Fever, N&V, Abd pain Hypotension, Hyperpigmentation in palmar creases Polydipsia
What oral hypoglycemic agent is contraindicated for men with Cr >1.5 and women >1.4?
Metformin. Contraindicated in renal dz.
MEN I (Wermer's Syn)
Pituitary tumor Parathyroid hyperplasia Pancreatic Islet cell tumor
MEN IIA (Sipple Syn)
Medullary thyroid ca. Pheochromocytoma Parathyroidism
Medullary thyroid ca. Pheochromocytoma Marfanoid
C1 Inhibitor Deficiency --> non-inflamm. edema of face, limbs, genitals, colic Dx: Dec. C4
Familial Hypocalciuric HyPERcalcemia Dx:
AutoDom Ca-sensing-Receptor gene mutation wherein higher Ca2+ concentrations are needed to inhibit PTH release and Ca2+ reabsorption Dx: Ca >10 Hypocalciuria = Ca2+/Cr ratio 2.0
Insulinomas are usually suggested by what triad?
Whipple's triad: 1. hypoglycemia 2. low glucose 3. relief of S&S when glucose is raised
Labs seen in Whipple's triad
1. Low glucose 2. High insulin, C-peptide, and pro-insulin
What would C-peptide levels be in surreptitious injection of insulin?
Low C-peptide. (C-peptide means body was making insulin)
Hashimoto Thyroiditis (Hypothyroidism) keywords
Enlarged non-tender thyroid Widespread destruction of follicles Anti-TPO, eosinophilic Hurthle cells Inc. risk thyroid lymphoma and papillary thyroid ca.
What is it called when the thyroid is functioning normally but does not receive stimulus from the pituitary to produce more hormone?
Dermatologically, how would primary adrenal insufficiency manifest? Why does this happen?
Darkening of the skin. Low Na+, High K+ There is an increase in production of ACTH to compensate for lack of aldosterone production.
2ndary adrenal insufficiency and 2ndary hypothyroidism together suggests?
Pituitary insufficiency most likely d/t pituitary tumor
In Carcinoid Syndrome, what neurotransmitter is most responsible for diarrhea?
What is the most common cause of thyroid cancer? Keywords? Tx? AE?
Papillary thyroid carcinoma. Orphan annie eyes, psamomma bodies in follicular cells Tx: Radioactive Iodine AE: drymouth/sialadenitis
From where do most carcinoid tumors originate?
Lupus nephritis Lab values
normal CRP Elevated ESR Decreased serum C3 and C4
Glipizide, Glyburide, Glimepiride, Tolbutamide belong in what class? MOA? Adverse SE?
Sulfonylureas. Increase endogenous insulin secretion ! hypoglycemia, weight gain, sulfa allergy, disulfiram-like rxn for tolbutamide
Rosiglitazone, Pioglitazone belong in what class? MOA? Adverse SE?
Thiazolidinediones. Increase insulin sensitivity. ! Edema, weight gain, hepatotoxicity, bone loss, not for heart failure pts.
Acarbose, Miglitol belong in what class? MOA? Adverse SE?
Alpha-Glucosidase Inhibitors. Decrease intestinal absorption of carbs ! Flatulence, hypoglycemia
Sitagliptin belongs in what class? MOA? Adverse SE?
DPP-4 Inhibitors. Inhibits degradation of GLP-1
Exenatide belongs in what class? MOA? Adverse SE?
Incretins. Is a GLP-1 agonist. ! Pancreatitis
How would Graves' Disease appear on RAIU?
diffuse (homogenous) uptake
When is methimazole allowable to treat hyperthyroidism in the pregnant woman?
What is a serious side effect?
2T (2nd trimester)
When is PTU allowable to treat hyperthyroidism in the pregnant woman?
1T (1st trimester). Generally, however, PTU is the one you pick in pregnancy.
Congenital Hypothyroidism S&S d/t?
poor feeding, constipatioin, large anterior fontanelle, macroglossia, umbilical hernia, MR d/t iodine deficiency, inborn errors of metabolism, thyroid dysgenesis
Myxedema Coma S&S Dx Tx?
hypothermia, bradycardia, hypoTN, hyponatremia, hypoglycemia Dx: Check cortisol prior to treating Tx: IV synthroid, Hydrocortisone
Thyroid Nodule Workup
Medullary Thyroid Ca. keywords
C-(calcitonin) Cells MEN 2A, MEN 2B