Overactive parathyroid gland - secrete too much PTH = incr level of Ca increase PTH =\> bone breakdown =\> Ca rise _Primary_ - d/t parathyroid adenoma _Secondary_ - physiologic resposnse to hypoCa or Vit D deficiency (MCC kidney disease) Sxs: same as hypercalcemia bone loss (incr PTH and Ca abs from bones) = pain in bones renal loss of Ca = kidney stones incr GI abs of Ca = abd groans irritability, psychosis, depression = moans Dx: Incr Ca, PTH, decr phosphorus urine - hyperphosphaturia, hypercalciuria Tx: Primary = surgical resection, if all 4, remove 3.5 glands Secondary = replace cause (vit D/Ca supp) if Ca very high = IV fluids, Lasix, calcitonin tx osteoporosis with bisphosphonates

Endocrinology - 7% Flashcards by Katie Mac

Acromegaly/Gigantism

Pituitary Disorders

dx, tx

serum IGF-1 elevation - 3-10x ULN
- can also monitor response to tx
Plasma GH via radioimmunoassay
- blood taken before breakfast, normal is < 5ng/mL
- then measure, GH suppression after glucose load
CT or MRI for pituitary tumor

Transsphenoidal surgical resection
Octreotide or Lanreotide to suppress GH secretion

How well did you know this?

Not at all

Perfectly

Acromegaly/Gigantism

Pituitary Disorders

MCC pituitary adenoma - excessive Growth Hormone

Gigantism - if GH hypersecretion begins in childhood, before epiphyses closure

Acromegaly - GH hypersecretion begins in adulthood, after epiphyses closure [A for Adults]

Sxs

Headaches, visual spot defects
Gnathism, weight gain
enlarged/spade hands and feet
congestive cardiac failure

How well did you know this?

Not at all

Perfectly

Addison’s Disease

(Adrenal Insufficiency)

dx, tx

Dx:

8AM Serum cortisol < 3mcg/dL and ele ACTH > 200 pg/mL
ACTH Stimulation Test
- Primary/Addison’s - high ACTH, low cortisol
- Secondary/pituitary - low ACTH, low cortisol
Cosyntropin Stimulation Test**
- Cortisol serum should rise > 20 ug/dL
- Primary/Addison’s: high ACTH, low cortisol
- Secondary/pituitary: low ACTH, low cortisol
Serum Dehydroepiandrosterone (DHEA) < 1000 mg/dL
HypoNa
HyperKalemia
CT of Adrenal gland
Adrenal Autoantibodies

Tx:

Addison’s - Glucocorticoid + mineralcorticoid replacement therapy
- Hydrocortisone 1st line
- Fludrocortisone - if no renin or aldosterone
DHEA for women who want to start a family
Secondary/pituitary - fix pituitary

How well did you know this?

Not at all

Perfectly

Addison’s Disease

(Adrenal Insufficiency)

eti, sxs

LOW cortisol d/t autoimmune destruction of adrenal cortex

can be precipitated by stress, illness, trauma, infection, met cancer

Sxs:

hyperpigmentation - bronze - increased ACTH
weakness
anorexia, wt loss
Pain - athralgias, myalgias
Anxiety, irritability, depression

How well did you know this?

Not at all

Perfectly

Cushing’s Disease

dx, tx

Dx:

24 hr urine free cortisol collection
- if ele cortisol => ACTH level
  - high plasma or serum ACTH = ACTH dependent cause
    - MRI of brain => pituitary adenoma (Cushing Disease)
  - low plasma or serum ACTH = ACTH independent cause
    - CT of adrenals => adrenal mass/adenoma
Low dose Dexamethasone Suppression Test
- failure of steroid to decrease cortisol = diagnostic
High dose Dexamethasone Suppression test
- no suppression (cortisol still high) = Cushing’s syndrome

Tx for Cushing’s Disease - Transsphenoidal resection

How well did you know this?

Not at all

Perfectly

Cushing’s Disease

eti, sxs

HIGH cortisol

Eti:

Cushing Syndrome
- sxs from prolonged exposure to excess cortisol
Cushing’s Disease
1. ACTH secreting pituitary microadenoma, usu on v small anterior pituitary
2. F 3x > M

Sxs:

Obesity - buffalo hump, moon facies, supraclavicular pads
HTN
Thirst
Pigmented striae
oligomenorrhea/amenorrhea
polyuria

How well did you know this?

Not at all

Perfectly

Diabetes Inspidus

eti, Sxs

Deficiency of or resistance to Vasopressin (ADH) - decr kidney’s ability to reabsorb water = massive polyuria

Eti: MC dx in children

Central DI

deficiency of ADH from posterior pituitary/hypothalamus
- no ADH production MCC idiopathic
- autoimmune destruction of posterior pituitary from trauma, infx, sarcoidosis

Nephrogenic DI

lack of reaction to ADH
- partial or complete Insensitivity to ADH
- Drugs (Lithium, Amphoterrible)
- HyperCa and hypoK - can’t concentrate urine
- Acute tubular necrosis

Sxs:

polyuria
polydipsia

How well did you know this?

Not at all

Perfectly

Diabetes Inspidus

dx, tx

Dx:

Serum osmolality (blood) is high - blood gets thicker bc water is not getting reabsorbed
Urine osmolality is low - too much water:solute ratio
Water Deprivation Test
- establish diagnosis of DI - urine continues to be dilute
- r/o psychogenic - ADH working so urine osmolality would increase
Desmopressin DDAVP Stimulation Test -differentiates btwn Central or Nephrogenic
- Central - urine concentration increase = response to ADH
- Nephrogenic - continue production of dilute urine bc kidneys do not respond

Tx:

Central - desmopressin/DDAVP
Nephrogenic - Na and protein restriction, HCTZ, indomethacin

How well did you know this?

Not at all

Perfectly

Diabetic Ketoacidosis

Medical emergency - complications of Diabetes

Increased insulin req’s = shortage. Body starts to use excess fat => ketone accumulations

Insulin deficiency => hyperglycemia => deH2O => ketonemia (anion gap Met Acidosis) => potassium def

Younger pts w/ Type 1 DM

Sxs:

thirst, polyuria, polydipsia, nocturia
weakness, fatigue, confusion
N/V
Chest pain/ abd pain
Signs - tachypnea/tachycardia, hypotension, decreased skin turgor, fruity breath/Kussmaul’s respiration

Dx:

Blood sugars > 250 mg/dL
anion gap Met acidosis pH < 7.3 and HCO3 < 18
Plasma ketones

Tx: IV fluids & insulin!

How well did you know this?

Not at all

Perfectly

Diabetic Mellitus Type 1

eti, sxs, dx, tx

Type 1 - MC in young people

Immune mediated - pancreatic islet B cells destruction via autoimmune (type 1A) and idiopathic (type 1B, MC in Asian and African)

Sxs:

Polyuria
Polydipsia
wt loss despite normal or increased appetite (polyphagia)
Blurred vision
Glucosuria

Random glucose > 200mg/dL
fasting glucose > 126 on > 1 occassion
HbA1c > 6.5%

Mediterranean diet
Insulin - regular insulin - in abd
Daily asp to decr DVT risk
Opthal exam
Mod exercise
prompt tx of infx

How well did you know this?

Not at all

Perfectly

Diabetes Mellitus Type 2

eti, sxs, tx (no meds)

Type 2 - younger persons who are overwt/obese; central obesity

Sxs:

Polydipsia
Polyuria
Fatigue
Candida vaginitis
Skin infx
blurred vision
poor wound healing

Random glucose > 200
Fasting > 126
- If btwn 100-125, PO glucose tolerance test - 3 hr plasma glucose > 200
A1c > 6.5%
- A1c 5.7-6.4 = Prediabetes
- Fasting glucose - 100-125
- 2 hr PO glucose tolerance test 140-199

Tx:

Weight loss - diet, exercise
monitor eyes/feet
control BP <140/90
Urine Albumin/Cr screening

How well did you know this?

Not at all

Perfectly

Diabetes Mellitus T2

Meds

Biguanid - Metformin

decr hepatic glucose production & intestinal absorption
C/I if eGFR < 30ml/min; not rec’d with 30 to 45 ml/min
- dc 24 hrs before contrast and resume 48 hrs after
- monitor Cr, stop if Cr > 1.5

Sulfonylureas -“Glyburide, Glipizide, Glimepiride”

stimulates pancreatic B-cell Insulin release
oldest DM drugs - risk of hypoglycemia
Glipizide, Glyburide, Glimepiride

Thiazolidinediones - “Pioglitazone, Rosigilitazone”

Increase Insulin sensitivity in peripheral receptor site adipose and muscle tiissues; has no effect on pancreatic beta cells
C/I - CHF, liver disease, fluid retnetion, wt gain, bladder cancer (pioglitazone), increase in MI/HF (rosigilitazone)

Alpha glucosidase Inhibitors

Delays Intestinal glucose absorption
GI side effects - TID dosing
Acarbose, miglitol

GLP-1 Agonists -“tide” - injectable

lower blood sugar by mimicking incretin -causes insulin secretion and decreased glucagon, delays gastric emptying, works on pancreas (can cause pancreatitis)
SE - req’s injection, freq GI SE,
benefits of weight loss, reduced CV mortality (semaglutide)
Dulaglutide (trulicity), Exenatide (bydureon)

DPP-4 Inhibitors

inhibits degradation of GLP1 so more circulating GLP1
expensivie, incr risk of HF (sxagliptin)
Sitagliptin (januvia)

SGLT2 Inhibitors -“flozin” urinate like crazy

lowers renal glucose threshold, Increases urinary glucose excretion
SE - vulvovaginitis, UTI, lower limb amps, AKI, DKA, ortho hypotension
Benefits - wt loss, reduction in systolic BP, reduce CV risk

Insulin

add in blood sugar A1C > 9
Basal supplement (NPH, lispro, glargine, detemir)
- rest and digest
Prandial bolus (lispro, aspart, glulisine vs regular [short acting]
- before meals

How well did you know this?

Not at all

Perfectly

Dwarfism

Pituitary Disorders

dx, tx

serial measurement > 2.5 dev below normal mean = GH eval
low IGF-1 and IGF-binding protein 3
Bone age - Xray of child’s hand for chronological age comparison
- if >2yrs behind chronological age = positive
- somatomedin C + GF with blood tests
MRI or CT of brain for cause

subcut injections of recombinant Human GH
Surgery for pituitary adenoma

How well did you know this?

Not at all

Perfectly

Dwarfism

Pituitary Disorders

eti, sxs

GH deficiency = slow growth pattern

primary or with hypothalamus and pitutiary disorders

Achondroplasia - FGFR3 mutation

Sxs

in adults - lower bone density and decreased muscle mass (no affects on bone growth)
GH deficiency in infancy = hypoglycemia and micropenis
in children = bone growth delays relative to chronological age
- understimulation of osteoblasts => short stature

How well did you know this?

Not at all

Perfectly

Hyperparathyroidism

Overactive parathyroid gland - secrete too much PTH = incr level of Ca

increase PTH => bone breakdown => Ca rise

Primary - d/t parathyroid adenoma
Secondary - physiologic resposnse to hypoCa or Vit D deficiency (MCC kidney disease)

Sxs: same as hypercalcemia

bone loss (incr PTH and Ca abs from bones) = pain in bones
renal loss of Ca = kidney stones
incr GI abs of Ca = abd groans
irritability, psychosis, depression = moans

Dx:

Incr Ca, PTH, decr phosphorus
urine - hyperphosphaturia, hypercalciuria

Tx:

Primary = surgical resection, if all 4, remove 3.5 glands
Secondary = replace cause (vit D/Ca supp)
if Ca very high = IV fluids, Lasix, calcitonin
- tx osteoporosis with bisphosphonates

How well did you know this?

Not at all

Perfectly

Hyperthyroidism

Study These Flashcards

Production of too much thyroxin hormone - increase metabolism

Eti - MCC Grave’s disease (autoimmune), toxic adenoma, thyroiditis, pregnancy, amiodarone

Sxs:

weight loss, anxiety
warm, moist skin
insomnia
fine tremor, muscle cramp, hyperreflexia
amenorrhea
tachycardia/palpitations
Graves - diffuse goiter w/ bruit, exopthalmos, pretibial myxedema
heat Intolerance

Dx:

TSH low and T4 high - primary disease
TSH high and T4 high - secondary dz
Anti-thyrotropin antibodies
RA Iodine uptake = increased uptake in
- Graves = diffusely high uptake
- Toxic Multinodular goiter = Discrete areas of high uptake

Tx:

BB symptomatic - propanolol
Methimazole
Propylthiouracil (PTU) - safe for pregnancies in the first trimester, then switch to Methimazole
Radioactive iodine I-131
Thyroidectomy - complication recurrent laryngeal

Hypoparathyroidism

Study These Flashcards

body secrets low PTH => decr serum Ca

MCC - thyroidectomy

Same Sxs as hypoCa:

Tetany, tingling, cataracts
Chvostek’s sign - facial n illicit twitch
Trousseau’s sign - carpal spasms after BP cuff inflation

HypoCa, low PTH
hyperphosphatemia
low urinary Ca

Vit D and Calcium gluconate

Hypothyroidism

Study These Flashcards

95% Autoimmune - MC Hashimoto’s or prev thyroidectomy/iodine ablation, congenital

Sxs: - everything LOW OR SLOW

Weakness, lethargy, slow speech
dry/coarse hair, weight gain
cold intolerance
depression
anemia, bradycardia, hyporeflexia

TSH high
T4 and T3 low
Antithyroid peroxidase
Antithyroglobulin ABs

Levothyroxine/Synthroid

Multiple Endocrine Neoplasia

Neoplasms

Study These Flashcards

Autosomal Dominant - inherited condition that develops multiple endocrine tumors

Three types

MEN Type 1 (Wermer Syndrome) - 3Ps
- Parathyroid hyperplasia
- Pancreatic islet cell tumors (2/3 of pts with MEN1, ZES or insulinoma
- Pituitary tumors
MEN Type IIa (Sipple Syndrome) - MPP - 2Ps
- Medullary thyroid carcinoma (100% of pts)
- Pheochromocytoma - >1/3 of pts
- Parathyroidism - primary
MEN Type IIB - MMMP
- Medulary Thyroid carcinoma - more aggressive than in IIa
- Mucosal neuromas - nasopharynx, oropharynx, larynx, conjunctiva
- Marfanoid body habitus
- Pheochromocytoma

Surgical resection
treat symptoms for MEN I
MEN II - MTC - tyrosine kinase inhibitors, chemotherapy

Neoplastic Syndrome

Neoplasm

Study These Flashcards

Consequence of cancer in body - mediated by humoral factors (cytokines and hormones) secreted by tumor cells or immune response against the tumor

SCLC

Tumor product - ACTH, ADH, ab against presynaptic Ca2+ channels
Cushing syndrome, SIADH, Lambert Eaton

Squamous Cell LC

PTH related peptide, TGF-B, TNF< IL-1

Renal Cell Carcinoma

Erythropoietin
Polycythemia, HyperCa

Thymoma

Antibodies against nicotinic Ach receptor at postsynatic neuromuscular junction
Myasthenia gravis

Intracranial Neoplasm

ADH
SIADH

Leukemias and lymphomas

Excess nucleic acide turnover, TLS
Gout , urate nephropathy

NonKetotic Hyperglycemia

Study These Flashcards

MC in DM T2 during physiological stress

high blood sugar = high osmolarity w/o significant ketoacidosis

Eti

acute infx/med conditions
drugs that impair glucose tolerance - glucocorticoid, or increase fluid loss (diuretics)

Sxs:

days to weeks
Altered LOC
signs of deH2O, weakness
leg cramps
vision problems

Dx:

Blood sugar > 600 mg/dL or 30 mmol/L
Osmolarity > 320 mOsm/kg
pH > 7.3

IV NS 0.9%
IV insulin (if K > 3.3 mEq/L)
LMWH - risk of clots
decrease slowly - risk of cerebral edema if not
K replacement as needed
target plasma glucose in acute tx is 250-300 mg/dL

Pheochromocytoma

Study These Flashcards

Catecholamin secreting adrenal tumor - secretes NorEpi and Epi

a/w Neurofibromatosis Type 1, MEN 2A/2B

Sxs - 5Ps

Pressure - HTN
Pain - HA
Perspiration - excessive sweating
Palpitations
Pallor

24 hr catecholamines w/ metabolites - metanephrine and vanillylmandelic acid
MRI or CT of abd

complete adrenalectomy
a blockade - phenoxybenzamine or phentolamine x 7-14d followed by BB for HTN control
- do NOT give BB first = life threatening HTN

Pituitary Adenoma

Pituitary Disorders

Study These Flashcards

Microadenomas < 1cm in diameter; adenomas are > 1cm = macroadenomas

35-60yo; benign

Sxs

Most to least common types
- Prolactinoma - Galactorrhea, amenorrhea, infertility, decreased libido
  - incr prolactin >200ng/mL
  - MRI dx
  - tx with Bromocriptine
- Non-secreting adenoma
  - secrets a-subunit
- Somatotroph adenoma - Acromegaly
  - incr GH or prolactin
- Corticotroph Adenoma - Cushing’s disease
  - incr ACTH
- Thyrotroph Adenoma - Hyperthyroidism
  - incr TSH

MRI - sellar lesions or tumors
Endocrine studies - TSH, FSH, prolactin, ACTH, LH

Transsphenoidal surgery - active or compressive tumors
medical mgmt - Dopamine inhibits prolactin Cabergoline or Bromocriptine
Acromegaly - TSS + Bromocriptine (dopamine dec GH production)

Adrenal Tumor/Neoplastic Disease

Primary Endocrine Malignancy

Study These Flashcards

see pheochromocytoma

**Thyroid Neoplastic Disease** Primary Endocrine Malignancy

Hoarse voice, solitary cold nodule on uptake sacan MC - papillary carcinoma, medullary is most deadly Dx * US - initial * Thyroid uptake scan * Microcalc, hypoechogenicity, solid cold nodule, irregular margins * **FNB - \*\*\*gold** - all lesions \>1cm Tx * Surgical resection * Chemo/ext beam radiation

**SIADH** eti, sxs Neoplasms

Inappropriate release of ADH = impaired water excretion = water retention and dilutional hypoNa Etis * Malignancy - small cell (oat cell) of lung * Medications - carbamazepine, cyclophosphamide, NSAID, sulfonylureas, SSRIs * CNS disturbnances - infection, malignancy, stroke * TBI * Pulmonary Disturbances - PNA, Tb * Mechanically ventilated pts Sxs * N/V, headache, confusion, weakness, fatigue

**SIADH** dx, tx

Dx * low serum Na \<135 mmol/L * low plasma osmolality \< 275 mOsm/kg * low serume uric acid \< 4mg/dl * Nl adrenal and thyroid function Urine studies * high urine Na (\>40 mmol) * high urine osmolality (\>100 mOsm/kg) Tx * fluid restriction * Na management * mild to mod =\> isotonic 0.9% saline with furosemid * Severe = hypertonic 3% saline * Meds * **Vaptans** (ADH receptor antagonist) = Tolvaptan, Conivaptan * **Demeclocycline** (ADH recept antagonist) * Lithium - decr responsiveness to ADH

**Subacute thyroiditis** | (de Quervain's Thyroiditis)

MCC of thyroid pain, mc in F\>M Eti - **post viral and muscle aches** - following symptoms of fever, myalgias, & pharyngitis Sxs: * Inflamed, painful thyroid - localized neck pain * fever and muscle aches * Early hyperthyroid course, then hypothyroidism Tx * NSAID * Methimazole, PTU Increased ESR 60-100

Thyroid Carcinoma

MCC = radiation exposure; nodules must be \>1cm to be palpated _Types_ 1. **Papillary carcinoma** is MC, thyroid adenoma MC benign nodule; young F 40-60 2. Follicular - hematologic spread, CNA or CNB to confirm 3. Medullary - MEN syndrome - calcitonin level, tx w/ ext beam radiation 4. Anaplastic - SOB, hoarseness, CNB, sx bx, tx w/ sx or palliative, poor prog Dx * US - malignant if * microcalcifications, hypoechogenicity, Irregular nodule margins, * lesions \> 1 cm biopsied * **Thyroid uptake scan** * ****cancerous lesion do **NOT** take up iodine "cold" * non-cancerous lesion will take up iodine "hot" * FNA to culture

**Thyroid Nodules** Evaluation

1. Palpable nodule \> 1cm 2. Confirm with **US** 3. if TSH low =\> * Thyroid Radioiodine Uptake or **Scintigraphy** scan * malignant wont take up iodine = nonfunctional "**cold"** * **Confirm with FNA** 4. if TSH normal or high =\> **FNA** if * microcalc, irreg margins * next to recurrent laryngeal n. or LNs Tx * malignant- thyroidectomy * benign - f/u in 6 mos * unsatisfactory specimen - FNA repeat 1-4 wks to mirror structure

Thyroiditis - Drug induced and Infectious

**_Drug Induced_** * antithyroid meds - methimazole and PTU * lithium - bipolar * amiodarone - antiarrhythmic * Interferon alpha * Tyrosine kinase inhibitors - anticancer * TSH recheched q 6-12 mos **_Infectious_** * Hematogenous spread of staph or strep * Inflammation - fever, heat, pain, redness, swelling * Incr WBC

Thyroiditis - Hashimoto's

Inflammation of the thyroid gland - multiple etiologies **Hashimoto's thyroiditis** autoimmune form - thyroid tissue is destroyed by antibodies over time = chronic hypothyroidism Sxs: * goiter on PE * high levels of **anti-TPO antibodies** Tx euthyroid - no treatment Chronic hypothyroidism - lifelong sub w/ T4 aka levothyroxine

Thyroiditis - Postpartum thyroiditis

2-12 months after giving birth Immune system diminished after pregnancy =\> after birth immune system becomes more active and attacks thyroid Hyperthyroid phase 5-7 mos after birth followed by normal thyroid function

Endocrinology - 7% Flashcards

(33 cards)