Endocrine Flashcards
(147 cards)
1
Q
Thyroid cancer risk is increased by
A
- history of radiation therapy during childhood for Wilm’s tumor, lymphoma, neuroblastoma
- low-iodine diet
2
Q
Hyperprolactinemia can be a sign of
A
-pituitary adenoma
3
Q
Hyperprolactinemia presentation
A
- slow onset
- amenorrhea
- galactorrhea in both males and females
- serum prolactin elevated
- if large tumor, c/o HA and vision changes
4
Q
Prolactin purpose
A
-stimulate breast milk production after childbirth
5
Q
Hormones from anterior pituitary
A
FSH LH TSH GH ACTH MSH Prolactin
6
Q
Hypothalamus stimulates what
A
anterior pituitary
7
Q
Posterior pituitary secretes
A
antidiuretic hormone (vasopressin) oxytocin
8
Q
Thyroid gland uses what to produce T3 and T4
A
iodine
9
Q
Parathyroid gland is responsible for
A
- PTH
- for calcium balance from bones, kidneys, and GI
10
Q
Pineal gland produces
A
melatonin
11
Q
Primary hyperthyroidism (Thyrotoxicosis) findings
A
-very low TSH with elevated free T4 and T3
12
Q
Most common cause of primary hyperthyroidism in US
A
Grave’s disease
13
Q
Grave’s disease presentation
A
- middle aged women
- rapid weight loss
- anxiety
- insomnia
- Cardiac: palpitations, HTN, afib, PAC
- warm and moist skin, diaphoretic
- opthalmopathy and lid lag
- diarrhea
- amenorrhea
- heat intolerance
- goiter
- pretibial myxedema: thickened skin over ankles, orange-peel look
- brisk DTR
14
Q
Grave’s disease labs
A
- Low TSH
- elevated free T3, T4
- Positive thyrotropin receptor antibodies (TSI)
- Thyroid peroxidase antibody (TPO): positive with graves and hashimoto’s
- palpable thyroid
15
Q
Grave’s disease treatment
A
- Thyroid ultrasound
- refer to endocrinologist
16
Q
Grave’s disease medications
A
PTU: shrink thyroid, decrease hormone production
Methimazole: same
17
Q
Grave’s disease medication side effects
A
- skin rash
- aplastic anemia
- thrombocytopenia
- hepatic necrosis
18
Q
Medication to manage symptoms of hyperstimulation in Grave’s
A
beta blockers
19
Q
Thyroid storm
A
need hospitalization
-look for decreased LOC, fever, abdominal pain
20
Q
Diagnostic test for thyroid cancer
A
fine-needle biopsy
21
Q
Monitoring response to treatment of thyroid disease
A
- recheck TSH every 6-8 weeks
- TSH goal is less than 5
- when stable, recheck every 6-12 months
22
Q
Primary hypothyroidism findings
A
- high TSH with low free T4
- common causes: Hashimoto’s thyroiditis, postpartum thyroiditis, thyroid ablation with radioactive iodine
23
Q
Most common cause of hypothyroidism in US
A
Hashimoto’s
24
Q
Hashimoto’s patho
A
- chronic autoimmune disorder of thyroid gland
- body produces destructive antibodies (TPO) against thyroid gland
25
Hashimoto's presentation
- overweight
- fatigue
- weight gain
- cold intolerance
- constipation
- menstrual abnormalities
- alopecia
- serum cholesterol elevated
- history of autoimmune disorders
26
Myxedema
- severe hypothyroidism
- endocrine emergency
- cognitive symptoms
27
Hashimoto's labs
- TSH, if elevated, order again with free T4
| - Order TPO to confirm Hashimoto's thyroiditis
28
Gold standard for diagnosing Hashimoto
TPO
29
Subclinical hypothyroidism
- TSH >5 but serum free T4 WNL
- asymptomatic to mild symptoms
- recheck again in 6 months
30
Hypothyroidism treatment
- Levothyroxine start 25-50 mcg/day
- start with lowest dose for elderly with CVD history (12.5)
- Increase every few weeks until TSH normal
- recheck every 6-8 weeks until normal, then check every 12 months when stable
31
Radioactive treatment for hyperthyroidism results in
hypothyroidism for life
32
Levothyroxine is synthetic ___
T4
33
Which thyroid hormone is more active
T3
34
Subclinical hypothyroidism with TSH >10
treat to prevent conversion to primary hypothyroidism
35
Subclinical hypothyroidism with TSH 4.5-10
- treatment not recommended
| - recheck in 6-12 months unless they are symptomatic
36
Major risks of prescribing levothyroxine
- accelerated bone loss
| - afib
37
Suggested Synthroid starting dose for young (<50) patients
1.6 mcg/kg/day
38
Suggested Synthroid starting dose for middle (50-60) patients
50 mcg
39
Suggested Synthroid starting dose for older or with CVD, or multiple comorbidities
25 mcg
40
T1DM patho
- destruction of B-cell sin islets of Langerhans
- abrupt cessation of insulin production
- ketone buildup--> DKA and coma
41
Ketone
-byproduct of fat breakdown
42
T2DM patho
- progressive decreased secretion of insulin resulting in chronic state of hyperglycemia and hyperinsulinemia
- genetic component
43
Other names for metabolic syndrome
- insulin-resistance syndrome
| - syndrome X
44
Metabolic syndrome increases risk for
CVD
| T2DM
45
Prediabetes labs
- A1C: 5.7-6.4
- Fasting glucose: 100-125
- 2 OGTT: 140-199
46
Diagnostic criteria for DM
- A1C: >6.5
- FPG: >126
- hyperglycemia symptoms: polyuria, polydipsia, polyphagia + random glucose >200
- 2 hour OGTT >200
47
Normal serum blood glucose
- FPG: 70-100
- Peak postprandial glucose: <180
- A1C: <6
- Elderly may have A1C <8 if tolerable
48
Newly diagnosed diabetic labs
- A1C every 3 months until normal
- A1C every 6 months once stabilized
- lipid panel once a year
- random urine for microalbuminuria once a year
- CMP, TSH, LFT's
49
LDL goal for DM
<100
50
A1C goal for DM
<7
51
BP goal for DM
<140/80
52
Preprandial plasma glucose goal
70-130
53
DM what to check every visit
- BP, feet, weight, BMI, blood sugar
- vibratory sense
- light and deep touch
- pedal pulses, reflexes
54
DM preventative care
- >50: Shingrix, 0, 2-6 months
- flu shot annually
- pneumococcal vaccine
- ASA 81 mg if risk for MI, stroke (not rec in <30)
- Yearly dilated exam
- T2DM: eye exam at diagnosis
- T1DM: first exam 5 years after diagnosis
- podiatry: once to twice a year
- BP goal: 130/80
- Dental health
55
Level 1 hypoglycemia
FBS < 70
56
Level 2 hypoglycemia
FBS < 54
57
What medication can blunt hypoglycemic response
beta blockers
58
A1C goal for T1Dm and most pregnant patients
<6
59
A1C goal for older adults with T2DM comorbids
<8-8.5
60
A1C goal for T2DM and healthy older adult
<7.5
61
A1C goal for T2DM for most adults
<7
62
Screening for T2DM
- annual for BMI> 25 and one or more risk factors for DM
| - entire population >45 every 3 years if screening is normal
63
Hypoglycemia treatment
- glucose 15-20 g for conscious patients
- orange juice, soft drink, candy
- recheck in 15 minutes
- glucagon for severe hypoglycemia (<54)
64
Exercising and DM
- may need to decrease medication before
| - increased risk of hypoglycemia if they do not compensate
65
Dawn phenomenon
- normal physiological event
- FBG elevation between 4-8 am
- normal people have insulin to combat this
66
Somogyi effect
- aka rebound hyperglycemia
- severe nocturnal hypoglycemia stimulates counterregulatory hormones (glucagon) from liver
- results in high fasting blood glucose by 7am
- due to overtreatment with evening and or bedtime insulin
- more common with T1DM
67
How to diagnose Somogyi effect
-check blood glucose early in morning (3am) for 1-2 weeks
68
Somogyi effect treatment
- eat snack before HS
| - or remove dinnertime NPH or lower dose
69
Diabetic retinopathy findings
- neovascularization (new growth of fragile arterioles)
- microaneurysms (dot and blot hemorrhages d/t neovascularization)
- cotton-wool spots or soft exudates (nerve fiber layer infarcts)
- hard exudates
70
T/F Patients with diabetic neuropathy should avoid excessive running or walking
True: avoid risk of foot injury
71
Charcot's foot and ankle
- aka neuropathic arthropathy
- deformity of foot caused by joint and bone dislocation and fractures due to neuropathy
- midfoot arch collapse (rocker bottom foot)
72
First line medication for T2DM
Metformin (glucophage)
73
Metformin (glucophage) mechanism
- biguanide
- decrease gluconeogenesis
- decrease peripheral insulin resistance
- rare hypoglycemia
74
Metformin side effects
-diarrhea
| nausea
75
Metformin contraindications
- renal disease
- hepatic disease acidosis
- alcoholics
- hypoxia
76
Metformin labs
- renal function
| - LFTs
77
Metformin has increased risk for
- lactic acidosis
| - occurs with hypoxia, hypoperfusion, renal insufficiency
78
Metformin and IV contrast dye
-hold on day of procedure and 48 hours after
79
Sulfonylurea mechanism
-stimulate beta cells of pancreas to secrete more insulin
80
Sulfonylurea examples
glipizide
Glyburide
Glimepiride
81
Sulfonylurea adverse effects
- increased risk of CV mortality
- hypoglycemia
- increased risk of photosensitivity
- blood dyscrasias
- avoid if impaired hepatic or renal function (monitor LFTs, creatinine, UA)
- Causes weight gain
82
Thiazolidinediones examples
-Pioglitazone (Actos)
83
TZD mechanism
-enhance insulin sensitivity in muscles and reduce hepatic glucagon production
84
TZD can be combined with
-metformin
-sulfonylurea
-GLP-1
-SGLT2
-DPP-4
-insulins
...so any diabetic med
85
TZD contraindications
- BBW: NYHA class 3 and 4, symptomatic heart failure
- water retention and edema '
- avoid with bladder cancer or history
- active liver disease
- Type 1 DM
- pregnancy
86
Bile-acid sequestrant example
-Cholestyramine
87
Bile-acid sequestrant mechanism
reduce hepatic glucose production and reduce intestinal absorption of glucose
-take with meals, lower LDL
88
Meglitinide (Glinides) examples
- Repaglinide (Prandin)
| - Nateglinide (Starlix)
89
Meglitinide mechanism
- stimulate pancreatic secretion of insulin
| - For T2DM with postprandial hyperglycemia
90
Meglitinide side effects
- weight neutral
- may cause hypoglycemia
- take before meals or 30 minutes after
- Hold if skipping a meal
- bloating, abdominal cramps, diarrhea, farting
91
Rapid acting insulins
- Lispro
- Aspart
- Glulisine
92
Basal insulins
- Glargine (lantus)
| - Detemir (Levemir)
93
alpha glucosidase inhibitors mechanism
Acarbose (Precose)
- slow intestinal carb digestion and absorption
- no hypoglycemia
- modest effect on A1C
- GI s/e: farting, diarrhea
94
Incretin mimetics or glucagonlike peptide mimetics examples
- Exenatide (Byetta)
| - Liraglutide (Victoza) injections
95
GLP-1 mechanism
-stimulate GLP-1
-increase in insulin production and inhibit postprandial glucagon release
increase satiety
96
GLP-1 may cause
- weight loss
- appetite suppression
- NO hypoglycemia
- Pancreatitis
- medullary thyroid tumors
97
GLP-1 contraindication
-personal or fam hx of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2
98
SGLT2 inhibitor examples
- Canagliflozin (Invokana)
- Dapagliflozin (Farxiga)
- Empagliflozin (Jardiance)
99
SGLT2 inhibitor mechanism
-blocks glucose reabsorption by kidney and increases glucosuria
100
SGLT2 is effective for
T2DM in any stage
| -no hypoglycemia
101
SGLT2 FDA warning
- may lead to DKA
| - weight loss, hypotension
102
SGLT2 renal s/sx
- polyuria
- increased creatinine
- increase in UTIs
- PN
103
SGLT2 increased risk for
leg and foot amputations
104
DPP-4 inhibitor examples
- Sitagliptin (Januvia)
- Saxagliptin (Onglyza)
- Linagliptin (Tradjenta)
105
DPP-4 inhibitor mechanism
- inhibit DPP-4 activity
- increase active incretin concentrations
- increase insulin secretion
- decrease glucagon
- no hypoglycemia
106
DPP-4 inhibitor FDA warning
may cause joint pain that can be severe and disability
- occur on day 1 or years later
- angioedema
- urticaria
- acute pancreatitis
107
T/F Incretin mimetics and Incretin enhancers can be combined
False
108
Treatment for mild A1C elevation
-try lifestyle modifications for 3-6 months
109
Metformin starting dose
500 mg daily
| max 2000 mg
110
If patient on max metformin and A1C not within range, then what
add sulfonylurea
111
Other choices for adding onto metformin
- any other medication
- DPP-4 inhibitor
- incretin mimetics
- TZD
112
Insulin should not be combined with what
meglitinides
| -severe hypoglycemia
113
Which diabetic meds can cause hypoglycemia
- sulfonylureas
- meglitinides
- rarely metformin
114
If A1C still elevated with metformin and sulfonylurea..
consider adding basal insulin
115
Causes weight loss
- metformin
- incretin mimetic
- GLT-2 inhibitors
116
Causes weight gain
- insulins
- sulfonylureas
- TZDs
117
Weight neutral
- meglitinides
- bile-acid sequestrants
- alpha-glucosidase inhibitors
118
Primary prevention for patients at high risk for T2DM
- encourage weight loss
- regular physical activity
- increase fiber
119
Metformin dosage increments
- 500mg once daily
- 500 mg BID
- 1000 mg BID
120
Initial A1C 9, plan
-start basal insulin
121
Diabetics are at risk for which eye problems
- cataracts
| - glaucoma
122
With new onset-afib, what endocrine complication should be checked
TSH
123
Insulin sensitivity and labs
-Elevated TG with low HDL
124
What other medications should be started with diabetics
- Statin
| - ACEI
125
What second agent should be considered in a patient with DM and ASCVD
- SGLT2-I
- empagliflozin (Jardiance)
- or Liraglutide (Victoza)
126
Dose to start basal insulin
0.1-0.2 units/kg
or 10 units daily
adjust 2-4 units once-twice weekly to reach FBG goal
if hypoglycemia, reduce by 4 units
127
Postprandial glucose goal
<180
128
Addison's disease
- adrenal insufficiency
- deficiency of cortisol and aldosterone
- aldosterone: sodium and K balance
- cortisol: maintain BP, cardiac function, blood sugars
129
Addison's disease presentation
- dysphagia
- fatigue
- weight loss
- hypotension
- abdominal pain
- amenorrhea
- NV
- thin, brittle nail
- hyperpigmentation
130
Addison's disease diagnosis
- measure AM serum cortisol level
- low cortisol level with normal to high K and low to normal Na
- ACTH stimulation test: measure cortisol level before and after injection
- CT
131
Addison's disease treatment
- Hydrocortisone (Cortef), prednisone, or methylprednisolone
- Fludrocortisone to replace aldosterone
- increase salt intake
132
Addisonian crisis treatment
- ED
| - IV corticosteroids, saline, dextrose
133
Cushing syndrome
-excess cortisol from adrenal glands
134
Cushing syndrome presentation
- red cheeks
- Buffalo hump
- abdominal stretch marks
- easy brusing
- pendulous abdomen
- thin arms and legs
- thin skin
135
Cushing syndrome diagnosis
- cortisol levels
| - CT MRI
136
Cushing syndrome treatment
- reduce corticosteroid use
- surgery if due to tumor
- Ketoconazole, Mifepristone (if with T2DM)
- i guess refer to endocrinology
137
Which diabetic med should be used with caution in patient with severe sulfa allergy
-Glyburide
138
T/F hyperglycemia can occur as a result of aerobic exercise
False
139
Which diabetic medication is helpful for minimizing postprandial hyperglycemia
meglitinide
140
T/F Insulin resistance can contribute to prothrombotic and proatherogenic state
true
141
Prolonged metformin usage increases risk for
Vitamin B12 deficiency
142
GLP-1 agonists increases risk for
pancreatitis
143
At minimum, what interval should TSH be reassessed after Synthroid dosage adjustment?
6-8 weeks
144
Hypercalcemia with suppressed PTH should raise concern for what
malignancy
145
How to distinguish between T1DM and T2DM
T1DM has HLA-DR3 or HLA-DR4
146
Normal free T4
4.6-11.2 mcg/dL
147
Which diabetic medication is contraindicated with history of medullary thyroid carcinoma?
GLP-1 agonists
