OME - Endocrine Flashcards by Alex Hamidi

What can cause Nephro DI?

Treat how?

Li toxicity, Demeclocycline

Diuretics - HCTZ and amiloride

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When should total insulin deman be 0.3 units/kg?

Cr > 1.5
Age > 65
bG > 180

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What is the Somogyi Effect?

W/u how?

Will show what?

D/t what?

Morning hyperglycemia

3AM bG test

will be LOW

Too MUCH insulin at night

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Find a PRLoma, 1st step in w/u?
Then?
Best?

PRL level
TSH/T4
MRI

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What is the thyroglobulin level like in the following?

Thyroiditis

Factitious

Struma Ovarii

Inc

Dec

Inc

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Hypoglycemia defined how?

Treat how?

bG < 70 or sx of hypoglycemia (palpitations, perspiration, presyncope)

PO glucose if awake, IV D50 if in coma

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Describe the following in cirrhosis/nephrosis:

Protein

Total T4

Normal Free T4

Dec

Normal

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Sx of Adrenal insufficiency?

HoTN, fatigue, N/V

Hyperpigmentation, Hyperkalemia

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How do you treat prediabetes?

Diet/exercise AND Metformin

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DDP-4-i SE?

Names?

Weight NEUTRAL

GLIPTIN

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Pt in DKA, what readings can you get?

What is Tmax of renal tubules of glucose?

Serum ketones > UA

180

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Pt w/refractory HTN or diastolic HT and HoKalemia has what?

Differentiate this how?

Conn’s

HIGH Aldo:Renin ratio > 20

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MC cause of Adrenal insufficiency in US is what?
Worldwide?

Can also occur when?

Autoimmune adrenalitis

B/L adrenal hemorrhage

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What is the DAWN phenomenon?

W/u how?

Will show what?

D/t what?

Morning hyperglycemia

3AM bG test

will be HIGH

Too little insulin at night

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What type of cosyntropin test indicates primary Adrenal failure?

Treatment?

No change in cortisol

Prednisone and Fludrocortisone

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Describe the following in pregnancy:

Protein

Total T4

Normal Free T4

Inc

Normal

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A pt that presents w/stupor, nuchal rigidity, HA, N/V and decompensating rapidly has what endocrine disorder?

Apoplexy d/t pre-existing tumor

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Fasting glucose screen, what is Pre-diabetes level?

2 hour GTT?

A1c?

100-124

140-199

5.7-6.4

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Pt w/primary hyperaldosteronism needs what test next?

Best test is what?

CT/MRI of ABD/Pelvis

Adrenal Vein sampling

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Symptoms of diabetes w/Random glucose screen: what is diabetes level?

Fasting glucose?

2 Hour GTT?

A1c?

> /= 200

> /= 125

> /= 200

> /= 6.5

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SE of Sulfonylurea drugs?

Names?

Hypoglycemia

Glyburide, Glipzide

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Pt w/suspected Cushing’s ACTH level after test is still high means what?

If low?

Not adrenal tumor - do high dose DST test

Adrenal tumor

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RAIU scan of toxic goiter appears how?

Multiple nodules or 1 BIG adenoma

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What meds disinhibit PRL?
What does that mean?

What directly stimulates PRL production?

Dopamine antagonists
More PRL is made

TRH

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Pt w/already established diabetes OR prediabetes Dx, what is the A1c goal?

< 7%

Thyroid lesion that is considered low risk for malignancy has what features?

Small, < 1cm for solid | < 2cm for cystic

When is Metformin Contraindicated? Oral agents reduce A1c by how much?

CKD, CHF, Liver disease d/t risk of lactic acidosis 3%

Zones of the adrenal medulla from outside to inside and what’s made there?

G - Aldosterone F - Cortisol R - Testosterone

MEN1?

Pituitary Parathyroid Pancreatic —> ZE, Insulinoma

TSH stimulates thyroid to make T4 and T3 in what ratio? Describe T4 How much is active?

10:1 ratio Inactive, bound to Thyroglobulin Binding Protein 0.1%

What autoantibodies are assoc w/T1 DM?

GAD65 #1 IA-2

1st step in w/u of Adrenal insufficiency? Next? Finally?

3am cortisol (will be < 3) Cosyntropin (ACTH) test CT or MRI

GLP-1 analogs SE? Names?

Weight loss, they are injectable TIDEs

Thalidizones SE? Mech? Names?

Weight gain, CHF Inc insulin sensitivity PioGLITazone

How do you treat SEVERE SIADH that fails diuretics and other fluid therapy?

Demeclocycline - induces nephro DI

Pt that has an incidental thyroid nodule w/normal TSH and no sx, what is the management?

Repeat US in 6 months

What insulin is used for basal coverage? Generic and brand

Glargine and Detemir Lantus and Levemir Ls Long acting

What is the mechanism behind organomegaly in acromegaly?

GH tells liver to make glucose AND to make IGF—> which directly stimulates growth of organs

What are the sx of thyroid storm?

Fever > 104 Delirium HoTN

Pt w/Pheo how do you want determine laterality?

MIBG scan

How do you treat DKA if the AG has not closed but glucose is approaching normal?

D5 half NS

Pt w/suspected Acromegaly: 1st step in w/u? Next? Finally? Treat how?

ILGF-1 levels Glucose Tolerance/suppression test MRI Octreotide (somatostatin) then surgery

What is the BEST test for SCREENING diabetes?

Fasting glucose

Pt w/Graves has what kind of RAIU scan? Treat how 1st? Then what? For chronic Graves? SE of treatment?

Diffuse Propanolol PTU/Methimazole Radioablation w/radioactive iodine Worsens ophthalmopathy

What are the MC causes of ectopic Cushing’s syndrome?

Lung -> Chest Ct Pancreatic —> ABD Ct Adrenals —> Pelvic CT

1st step in w/u of Cushing’s? 2nd? 3rd? Finally?

24 hour free urine cortisol AND low dose (1mg) overnight Dexamethasone ACTH High dose dexamethasone CT or MRI

What is a + glucose tolerance test?

Failure to suppress GH levels

What is the idiot insulin?

NPH / regular insulin mixture Humulin, Novolin

How do you approximate insulin demand? Give when?

0.5 units/kg Half at night Half prandial

What does insulin dependent diabetes mean?

Type 1

HoGlycemia in non-diabetic defined how?

bG < 60 AND sx

What insulin is used for prandial? Generic and brand names

Lispro and Aspart Humalog and Novolog

MEN2A? 2B?

Parathyroid, Pheo, Medullary thyroid Pheo, Medullary, Neuronal/Marfanoid

What is the treatment for thyroid storm?

IVF and cooling blankets 1st BBlocker 2nd PTU/Methimazole Steroids Iodide can be given

When should insulin be started in diabetics in relation to A1c? Can bring down levels by how much?

> 9% 7%

What normally triggers thyroditis? 1st appear how? Then what? RAIU looks like what?

Infection/trauma, drugs or subacute Hyperthyroid (d/t release of preformed T4) Hypothyroid COLD

Pt that has elevated bG w/NO Acidosis but does have AMS is in what? Tx?

HHNKC IVF and insulin

Papillary Thyroid cancer - tell me about it (3) things Prognosis?

MC, Orphan-Annie Nuclei, Psammoma bodies Good

Follicular thyroid cancer, tell me about it Treat how?

Spreads hematogenously Resection and radioactive iodine ablation

When you find an adrenal incidentaloma what do you need to workup? Treat how?

r/o Cushing’s, pheo, Aldo < 4cm watch and wait > 4cm or increase in size over time you MUST intervene

Meglitinides SE? Mech? Names?

Hypoglycemia Inc insulin secretion GLINIDEs

What type of cosyntropin test indicates secondary Adrenal failure? Treatment?

Increase in cortisol after 60 minutes Prednisone only

In hypopitutarism what test can be used to screen 1st? What is a + test? Confirm with what?

Insulin/glucose stimulation test Hypoglycemia fails to stimulate GH MRI

In hypopituitarism what hormones go 1st to last in order?

FSH/LH GH TSH ACTH

1st test after a nodule is discovered? If low then what?

TSH RAIU

Medullary Thyroid cancer - tell me about it?

C-cell produce calcitonin Hypocalcemia MEN2a and MEN2b

Main 3 symptoms of myxedema coma are what? D/t what? Treatment?

Hypothermia, HoTN, coma/AMS Hypothyroid IVF, high-dose T4 (IV Thyroxine)

What PE findings are suspicious for malignancy?

Fixed, hard, firm NT LNs Painless

What is an alternate endocrine cause of SIADH? Mechanism? Presents w/what lab values?

Hypothyroid TSH stimulates ADH at high doses Serum Osms low, Urine Osms high

What hx is suspicious for thyroid cancer?

Radiation to H&N Hoarseness Under 20 y/o Over 60 y/o

How to do you treat a pt w/PRLoma? What specific meds?

DA agonists Cabergoline > bromocriptine

Nodule is found with TSH level of normal or high, what does this mean? Next step?

HIGH-risk US

Pt that has wacky thyroid and is in the ICU, what do they have? Need to check what?

Euthyroid sick syndrome Reversed T3

When do you order a Free T3 in workup of Thyroid? Used when you suspect what?

Only if Dec TSH and Normal/dec T4 Hyperthyroid but normal T4

Pt w/thyroid nodule and Cold RAIU scan what is next step in w/u? If suspicious then what?

US FNA

What 4 cancers spread hematogenously?

Follicular thyroid cancer RCC HCC Choriocarcinoma

How does high T4 effect thyroglobulin?

Increases it

How does subclinical thyroid present? Treat when? What happens to their LDL levels?

Inc TSH and normal T4/T3 When hypothyroid sx start or TSH > 10 Inc

How does T4/T4 effect metabolism?

Increases it | Catabolic AND thermogenic

Pt that presents w/hypotonic hyponatremia can only have what?

``` RATS RTA Addison’s Thyroid SIADH ```

OME - Endocrine Flashcards

(80 cards)