Endocrinology Flashcards Preview

R2 - Family Medicine > Endocrinology > Flashcards

Flashcards in Endocrinology Deck (14)
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1
Q

DM type I

A
  • onset: slow in adults, rapid in children, autoimmune, Finland/Sardinia (by Italy)
  • Type 1A: immune mediated, HLA associated, white, no FHx, autoantibody (+)
  • Type 1B: idiopathic, AA/Asian, autoantibody (-), FHx
  • sxs: 3Ps (polyuria, polydipsia, polyphagia), wt loss, infxn, nocturia, blurry vision
  • dx: autoimmune markers, GAD65 autoAbs, islet cell autoAbs, insulin autoAbs, C-peptide low (no active insulin in body)
  • tx: insulin pen, vial and basal bolus with carb counting, check gluc at least 4x daily
2
Q

DM type II

A
  • insulin resistance: hyperinsulin at first, then hypoinsulinemic
  • insulin resistance doesnt change - insulin secretion changes, B-cell decline gradual, def of amylin, def of GLP-1: stops glucagon, satiety, inc insulin release, postprandial gluc increases over time
  • RF: first deg relative, age, obesity
  • sxs: blurred vision, 3Ps, WIN, Acanthosis nigricans, ketonuria and wt loss (rare), fatigue, pruritus, recurrent candidal vaginitis, blurred vision, poor wound healing
  • dx: randome glucose >200 (w/ sxs), fasting >126 (2+ occasions), HbA1C >6.5%, OGTT if fasting 100-125, diabetic dyslipidemia (high TGs, low HDL, altered LDL)
  • tx: diet, exercise, wt loss, metformin
  • goal of HbA1C = 6-6.5, FBS goal = 100-124, 1-2 PP (<180), screen annually
3
Q

dawn phenomenon and somogyi phenomenon

A
  • dawn phenomenon: increased resistance to insulin in the early morning d/t counter-reg hormones
    • tx: increase overnight basal insulin, exercise, metformin, TZD
  • somogyi phenomenon: rebound fasting hyperglyc following undetected hypoglyc overnight, excess hunger, wt gain, worsening hyperglyc
    • tx: dec overnight basal insulin or eat a snack at bedtime
4
Q

hyperthyroidism

A
  • associated: afib
  • subclinical hyperthyroidsim = low TSH, normal T3/T4
  • sxs: anxiety, insomnia, irritability, palps, wt loss, heat intolerance, sweating, D, increased freq, oligomen, tremor, hyperactivity, tremulousness
  • signs: moist skin, tachycardia, hyperreflexia, flushed, diaphoretic, wide pulse pressure
  • dx: Primary hyperthyroid - TFTs (TSH low, total T3 high, free T4 high)
    • ​autoantibody tests (antithyroid peroxidase Ab, TS-immunoglob
    • scintigraphy (thyroid scan) - if etiology unclear after initial labs
  • tx: propranolol, methimazole, propylthiouracil (can . use in preg and thyroid storm), RAI tx, thyroidectomy
5
Q

hypothyroid

A
  • primary: failure of thyroid to produce sufficient T3 (iatrogenic - prior tx of hyper thyroid, hashimotos)
  • secondary: hypothyroid dt pituitary dz, low TSH/free T4
  • tertiary: dt hypothal dz (TRH def), low TSH/free T4
  • associated: carpal tunnel syndrome
  • sxs: constipation, fatigue, lethargy, weakness, wt gain, depression, menorrhagia, cold intolerance, cramps, slow mentation, inability to concentrate, dull expresion, m weakness, arthralgias, hoarseness
  • signs: dry, rough skin, coarse hair, palpable enlarged thyroid, brittle nails, puffy face and eyelids, yellowing of skin (carotenemia), decreased DTRs
  • dx: thyroid fn tests
    • primary: high TSH (most sensitive)
    • secondary: low TSH
    • tertiary: low TSH
    • free T4 low in clinically overt
    • Ab testing, CBC (normocytic anemia MC)
  • tx: levothyroxine (T4) → effects in 2-4wk →monitor TSH and clinical state periodically
6
Q

Grave’s dz (diffuse toxic goiter)

A
  • 80%, metabolically active gland, MCC of hyperthyroidism, mostly younger women with other autoimmune conditions, Autoimmune (thyroid stimulating IgG Ab binds TSH receptors on surface o f thyroid cells triggering synthesis of excess thyroid hormone)
  • sxs: pretibial myxedema, exophthalmos (periorbital edema, diplopia, or proptosis), thyroid bruit, diffusely enlarged, symmetric, nontender gland
  • dx: measurement of thyroid Abs (anti-TPO high, TSI high), scintigraphy (diffuse uptake)
  • tx: antithyroid meds, radioactive iodine preferred, saline eye drops and tight fitting sunglasses, high dose steroids with orbital decompresison surgery and ocular radiation tx for severe exophthalmos
7
Q

thyroid storm

A
  • rare, life-threatening complication of thyrotoxicosis, acute exacerbation of hyperthyroidism
  • precipitating factors: infxn, DKA, stress (trauma, surgery, illness, labor)
  • sxs: marked fever, agitation, psychosis, confusion, nausea, vomiting, diarrhea, signs: tachycardia
  • tx: supportive tx, antithyroid agents (PTU q2h, iodine), BB, dexameth (generates peripheral T3 from T4, adrenal support
  • high mortality (20%)
8
Q

hashimoto’s thyroiditis

A
  • MCC: autoimmune thyroid disorder and MCC hypothyroidism
  • MC in F, genetics + FH common, slow decline in thyroid fn
  • sxs: puffiness of face and . eyelides: periorbital myxedema, thinning of outer halves of eyebrows, goiter (MC feature) - hard, nonpainful, nontender, multinodular, irregular, asymmetric
  • dx: antiperoxidase Abs (90% +), anti thyroglobulin . Ab, antimicrosomal Ab high, irregular I-131 on thyroid scan (not required to DX)
  • tx: levothyroxine (T4)
9
Q

myxedema coma

A
  • rare condition, precipitating factors (cold exposure, infxn, trauma, narcotics)
  • sxs: depressed state of consciousness, profound hypothermia, resp depression
  • tx: supportive tx for BP and breathing, IV thyroxine, IV hydrocortisone
  • high mortality rate (50-75%)
10
Q

primary adrenal insufficiency (addison dz)

A
  • chronic adrenocortical insufficiency
  • adrenal gland does not produce cort, aldosterone, or sex hormones (retain no sodium), primary adrenal failure from autoimmune adrenalitis
  • sxs: hyperpig dt increased ACTH, MSH (POMC), anorexia, abdominal pain, N, V, wt loss, lethargy, confusion, psychosis, weakness, malaise, postural HoTN, dizziness, salt craving
  • signs: hypotension (orthostasis)
  • dx: electrolytes (hyponat, hyperkalemia, hypoglycemia, hypercalcemia, elevated SCr), low serum cort, high ACTH, low aldo and high renin
    • cosyntropin test = definitive (cort will not elevate sufficiently → test also known as astandard ACTH test
  • tx: daily oral steroids (hydrocort, prednisone), daily fludrocort (mineralocort)
11
Q

secondary adrenal insufficiency

A
  • long-term steroid therapy - most common cause overall, dysfunciton of hypothalamic pituitary . component of HPA axis: only steroid and androgen deficiency present
  • sxs: hx of prior use of oral steorids shuts down adrenal axis and causes acute adrenal crisis when stopped (weakness, malaise, postural HoTN, lethargy, confusion, psychosis)
  • sings: alabaster pale skin
  • dx: electrolytes (hyponat, hyperkalemia, hypoglyc, serum cort low, serum ACTH low, nl aldosterone and renin, ACTH test → cort will not respond at all)
  • tx: only daily steroid required
12
Q

addisonian (adrenal) crisis

A
  • HoTN refractory to IV fluids or acutely ill pts with chronic steroid use (moon facies, buffalo hump), any stress can precipitate adrenal crisis
  • sxs: fatigue, anorexia, generalized aches, weakness, lethargy, abd pain, N, V
  • signs: severe HoTN (orthostasis)
  • dx: hyponatremia, hyperK, hypoglyc, elevated SCr, metabolic acidosis, acute renal failure, cortisol low, ACTH stim test or cosyntropin test (cort will not elevate sufficiently)
  • tx: IV hydrocortisone, fludrocortisone, IV fluids, monitor fluid intake and output, and serum K levels frequently
13
Q

primary aldosteronism (Conn syndrome)

A
  • benign adenoma of the adrenal cortex (makes aldosterone, retian sodium)
  • sxs: pt on no meds with HTN
  • dx: hypokalemia (unprovoked), hypernatremia
14
Q

cushing syndrome

A
  • excessive exogenous cort, MCC = iatrogenic dt prescribed prenisone, androgen excess absent (exog steroids suppress production by adrenals), second MCC = ACTH secreting adenoma (AKA cushing dz) →bilateral adrenal hyperplasia (androgen excess common)
  • sxs: striae, buffalo hump, central obesity, moon facies, lanugo, acne, easy bruising, proximal muscle weakness and wasting, osteoporosis, AVN of fem head, HA, depression, mani
  • signs: HTN, DM, menstrual irreg, infertility, Cushing dz only = masculinization
  • dx: HD dexamethasome suppression test, midnight serum cortisol, late night salivary cort, urinary free cort, CT or MRI, sustained elevated cort, hypoK, hyperglyc, glucosuria
  • tx: if iatrogenic → taper steroids, if ACTH secreting adenoma, transphenoidal resection of tumor, adrenal adenoma → pit radiation, med adrenalectomy, bilateral adrenalectomy, ectopic ACTH production (2/3 SCC from lungs)