acromegaly/Gigantism may be associated to

MEN syndrome

50

dx of acromegaly/gigantism

MRI for pituitary tumor
● Prolactin, Growth hormone, Insulin-like growth factor 1 (IFG-1)

51

Cushing’s disease tx

resection

52

cushing disease syndrome tx

depends on size of tumor and level of cortisol

53

tx of acromegaly

Adenoma resection
● Somatostatin for refractory cases
● Pegvisomant normalizes IGF-1 in 90% of cases

54

Pituitary Dwarfism

lacking growth hormone--hormone replacement

55

deficiency of vasopressin (ADH)

Diabetes Insipidus (Central) you pee a lot!!

56

symptom of Diabetes insipidus

Intense thirst
● Craving for ice water
● Large volume polyuria
● Unremitting enuresis may be present in partial disease

57

dx confirmed

Central DI can be confirmed with vasopressin challenge test

58

Treatment

Desmopressin acetate

59

addision crisis can be caused by

primary at the adrenals, secondary at the pituitary (ACTH) or tertiary at the hypothalamus (CRH)

60

tx of addison's dz

replacing the absent hormones (oral hydrocortisone and fludrocortisone

61

Patient has Hyperkalemia, hyponatremia Hypoglycemia
● Hypercalcemia
● Low BUN
○ Low am cortisol
● High ACTH

addison's crisis

62

what is cushing dz

Cushing's syndrome is caused by either excessive cortisol-like medication such as prednisone or a tumor that either produces, or results in the production of excessive cortisol by the adrenal glands.

63

These patients present with hypertension, hypernatremia, and hypokalemia due to the effects of aldosterone on the body.

primary hyperaldosterism

64

As a coronary heart disease equivalent, type 2 diabetes should be managed with a goal of LDL

65

Nocturnal spikes of ___________secretion are the most likely mechanism of the dawn phenomenon

growth hormone

66

another name for Acantholysis is

Nikolsky’s sign’

67

what two hormones are produced by the posterior pituitary

Vasopressin (ADH) and oxytocin are the hormones produced in the posterior pituitary

68

the most likely diagnosis is a prolactinoma, what is the surgical procedure if medical therapy has failed

Trans-sphenoidal resection

69

A 66 year old male that is receiving corticosteroid replacement therapy because of Addison’s disease is scheduled for a total knee arthroplasty for next week. Which of the following is the best course of action for this patient’s treatment?

Stress dose steroids on the day of surgery

70

Rosiglitazone is a thiazolidinedione that is used to increase the body’s sensitivity to insulin’s effects. Biggest side effect?

Hard on liver