Patho Midterm IV (endocrine)

primary vs. secondary hypothyroidism (problem with, labs)

primary- problem with thyroid gland itself (high TSH, low T4)

secondary- problem with pituitary gland (low TSH, low T4)

primary vs. secondary hypothyroidism causes

primary: Hashimoto’s, iatrogenic (thyroidectomy, radioactive iodine, external neck radiation)

secondary: brain/ pituitary (hypothalmic tumors, trauma, surgery)

Hashimotos lab confirmation

incr TSH, positive TPO antibodies

hypothyroidism symptoms

tired, weight gain, always cold, bradycardia

hypothyroidism management

levothyroxine, monitor TSH every 6 weeks

myxedema coma

severe hypothyroid

hypothermia, bradycardia, and altered mental status

hyperthyroidism primary vs. secondary (problem with, labs)

primary- problem with thyroid gland itself (low TSH, high T4)

secondary- problem with pituitary gland (high TSH, high T4)

hyperthyroidism primary vs. secondary causes

primary- Grave’s disease, toxic nodular goiter

secondary- pituitary adenoma

thyrotoxicosis without hyperthyroidism (what is it, causes)

excess thyroid hormones but glands itself aren’t producing them

causes: subacute thyroiditis, silent/ postpartum, amiodarone/ radiation-induced, exogenous hormone ingestion

thyrotoxicosis/hyperthyroidism symptoms (+ cardiac, elderly)

weight loss, incr appetite, feeling hot, jittery (nervous, palpitations), tachycardic, a-fib

*osteoporosis - elderly

Grave’s pathology & classic symptom

TSI (thyroid stimulating immunoglobinin) chronically stimuate TSH receptors

bulging eyes (exophthalmos), pretibial myxedema (orange-peel plaque on shins)

Grave’s dx confirmation

• antibodies (TSI, TRAb)

• Radioactive Iodine Uptake (RAIU) and Scan (diffuse uptake)

• Color-Flow Doppler Ultrasound

thyroid storm symptoms & treatment

fever, tachycardia, CNS dysfunction (confusion)

tx: PTU, beta-blockers

elderly thyroid dysfunction symptoms

atypical- falls, CNS changes

pregnancy & TSH

• First Trimester: <2.5 mIU/L.

• Second and Third Trimesters: <3.0 mIU/L

may need 30–50% increase in their levothyroxine dose during pregnancy

primary hyperparathyroidism (causes, labs)

issue w/ parathyroid gland itself - parathyroid adenoma, hyperplasia

high PTH, high Ca, low/norm phosphate

primary hyperparathyroidism classic symptoms

"bones, stones, groans, and psychiatric overtones"

bone pain, kidney stones (nephrolithiasis), GI distress, and mood/ cognitive changes

secondary hyperparathyroidism (causes, labs)

CKD, vitamin D deficiency (chronically low Ca state- body tries to overcompensate)

high PTH, low/norm Ca, high phosphate

tertiary hyperparathyroidism (causes/ labs)

excess PTH after a very long-standing period of secondary hyperparathyroidism (end stage renal disease)

high PTH, high Ca, high phosphate

hypoparathyroidism (labs, causes)

• low PTH, low Ca, high phosphate

• post-surgical (parathyroid glands), autoimmune, genetic (DiGeorge)

chronic hypoparathyroidism symptoms

fatigue, cognitive decline, tingling and numbness, muscle weakness, dry skin

acute hypoparathyroidism symptoms

cramps, tetany, seizures, Chvostek’s & Trousseau’s

(severe drop in Ca)

pseudohypoparathyroidism (PHP)

low Ca, high PTH

end-organ resistance to PTH; short, obesity, mental retardation

primary adrenal insufficiency (cause, labs)

Addison’s disease

low cortisol (in morning), high ACTH —> hyponatremia, hyperkalemia

Addison’s classic symptoms

• weight loss, fatigue, orthostatic hypotension, salt craving, GI distress

• hyperpigmentation (palms, knuckles, oral mucosa)

secondary adrenal insufficiency (cause, labs)

steroid withdrawal

low cortisol, low/norm ACTH

adrenal crisis

(too low)

hypotension, shock, abdominal pain, fever

adrenal insufficiency/crisis treatment

hydrocortisone (glucocorticoids) + fludrocortisone (mineralcorticoids)

fluids, glucose correction

during rapid Na correction watch for

osmotic demyelination syndrome

Cushing’s syndrome vs. disease

syndrome: chronic cortisol excess

disease: specifically ACTH-producing pituitary adenoma

most common cause: steroid use

Cushing’s symptoms

• central obesity, moon face, dorsocervical fat pad (buffalo hump)

• easy bruising/ purple striae, thin skin

diagnostic lab to confirm Cushing’s

24hr urine free cortisol

overnight low-dose dexamethasone suppression test

late-night salivary cortisol

DM1

T-cell mediated destruction of pancreatic beta cells

absolute deficiency in insulinD

DM2

insulin resistance, progressive beta-cell dysfunction

gestational diabetes

hyperglycemia usually in 2nd/3rd trimester

placental hormones causing insulin resistance

hyperglycemia symptoms

polyuria, polydipsia (thirst), polyphagia (hunger), weight loss, fatigue

DM1 vs. DM2 presentation differences

DM1- early childhood/ adolescent, significant weight loss

DM2- weigh gaint, acanthosis nigricans and older age onset, often asymptomatic initially.

DKA (diabetic ketoacidosis)

+ketones, anion gap metabolic acidosis

severe dehydration, Kussmaul breathing, fruity breath, altered mental status

DM diagnosis

• fasting plasma >126

• HbA1c >6.5

• random plasma glucose >200

• 2 hr glucose tolerance test (OGTT) >200

DM chronic complications, routine checking

• microvascular- retinopathy, nephropathy, neuropathy

  • check kidneys (microalbuminuria), feet, retinal exams

• macrovascular - stroke, CAD, peripheral artery disease

DM1 diabetes management

insulin replacement, glucose monitoring

DM2 diabetes management

lifestyle- weightloss, exercise

• metformin - first-line

• GLP1s, SGLT2/ DPP-4 inhibitors, eventually insulin

metabolic syndrome

insulin resistance, hypertension, dyslipedemia, central obsesity, Acanthosis Nigricans

>incr risk of CV disease/diabetes