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Flashcards in Endocrine and metabolic disorders Deck (29)
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What is the dawn phenomenon?

Decreased sensitivity to insulin between 5 am and 8 am


What is the Somogyi effect?

nocturnal hypoglycemia -> surge of counter-regulatory hormones -> increased blood glucose by 7 am


What is myxedema crisis? What is the diagnostic workup?

What are the s/s?

What often precedes it?

How is it managed?

Extreme hypothyroidism (decr. free T4, incr. TSH)


  • hypothermia
  • hypoventilation
  • hypotension
  • AMS (including coma)
  • hyponatremia
  • hypoglycemia

Often preceded by:

  • infection
  • major cardiopulmonary illness
  • major neurologic illness


  • Load T4 IV
  • Maybe T3 if unstable
  • Adrenal replacement therapy
  • Levothyroxine

purple book 7-4


What is thyroid storm? What is the diagnostic workup?

What are the s/s?

How is it managed?

Extreme hyperthyroidism (incr. free T4 and T3, decr. TSH)


  • delirium
  • fever
  • tachycardia
  • systolic HTN with wide pulse pressure
  • GI symptoms


  • B blocker
  • PTU or methimazole

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Thyrotoxicosis is another term for hyperthyroidism.

What is the diagnostic workup for hyperthyroidism?

What are the s/s of hyperthyroidism?

What is the management for hyperthyroidism?

Incr. FT4, FT3; decr. TSH


  • restlessness
  • sweating
  • tremor
  • moist, warm skin
  • fine hair
  • tachycardia, afib
  • weight loss
  • increased frequency of stools
  • menstrual irregularities
  • hyperreflexia
  • osteoporosis
  • stare & lid lag


  • B blocker
  • methimazole, PTU
  • maybe surgery, depending on cause

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What is the definition of sick euthyroid syndrome?

Should you replace thyroxine in this case?

  • Thyroid function test abnormalities in patients with severe nonthyroidal illness
  • Replacement thyroxine not helpful nor recommended for critically ill patients with decreased T3/T4 unless other s/s of hypothyroidism

purple book 7-5


Review the adrenal axis


What are the clinical manifestations of adrenal insufficiency?

  • weakness, fatigue
  • anorexia
  • orthostatic hypotension
  • N/V
  • hyponatremia
  • primary: hyperpigmentation, hyperkalemia

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What is the diagnostic workup for suspected adrenal insufficiency?

  • Early a.m. serum cortisol < 3 mcg/dL virtually diagnostic
  • > 18 rules it out
  • Cosyntropin stimulation test


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What is the management of adrenal insufficiency?


  • volume resuscitation with NS
  • IV hydrocortisone


  • Hydrocortisone or prednisone
  • Fludrocortisone (not in secondary)
  • Dexamethasone prefilled syringe given to pt for emergency situations


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What are some causes of primary adrenal insufficiency?

  • autoimmune
  • infection
  • vascular (hemorrhage, thrombosis, HIT, etc)
  • metastatic
  • deposition diseases (hemochromatosis, sarcoidosis, etc)
  • drugs (ketoconazole, rifampin, etc)

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What is the difference between Cushing syndrome and Cushing disease?

Cushing syndrome: cortisol excess

Cushing disease: cortisol excess due to pituitary ACTH hypersecretion



What are some causes of hypercortisolism?

  • Most common is iatrogenic Cushing syndrome caused by exogenous glucocorticoids
  • Pituitary adenoma (Cushing disease)
  • Adrenal tumor (Cushing syndrome)
  • Ectopic ACTH (SCLC, etc.)

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What are the clinical manifestations of hypercortisolism?

  • Most specific: spontaneous bruising, proximal myopathy, striae, hypokalemia
  • Less specific: central obesity with extremity wasting, dorsocervical fat pads, rounded facies
  • Nonspecific: glucose intolerance or DM, obesity, oligo- or amenorrhea, osteoporosis


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How is Cushing syndrome treated?

Surgical resection of pituitary adenoma, adrenal tumor, or ectopic ACTH-secreting tumor with lifelong glucocorticoid replacement therapy


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What are some causes of primary hyperaldosteronism?

  • adrenal hyperplasia
  • adenoma
  • carcinoma


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What are the clinical manifestations of hyperaldosteronism?

  • Mild to moderate HTN
  • HA
  • muscle weakness
  • polyuria
  • polydipsia
  • hypokalemia

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What diagnostic studies are used to confirm hyperaldosteronism?

  • Check aldosterone and plasma aldosterone:renin ratio (>20 = primary hyperaldosteronism)
  • Confirm with sodium suppression test (sodium load fails to suppress aldosterone)

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What is the treatment for hyperaldosteronism?

  • Hyperplasia -> spironolactone
  • Adenoma -> adrenalectomy vs medical rx with spironolactone
  • Carcinoma -> adrenalectomy

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What are the common precipitants of DKA (6 I's)?

  • Insulin deficiency
  • Iatrogenic (glucocorticoids)
  • Infection
  • Inflammation
  • Ischemia/Infarction
  • Intoxication

purple book 7-14


What are the clinical manifestations of DKA?

  • polyuria, polydipsia, dehydration, increased HR, hypotension, dry mucous membranes, decreased skin turgor
  • N/V, abdominal pain, ileus
  • Kussmaul respirations (deep) to compensate for metabolic acidosis, with acetone breath
  • AMS (somnolence, stupor, coma)

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What diagnostic studies are used to confirm DKA?

  • Anion gap metabolic acidosis
  • Ketosis (urine and serum ketones)
  • Increased serum glucose


How is DKA managed?

  • Rule out possible precipitants (infections, MI, etc.)
  • Aggressive hydration (NS)
  • Insulin
  • Electrolyte supplementation

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What is the definition of hyperosmolar hyperglycemic state (aka nonketotic hyperosmola coma)?

  • Extreme hyperglycemia without ketoacidosis + hyperosmolarity + AMS in DMII (usually elderly)


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What are the clinical manifestations of hyperosmolar hyperglycemic state?

What are the lab findings?

Volume depletion and AMS, with

  • Increased serum glucose
  • Increased serum osmolality
  • No ketoacidosis

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How is hyperosmolar hyperglycemia state managed?

  • Aggressive hydration! NS then 1/2 NS up to 8-10 L
  • Insulin

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What are the criteria for diagnosing hypoglycemia in a nondiabetic patient?

  • Symptoms consistent with hypoglycemia
  • A low plasma glucose concentration measured with a precise method (not a home glucose monitor) when symptoms are present
  • Relief of those symptoms after the plasma glucose level is raised



List some possible causes of nondiabetic hypoglycemia.

  • Alcohol
  • Critical illness
  • Malnourishment
  • Cortisol deficiency
  • Nonislet cell tumors




Management of hypoglycemia?

  • Glucose tablets, paste, fruit juice if pt can take PO
  • IV D50
  • If no IV, glucagon

purple book 7-15