Endocrine High Yield Flashcards by Serena Arancibia

What is Hyperthyroidism and what does it do in your body

High T3/T4 = Increases Metabolism
Increases glucose absorption from GI
Catabolic effect on muscle mass
Increased CO and RR
Increased Catecholamine Levels
Increased Oxygen Consumption

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What is the most common cause of Hyperthyroidim

Graves

Autoimmune against TSH receptor

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What is a common cause of Hyperthyroidism in the elderly

Toxic Nodular Goiter

Leads to Thyrotoxicosis (increased T3/T4)

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Sx of Hyperthyroidism

Anxiety, Emotional Lability, Weight Loss, Weakness, Tremor, Palpitations, Heat Intolerance, Warm, Moist Skin, Thin Hair, Tachycardia, Fine Resting Tremor, Hyper-Reflexia

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What is a unique sx seen in Graves

Exopthlamos: Proptosis, Lid Lag, Eyes bulging

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Dx of Hyperthyroidism

Low TSH, High T3/T4

If Graves see thyroid-stimulating Immunoglobulin Antiodies

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Tx of Hyperthyroidism

Anti-Hormone Therapy: PTU (Propylthiouracil) or Methimazole

Radioactive Iodine destroys gland

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Which of the tx for Hyperthyroidism can be used in pregnancy

PTU

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What drugs can you use to curb sx of Hyperthyroidism

Beta Blockers: Propranolol decreases HR and BP

Glucocorticoids prevent conversion of T4 to T3

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Dx of TSH Secreting Pituitary Adenoma

High TSH, High T3/T4

MRI to look for pituitary adenoma

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Tx of TSH secreting Pituitary Adenoma

Transphenoidal Surgery to remove pituitary tumor

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What is Hyperparathyroidism

Overactive Parathyroid Glands that lead to increased Calcium Absorption

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What is Primary Hyperparathyroidism and what causes it

Excess inappropriate PTH production

Parathyroid Adenoma is most common cause

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What is Secondary Hyperparathyroidism and what causes it

Increased PTH due to hypocalcemia or Vitamin D Deficiency

Chronic Kidney failure is common cause

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Sx of Hyperparathyroidism

Bones, Stones, Groans, and Psychic Groans

Bony Pain, Kidney Stones, Abdominal Pain, Constipation, Depression and Confusion

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Dx of Hyperparathyroidism

Increased PTH
Hypercalcemia
Decreased Phosphate
Check 24 hour urine calcium excretion
Osteopenia on bone scan

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Tx of Hyperparathyroidism

Surgery, Parathyroidectomy

Vitamin D/Calcium supplement if secondary

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What is Hypoparathyroidism

Due to low PTH or Insensitivity to its action

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What are the more common causes of Hypoparathyroidism

Accidental damage/removal of parathyroid during neck/thyroid surgery
Autoimmune destruction of parathyroid gland

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Sx of hypoparathyroidism

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Hypocalcemia: Carpopedal Spasms, Trousseau and Chvostek Sign, Perioral Parasthesias, Increased DTR
Chvostek Sign: Tap on facial nerve causes facial twitching
Trousseau Sign: Blood pressure cuff on arm blocks flow to brachial artery, causes flexion in fingers, extension of wrist

Dx of Parathyroidism

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Hypocalcemia
Decreased PTH
Increased Phosphate

Tx of Parathyroidism

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Calcium Supplement and Vitamin D
Vitamin D helps absorb Calcium in gut
(Ergocalciferol or Calcitriol)

What is Chronic Adrenocortical Insufficiency

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Disorder where adrenal gland does not produce enough hormones

What is Primary Adrenocortical Insufficiency (Addison’s Disease)

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Adrenal Gland Destruction
Leads to both lack of Cortisol and Aldosterone
High ACTH, Low Cortisol
Normal RAAS system, Low Aldosterone

What are causes of Primary Adrenocortical Insufficiency

Autoimmune, Infection (TB, Fungal), Vascular

What are causes of Secondary Adrenocortical Insufficiency

Pituitary failure of ACTH secretion (lack of Cortisol) You will see Low ACTH and Low Cortisol Aldosterone is intact because ACTH has nothing to do with Aldosterone, instead RAAS system controls that Exogenous Steroid Use

Sx of Primary Adrenocortical Insufficiency

No Cortisol, No Aldosterone, No Sex hormones from Adrenal Gland Hyperpigentation due to increased ACTH Orthostatic Hypotension, Severe Hyponatremia, Hyperkalemia and non-anion gap Metabolis Acidosis, Hypoglycemia Reduced sex hormones in women leads to loss of libido, amenorrhea, loss of axillary and pubic hair

Dx of Adrenocortical Insufficiency

1. Get baseline ACTH, Cortisol, and Renin 2. High dose ACTH Stimulation Test. Normal response is a rise in blood/urine cortisol levels. If no rise in cortisol = Adrenal Insufficiency 3. CRH Stimulation Tests will differentiate the cause. Primary will produce high levels of ACTH but low Cortisol. Secondary will produce low ACTH and low Cortisol

Tx of Adrenocortical Insufficiency

Primary: Glucocorticoids + Mineralocorticoids Secondary: Glucocorticoids only Glucocorticoids: Hydrocortisone 1st line, Presdnisone, Dexamethasone Mineralocorticoids: Fludrocortisone

What does the Anterior Pituitary Secrete

Prolactin, Somatotropin (GH), ACTH, TSH, FSH/LH

Sx seen with Prolactinomas

Oligomenorrhea, galactorrhea, amenorrhea, infertility

What inhibits prolactin

Dopamine

Sx of Somatotropinoma

In adults: Acromegaly In Children: Gigantism DM and glucose intoelrance

Dx of Acromegaly

Insulin-like growth factor screening test | Confirmatory test: Oral Glucose suppression. If increased GH levels you have Acromegaly

Sx of Adrenocorticotropinomas

They secrete ACTH | Cushing's Disease and Hyperpigmentation

Sx of TSH secreting Adenomas

Secrete TSH Thyrotoxicosis Increased T3/T4

Dx of Anterior Pituitary tumors

MRI | Endocrine Studies

Tx for Anterior Pituitary Adenomas

Transsphenoidal Surgery

Tx for Acromegaly

TSS + Bromocriptine | Octeotride

Tx for Prolactinoma

Cabergoline or Bromocriptine (Dopamine agonist that inhibits prolactin)

What is DM Type I

Insulin Deficiency Inability to produce insulin and insulin resistance Autoimmune destruction of pancreatic beta cells

What is DM type II

Insulin Resistance and Relative Impairment to insulin secretion Likely genetic and environmental, especially weight gain and decreased physical activity

Dx of DM

Fasting blood sugar >126 Random blood glucose >200 Blood Sugar after oral glucose tolerance test >200 HgA1C >6.5%

Sx of DM

Polyuria, Polydipsia, Polyphagia, Weight Loss | DKA

Complications of DM

Parastehsias, Abnormal Gait, Decreased Proprioception, Pain, Decreased DTR Orthostatic Hypotension, Gastroparesis Constipation Retinopathy: Painless deterioration of small retinal vessels, may lead to permanent vision loss/blindness

Sx of Nephropathy and Tx

Progressive kidney function deterioration leading to microalbuminuria Tx: Ace-I

How does a Sulfonylureas Work

Stimulates pancreas to release more insulin Can cause hypoglycemia Glipizide

How do Biguanides work

``` Suppress Hepatic Gluconeogenesis No Hypoglycemia Can cause lactic acidosis GI side effects are common Metformin ```

How do Thiazolidenediones work

Increase sensitivity to insulin Affect fat metabolism Side effects are hepatitis and edema, Acites

Endocrine High Yield Flashcards

(49 cards)