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endocrine Flashcards

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1
Q

thyroid hormone fxn

A

T4 = 90%, T3 = 10% of production, also calcitoninaffects almost all body tissuesmaintains metab stability by regulating O2 reqs & metabprotein synthesis & catabolism (if x hormone)temp regimpacts CHO metab: enhances epi to stim glycogenolysis & gluconeogenesisaffects lipid metabolism (accelerates degradation of LDL)↑s AV node depol to ↑ HR↑s resp drive, mental alertness, GI motility

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2
Q

when hypothalamus releases TRH x2

A

in resp to ↓ circulating T3 & T4cerebral cortex resp to ↓ body T or cold

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3
Q

TRH & TSH impact

A
  • TRH: anterior pituitary → release TSH * TSH stimulates thyroid to release T3 & T4
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4
Q

thyroid hormones: secreted most vs active hormone

A

T4 secreted 90%unbound T3 is most active (90% from T4 deiodination)

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5
Q

hormone ↑ in primary hypothyroidism

A

TSH

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6
Q

hormone ↓ in primary hyperthyroidism

A

aka Graves DiseaseTSH

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7
Q

hormone ↑ in primary hyperthyroidism

A

FT4 (false if on heparin)T4

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8
Q

hormone ↓ in primary hypothyroidism

A

FT4T4

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9
Q

palpable thyroid nodules: mgmt

A

1. thyroid fxn tests (TSH, FT4, thyroid antibodies)#2. imaging – US (assess if more than 1 nodule, if it is a cyst or solid)#3. Fine Needle Aspiration bx

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10
Q

thinning of outer third of eyebrows sign of

A

hypothyroidism

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11
Q

primary vs secondary hypothyroidism

A

primary: gland dysfxnsecondary: pituitary or hypothalamus dysfxn (normal or ↓TSH)

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12
Q

most common cause of hypothyroidism

A

Hashimoto’s (autoimmune)- evidence of ab to thyroid ags

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13
Q

Hashimoto’s Thyroiditis

A

transient hyperthyroidism w/ an ↑in antibodies fol↓ed by hypothyroidism

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14
Q

Graves Disease

A

autoimmune disease w enlarged thyroid goiterthyroid eye disease (opthalmoptosis)↓TSH↑ T4 or Ft4↑ antithyroglobulin ab, alk phos, thyroid radioactive iodine uptake)hypercalcemia

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15
Q

hypothyroidism tx

A

Levothyroxine (Synthroid, Levoxyl)

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16
Q

Graves Disease tx

A
  • inderal (Propranolol)- thiourea drugs: PTU, methimazole (Tapazole)- radioactive I- surgery
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17
Q

thiourea drugs

A

block synthesis of T3 & T4PTU, methimazole (Tapazole)call NP: fever, infection, agranulocytosis (abs neut count lt 500)

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18
Q

hypothyroidism: monitor & goal

A

TSH (barometer vs T4 for dx)maintenance dosage levothyroxine 100 - 200 ug/d

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19
Q

if thyroid replacement too rapid

A

↑HR, dyspnea, orthopnea, angina, palpitations, nervousness, insomnia

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20
Q

thyroid crises + s/s

A

myxedema or thyroid stormAMS, altered thermal reg, precipitating event/illness

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21
Q
  • myxedema *
A

Severe HYPOTHYROIDISM- ↓ thyroid fxn + subsequent ↓T3 & T4 → alteration F/E - ↑ capillary permeability, fluid retention- non-pitting edema hands/feet- 50-80% mortality rate d/t hypercapnia & hypoventilation

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22
Q
  • myxedema presenting s/s *
A
  • resp depression, hypotension *stupor, coma, hypothermia
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23
Q

thyroid storm

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A

Extreme form of HYPERTHYROIDISMMay be brought on by stressful illness or trauma, radioactive iodine, or thyroid surgery↑ mortality rate

24
Q
  • thyroid storm s/s *
Study These Flashcards
A
  • CV collapse *↑ feverSevere agitationConfusionResp distress if thyroid enlargedVomiting & Diarrhea
25
thyroid storm tx
Inderal (monitor carefully: HF)Thiourea Drugs (PTU, Tapazole)HydrocortisoneSodium Iodine (radioactive I) - 1 hr after Thiourea- goal: destroy thyroid parenchyma
26
adrenal layers - what secretes what?
outer: aldosteroneinner: cortisol
27
cortisol
major glucocorticoid, counters insulin → inhibits insulin secretion, ↑ hepatic gluconeogenesis
28
* ↑ skin pigmentation cardinal sign of *
Addison's disease
29
Addison's dx
Cosynthropin Stimulation Test → give ACTH (corticotropin) & check serum cortisol levels in 30 & 60 minutes,eval for plasmas cortisol rise, in Addison’s level ↓
30
Cosynthropin Stimulation Test
Addison's dx test
31
Addison's tx
replacement tx: mineralocorticoidsglucocorticoids- hydrocortisone- prednisone (alternate)- fludrocortisone
32
fludrocortisone
for insufficient salt retention during Addison's, stimulates renal tubules to reabsorb Na/excrete K
33
adrenal crisis
acute adrenal insufficiencyresult of insufficient cortisol either from insufficient intake or ↑d need
34
* adrenal crisis s/s *
* hypotension s/t ↓ vascular tone (shock-like state), hyperpigmentation *HA, confusion, coma, n/v/d, abd pain, fever, dehydration
35
addison's + infections
must be tx immediately & vigorously: ↑ hydrocortisone - w major stresses, surgery, trauma, ↑ dose, MediAlert bracelet!
36
adrenal crisis mgmt
hydrocortisone IV STAT3L bolus NS or D5NS over 2-3 hrtx precipitating factors & hypoglycemiaone resolved, determine degree of insufficiency - cosynthropin stimulation test
37
Cushing's Sydrome causes x3
exces intake glucocorticoids (Prednisone)if spontaneous (rare):- excess ACTH by pituitary (70%)- lung cancer (SCLC = ectopic source, 15%)- adrenal tumor (15%)
38
Cushing's tests x3
screening: 1mg dexamethasone (Decadron) @ 2300 + check serum cortisol @ 080024 hr urine test (cortisol & creatinine; cort/cr gt 95mcg = hypercort)suppression test (further testing)- give decadron, collect urine day 2- urine free cortisol gt 20 = Cushing's
39
* the key to Cushing's mgmt *
DETERMINE CAUSE/SOURCE- ACTH normal or ↓: ot pituitary- ACTH ↑ = Cushing's
40
Cushing's tx
treat the causetransphenoidal resection if pituitary tumor +/- radunilateral adrenalectomy + hydrocort replacement tx until remaining gland recovers
41
ADH
works in tubules: ↑ H2O reabsorptionreleased: serum Na ↑(hyperosmolar) or hypovolemiaunder influence of neural input (CNS) & baroreceptors in the chest
42
diabetes insipidus causes
familialpituitary or hypothalamus damagenephrogenic DI (inability of kidney to respond to vasopressin)
43
* DI dx *
* 24 hour urine ** vasopressin challenge: desmopressin (IN) = measure UOP & intake *clinical s/sMRI: pituitary tumor
44
DI tx
desmopressin (IN, PO, IV)mild: adeq fluid intake
45
SIADH s/s
- euvolemic & not osmolality dependent- hyponatremia- serum osm lt 280 mOsm/kg + inappropriate ↑ urine osm gt 900mOsm/kg- no cardiac, liver, lung dz- urine Na gt 20mEq/L- no edema or HTN bc ↑ H2O evenly distributed
46
SIADH causes
CNS structural (basilar skull fx) or metabolic disorderSCLC (ectopic source)drug induced: antidepressants (amitriptyline), carbamazepine, haloperidol, chlorproamide
47
SIADH tx
drug induced? dcmild-mod H2O intox? restrict fluid 800-1000 mL/daysevere hypoNa + neuro changes: 250 - 500 mL 3% NaCl over 2-4 hr and Lasix- avoid rapid correction d/t risk of demyelination of pons!
48
somogyi phenomenon + mgmt
morning REBOUND hyperglycemia & ketouria responding to NOCTURAL HYPOGLYCEMIA (stims counter-reg hormones)monitor: 3AM glucoses (expect ↓)tx: ↓ insulin qH 10% or + ↑ CHO @ qHS
49
dawn phenomenon + mgmt
AM fasting hyperglycemia, no sx nocturnal hypoglycemia Normal or ↑BG @ qHS blood glucose checkd/t circadian rhythm & release of growth hormone → ↑ BG btw 5 & 8AMtx: ↑qHS insulin 2-3 units
50
non-ketotic hyperglycemic hyperosmolar coma: serum osm 310 manifestation
lethargy & confusion
51
non-ketotic hyperglycemic hyperosmolar coma: serum osm 320 - 330 manifestation
coma
52
non-ketotic hyperglycemic hyperosmolar coma: dx
hyperglycemia 600+serum osm 310+pH 7.3+HCO3 15+anion gap lt 14
53
non-ketotic hyperglycemic hyperosmolar coma
partial/relative insulin insufficiency triggering gluconeogenesis but NOT ACIDOSIS= profound volume depletion (6-10 L) resulting in RENAL INSUFFIENCY = ↓ glucose excretion & contrib to ↑BGpoorly recognized until profound volume depletion
54
* cornerstone of non-ketotic hyperglycemic hyperosmolar coma therapy *
* FLUID REPLACEMENT! *- hypotn: NS 1-2L first hr- normotn: 0.45% NS 4-6L in 1st 8 hrs- glucose @~250 = D5W or D1/2NSgoals- glucose: 250-300 (↓ risk cerebral edema)- UOP 50cc +monitor for HF esp elderly
55
critically ill: target glucose
140 - 180monitor q 30 w 2 hr IV infusions
56
non-critically ill: target glucose
fasting lt 140random checks lt 180preferred insulin: scheduled SQ + basal, nutritional, correction components
57
basal insulin requirement
0.01 u/kg/hr

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