Endocrine pt 2 Txs Flashcards
(21 cards)
How do you tx pituitary adenomas?
Microadenomas get followed with serial MRI
Macroadenomas are candidates for transsphenoidal resection
Hyperprolactinemia:
1) How do you Tx if med induced?
2) How do you Tx if Adenoma or other?
3) What if this Tx doesn’t work?
1) Stop, reduce, or change the med
-1st and 2nd gen antipsychotics
-Metoclopramide, promethazine, prochlorperazine
2) Dopamine agonists: Cabergoline or bromocriptine are both first line; Cabergoline is better tolerated
3) Transsphenoidal surgery if adenoma is greater than 3cm
-Radiation rarely used
How do you Tx GH tumors? Explain
1) Transsphenoidal surgery is preferred
2) Medical management:
-Either in addition to surgery or when surgery is not possible
-Octreotide or Lanreotide is first line: Somatostatin inhibits GH release
-Sometimes pegvisomant is given (GH receptor antagonist)
3) Radiation therapy is not optimal & is reserved for other treatment failure
______________ or ____________ is first line Tx for GH tumors
Octreotide or Lanreotide
GH Deficiency: How is it treated?
Growth hormone supplementation before the growth plates close
Hypopituitarism: Tx?
Lifelong hormone replacement to give them what they lack
Hypercortisolism: What is the Dx/Tx?
Low cortisol/low ACTH
Give them what they lack
Glucocorticoids
Hypercortisolism: How to Tx pituitary adenoma?
Find it and cut it out
MRI petrosal sinus sampling if needed transsphenoidal resection
Hypercortisolism: How to Tx adrenal adenoma?
Find it and cut it out
Hypercortisolism: How to Tx endocrine secreting tumor?
Find it and cut it out
If nonresectable, ketoconazole or metyrapone can be given
Hypercortisolism: How to Tx (Other) Exogenous use of steroid?
Because these patients have high levels of cortisol which will decrease the hormones produced upstream
This will drop their ACTH and atrophy of the adrenal glands
This is why patients on long term steroids need to be tapered
Treatment is to d/c steroid
HypOcortisolism / HypOaldosteronism: Describe further management
1) Because cortisol is a stress hormone, patients will need IV glucocorticoids and IV fluids before and after surgical procedures
This is to mimic the body’s natural response
2) During illness/surgery/fever, oral dosing needs to be adjusted as well
3) They need a medical alert tag
Hyperaldosteronism:
1) What is the first line Tx?
2) What is the second line Tx?
3) What else should you do?
4) What should you do in Conn’s syndrome?
1) 1st Spironolactone
-Blocks aldosterone
2) ACE inhibitors, CCB
3) Correct electrolyte abnormalities
4) Find it and cut it out
SIADH: How do you Tx?
1) Treat underlying cause
2) Correct Hyponatremia
-Mild: water restriction
-Mod-severe: ADH receptor antagonists – conivaptan, tolvaptan
-Severe hyponatremia: IV hypertonic saline + furosemide
How do you Tx psychogenic polydipsia?
“Stop doing that”
DI:
1) How do you Tx central? What is 1st line + what is 2nd?
2) How do you Tx nephrogenic?
1) Desmopressin first line – intranasal injection or oral
-Second line is carbamazepine
2) Correct underlying cause; sodium and protein restriction
-Hydrochlorothiazide, indomethacin, amiloride (for lithium induced)
Pheochromocytoma: DO NOT initiate therapy with _________________ because of unopposed alpha constriction during catecholamine release which can lead to hypertensive crisis
beta-blockade
Pheochromocytoma:
What is the initial therapy?
What do you do next?
1) Nonselective alpha-blockade is initial therapy
PHEnoxybenzamine or PHEntolamine for 1-2 weeks
Both of these block alpha cascade
2) Then beta blockers or CCB to control blood pressure
Pheochromocytoma: How do you Tx patients in hypertensive crisis?
Phentolamine, nitroprusside, nicardipine can all acutely lower blood pressure
MEN 1:
1) Dx
2) Tx
3) F/u
1) Genetic testing
2) Tumor specific
3) Screen PTH, Calcium, gastrin, prolactin
MEN II:
1) Dx
2) Tx
3) F/u
1) Genetic testing
2) Tumor specific
3) Screen calcitonin, epinephrine, PTH, calcium
