Endocrinology

Question 1

Type I diabetes

Answer 1

no insulin production

Question 2

Type II diabetes

Answer 2

diminished insulin sensitivity

diminished insulin secretion

increased glucose production

Question 3

gestational diabetes

Answer 3

insulin resistance during late pregnancy

normally resolves after pregnancy but risk of developing DM later in life is increased

Question 4

prediabetes

Answer 4

impaired glucose tolerance and/or impaired fasting glucose

Question 5

DMkey labs for DM

Answer 5

HbA1C

plasma glucose

liver function - ASTs, ALTs

kidney function - albumin, creatinine

blood lipids

Question 6

physical exam for DM

Answer 6

BMI

condition of feet

peripheral sensation

peripheral edema

cardiac exam

reflexes

Question 7

biguanides

Answer 7

meformin, glucophage, etc. decreases gluconeogenesis and potentiates insulin action on adipocytes and myocytes

Question 8

Sulfonylureas

Answer 8

Glipizide, Glyburide, etc. Stimulates insulin secretion. May cause hypoglycemia

Question 9

Meglitinides

Answer 9

Repaglinide, Netglinide. Similar mechanism to sulfonylureas. Thus, also risk of hypoglycemia.

Question 10

Insulin

Answer 10

Avail in several formulations which vary according to onset of peak action and duration. Regular = short acting (Novlin). Long acting (Novolog, Lantus). Mix (Novolog 70/30). B/c of differences in onset and duration, timing of injections relative to meals is v. important.

Question 11

signs and symptoms of DM

Answer 11

Retinopathy - Blurry vision

Neuropathy - Loss of sensation in extremities. Diminished reflexes

Nephropathy - Albumin in urine. Inc serum creatinine.

Cardiovascular disease

Question 12

what to ask for DM

Answer 12

○ When dx’d with diabetes

○ Current medications

○ If Pt maintains a journal of blood sugar levels and if they brought it.

○ If no journal, how often they check levels, what time of day, before or after meals, what the numbers are (average, highest, lowest)

○ Problems with vision

○ Does Pt check feet every day for cuts, sores, etc.

○ Last time Pt. went to ophthalmologist

○ Diet and exercise

○ Episodes of dizziness or lightheadedness

Question 13

symptoms of hypothyroidism

Answer 13

Weight gain
fatigue,
weakness,
cold intolerance,
constipation,
depression,
menorrhagia,
dry skin,
bradycardia,
delayed return of deep tendon reflexes,
anemia,
low FT4,
elevated TSH (Primary)

Question 14

symptoms of hyperthyroidism

Answer 14

sweating,
weight loss or gain,
palpitations,
loose stools,
heat intolerance,
irritability,
fatigue,
weakness,
menstrual irregularity,
increased T4,
suppressed TSH (Primary)

Question 15

key labs for thyroid disorders

Answer 15

TSH

T4

Question 16

history of thyroid disorders

Answer 16

○ Known Dx of thyroid disease
○ Family Hx of thyroid disease
○ Hx of symptoms listed above

Question 17

thyroid disorders physical exam

Answer 17

○ BMI
○ Thyroid Palpation
○ Tremor
○ Peripheral Edema
○ Reflexes
○ General deportment (anxious? lethargic? pressured speech?)
○ Cardiac Exam

Question 18

Cushing’s Syndrome

Answer 18

Excess cortisol production or administration.

CRH (hypothalmus) -> ACTH (anterior pit.) -> Cortisol (Zona fasiculata of adrenal cortex)

Question 19

classification of Cushing’s Syndrome by etiology

Answer 19

Cushing’s Disease - Excess secretion of ACTH by pituitary gland
Ectopic ACTH production - Excess secretion of ACTH from non-pituitary source
Exogenous steroids - Therapeutic administration of steroids or ACTH
Adrenal cancers (usu. unilateral)

Cushing’s disease and ectopic ACTH production are most common causes. Both result in bilateral adrenal hyperplasia.

Question 20

signs and symptoms of Cushing’s

Answer 20

● Central obesity
● Fat deposition on face and b/w scauplae (“moon face” and “buffalo hump”)
● Purple abdominal striae (strech marks)
● Inc. susceptibility to bruising
● Amenhorrea
● HTN
● Glucosuria
● Osteoporosis
● Hirsutism
● Emotional lability

Fat deposition patterns, bruising, and purple strechmarks are more specific to Cushing’s syndrome than the others.

Question 21

labs/studies for Cushing’s

Answer 21

Dexamethasone suppression test - Dexamethasone is a highly potent synthetic glucocorticoid. Administration in normal patients will cause neg. feedback at the adrenal pituitary and decreased ACTH.
Cortisol
Plasma ACTH
Abdominal CT
Pituitary MRI

NB: Cortisol and ACTH levels vary throughout the day.

Treatment is usually surgery to resect tumor (or in some cases, complete adrenal gland) with steroid replacement therapy.

Question 22

aldosteronism

Answer 22

Primary - Aldosterone secreting adenoma (unilateral) or idiopathic bilateral hyperplasia.
Secondary - Increased renin production due to decreased renal perfusion or renin secreting tumor.

Question 23

signs/symptoms of aldosteronism

Answer 23

Headaches
High diastolic BP
Hypokalemia
Muscle weakness, Fatigue
Polyuria
Polydipsia
High urine pH
Metabolic alkalosis
Edema in secondary, but not primary

Question 24

labs/studies for aldosteronism

Answer 24

Potassium
Renin
Blood pH
Left ventricular hypertrophy

Question 25

physcial for aldosteronism

Answer 25

BP

Question 26

treatment for aldosteronism

Answer 26

Potassium Renin Blood pH Left ventricular hypertrophy

Question 27

Addison's disease

Answer 27

Primary - Atrophy of adrenal glands Secondary - ACTH deficiency.

Question 28

symptoms of Addison's

Answer 28

Weakness Weight loss Hyperpigmentation in Primary but not Secondary. Hypotension GI Dysnfunction Axillary and pubic hair loss Hyperkalemia Hyponatremia

Question 29

labs for Addison's

Answer 29

ACTH stimulation test ACTH Aldosterone - Dec in primary, but typically normal in secondary Serum electroyltes

Question 30

physical for Addison's

Question 31

treatment for Addison's

Answer 31

Hormone replacement. Hydrocortisone (Glucocoritcoid). Fludrocortisone (Mineralcorticoid), usu. not necessary in Secondary..

Question 32

hypoaldosteronism

Answer 32

Decreased aldosterone levels with normal cortisol levels. Often due to hyporeninism.

Question 33

tests for hypoaldosteronism

Answer 33

ACTH stimulation test Renin and aldosterone levels following postural changes and sodium restriction Failure to inc. aldosterone following Na+ restriction. Hyperkalemia

Question 34

treatment for hypoaldosteronism

Answer 34

Fludrocortisone. Furosemide with Na+ restriction

Question 35

parathyroid disorders

Answer 35

hypoparathyroidism hyperparathyroidism

Question 36

Hypoparathyroidism

Answer 36

tetany, carpopedal spasms, tingling of lips and hands, muscle and abdominal cramps, psychological changes, serum calcium low, serum phosphate high, alkaline phosphatase normal, urine calcium excretion reduced, low serum PTH

Question 37

Hyperparathyroidism

Answer 37

often asymptomatic, but can be characterized renal calculi, polyuria, hypertension, constipation, fatigue, mental changes, bone pain, serum and urine calcium elevated, urine phosphate high with low to normal serum phosphate, elevated PTH

Question 38

adrenal androgens

Answer 38

**Excess** virilization, male-pattern hair growth and balding, upper lip chin around areolae midsternum and down linea alba pattern may vary among ethnic groups increased serum DHEA acne, deepening of voice (only occurs at very high levels in women) **Low** Diminished sex drive, Erectile dysfunction Sleep disturbances Fatigue

Question 39

signs and symptoms of polycystic ovary syndrome

Answer 39

Common cause of hyperandrogenism in women **Diagnostic criteria include:** Ovaluatory dysfunction (iirregular periods) Hyperandrogenism Cystic ovaries **Signs and symptoms** Excess androgens (see above) Insulin resistance Dyslipidemia (low HDL, high LDL, high triglycerides)

Question 40

treatment for polycystic ovary syndrome

Answer 40

■ Varies according to women’s goals, most importantly desire to have children in near term ■ In overweight women, weight loss alone may lead to decreased androgen levels and resumption of ovulation ■ In women w/ Insulin Resistance: Metformin ■ For women who wish to resume ovulation ● Clomiphene (inc gonadotropin release by inhibiting neg feedback of estrogen at hypothalamus) ■ Women w/ no desire to become pregnant ● Estrogen/Progesterone contraceptives ● Spironolactone (anti-androgen)