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CHC > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Type I diabetes

A

no insulin production

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2
Q

Type II diabetes

A

diminished insulin sensitivity

diminished insulin secretion

increased glucose production

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3
Q

gestational diabetes

A

insulin resistance during late pregnancy

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

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4
Q

prediabetes

A

impaired glucose tolerance and/or impaired fasting glucose

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5
Q

DMkey labs for DM

A

HbA1C

plasma glucose

liver function - ASTs, ALTs

kidney function - albumin, creatinine

blood lipids

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6
Q

physical exam for DM

A

BMI

condition of feet

peripheral sensation

peripheral edema

cardiac exam

reflexes

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7
Q

biguanides

A

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

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8
Q

Sulfonylureas

A

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

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9
Q

Meglitinides

A

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

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10
Q

Insulin

A

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.

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11
Q

signs and symptoms of DM

A

Retinopathy - Blurry vision

Neuropathy - Loss of sensation in extremities. Diminished reflexes

Nephropathy - Albumin in urine. Inc serum creatinine.

Cardiovascular disease

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12
Q

what to ask for DM

A

○ 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

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13
Q

symptoms of hypothyroidism

A

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

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14
Q

symptoms of hyperthyroidism

A

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

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15
Q

key labs for thyroid disorders

A

TSH

T4

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16
Q

history of thyroid disorders

A

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

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17
Q

thyroid disorders physical exam

A

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

18
Q

Cushing’s Syndrome

A

Excess cortisol production or administration.

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

19
Q

classification of Cushing’s Syndrome by etiology

A

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.

20
Q

signs and symptoms of Cushing’s

A

● 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.

21
Q

labs/studies for Cushing’s

A

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.

22
Q

aldosteronism

A

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

23
Q

signs/symptoms of aldosteronism

A

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

24
Q

labs/studies for aldosteronism

A

Potassium
Renin
Blood pH
Left ventricular hypertrophy

25
Q

physcial for aldosteronism

A

BP

26
Q

treatment for aldosteronism

A

Potassium
Renin
Blood pH
Left ventricular hypertrophy

27
Q

Addison’s disease

A

Primary - Atrophy of adrenal glands

Secondary - ACTH deficiency.

28
Q

symptoms of Addison’s

A

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

Hyperkalemia
Hyponatremia

29
Q

labs for Addison’s

A

ACTH stimulation test

ACTH

Aldosterone - Dec in primary, but typically normal in secondary

Serum electroyltes

30
Q

physical for Addison’s

A
31
Q

treatment for Addison’s

A

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

32
Q

hypoaldosteronism

A

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

33
Q

tests for hypoaldosteronism

A

ACTH stimulation test

Renin and aldosterone levels following postural changes and sodium restriction

Failure to inc. aldosterone following Na+ restriction.
Hyperkalemia

34
Q

treatment for hypoaldosteronism

A

Fludrocortisone. Furosemide with Na+ restriction

35
Q

parathyroid disorders

A

hypoparathyroidism

hyperparathyroidism

36
Q

Hypoparathyroidism

A

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

37
Q

Hyperparathyroidism

A

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

38
Q

adrenal androgens

A

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

39
Q

signs and symptoms of polycystic ovary syndrome

A

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)

40
Q

treatment for polycystic ovary syndrome

A

■ 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)

CHC (1 decks)

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