Endocrine System

unilateral adrenal aldosteronoma cause for primary hyperaldosteronism

conn’s syn

HTN + hypokalemia + met alkalosis

primary hyperaldosteronism

how to dx primary hyperaldosteronism

plasma renin activity and plasma aldosterone (shows hi aldosterone and lo renin)

CT/MRI to look for mass.

tx b/l primary hyperaldosteronism

spironolactone

tx conns syn

laparoscopic u/l adrenalectomy + spironolactone

adrenocortical insufficiency

addisons

what causes chronic AI

hx of exogenous GCC use mcc

hyperpigmentation + ortho HoTN

addisons dz

primary AI on lab

inc ACTH, dec cortisol

secondary AI lab

dec ACTH, dec cortisol

what electrolytes are inc or dec in addisons

hyponatremia, hyperkalemia, met acidosis non anion gap

autoimmune addisons is marked by

21-hydroxylase antibodies

if high dose ACTH stim test shwos adrenal insuff what is shown in the results

absent rise in cortisol

tx chronci adrenocorticol insuff

hydrocortisone first line. if Addisons then add fludrocortisone

pt had a time of stress and is now reporting shock sx.

acute addisons dz`

how to tx acute adrenocorticol insufficiency

isotonic IV fluids, IV hydrocortisone bolus

pt with suspected cushing syn begins confirmatory tests with this exam

24 hr urinary cortisol

low dose dexamethasone test shows elevated cortisol or no suppression of cortisol. this pt has

cushing syn

when you know the pt has a form of cushing syn bc they have high cortisol what is the next screening step

baseline plasma ACTH levels

if plasma ACTH levels are high what does that indicate

pituitary tumor (cushing dz) or an ectopic ACTH tumor (SCLC)

if plasma ACTH levels are low what does that indicate

long term steroid use, adrenal tumor (if pt isn’t on steroids, do CTap)

how to distinguish between if a pt has a pituitary tumor (cushing dz) or an ectopic ACTH tumor

high dose dexamethasone suppression test

what does high dose dexa supp test show in a pt with a pit tumor

cortisol is suppressed. do head MRI to see if they have a tumor then do transsphenoidal resection

what does high dose dexa supp test show in a pt with an ectopic ACTH producing tumor

no suppression of cortisol. thorax imaging to r/o SCLC

this tumor secretes norepinephrine, epinephrine, and dopamine from adrenal medulla

pheochromocytoma

pt has PHE: Palpitation, HA, Excessive sweating. also HTN

pheochromocytoma

how to test for pheochromocytoma

metanephrines (urine or plasma testing). then MRI/non contrast CTap to find the tumor after lab comes back

tx pheochromocytoma

phenoxybenzamine or phentolamine

what meds can cause hypothyroidism

amiodarone, lithium, PTU and MMI, exogenous thyroid hormone use

what thyroid antibody dx hashimotos

anti TPO

what thyroid antibody dx graves

TSH receptor ab

best initial test to dx thyroid dysfxn

TSH

in primary thyroid disorder what is the problem

thyroid itself

radioactive iodine scan shows diffuse inc uptake

graves dz or TSH secreting pit adenoma

radioactive iodine scan shows diffuse dec or absent uptake

thyroditis

radioactive iodine scan shows a hot nodule

toxic adenoma

radioactive iodine scan shows multiple nodules

TMNG

radioactive iodine scan shows cold nodules

rule out malignancy

how do babies develop cretinism (congenital hypothyroid)

lack of maternal iodine intake. also from improper thyroid formation

kid has prolonged jaundice, feeidng problems, hypotonia, enlarged tongue, delayed bone maturation, umbilical hernia, mental dveelopment delay

cretinism

tx cretinism

levothyroxine

what are the lab values of subclinical hypothyroidism

hi TSH nl t3 t4

tx subclinical hypothyroidism

observe and repeat TSH levels in 3-6 mo

abnl thyroid panel with nl thyroid fxn.

sick euthyroid syn

sx of hypothyroidism + AMS and hypothermia. brady, hypoventilation, diastolic HTN

myxedema coma

tx myxedema coma

IV hydrocortisone, IV levothyroxine, IVF

pt had a viral infxn and now has neck pain, diffuse tender small goiter, thyroid pain, viral sx. labs show hyperthyroid, then hypothyroid, then it resolves

subacute granulomatous (dequervain) thyroiditis

tx subacute granulomatous (dequervain) thyroiditis

supportive care bc self limiting

DquerPAINS for subacute granulomatous (dequervain) thyroiditis

diffuse dec uptake on radioactive scan, Painful thyroid, After viral illness, Inc ESR/CRP, Negative thyroid ab, Self limiting

pt has a palpable nodule on their thyroid. signs of hyperthyroidism. hoarseness. radioactive scan shows a hot nodule of inc uptake.

toxic thyroid gland adenoma

tx toxic thyrodi gland adenoma

radioiodine ablation and surgery

pt has a diffuse goiter and signs of hyperthyroidism. they also complain of HA and bitemporal hemianopsia

pituitary TSH secreting adenoma

how to dx pituitary adenoma on thyroid panel

inc T4 and inc TSH (secondary issue bc in pituitary gland)

imaging to dx pit adenoma

pit MRI

definitive tx for pit adenoma

transsphenoidal surgery

what thyroid diseaseds are painful

subacute and infectious thyroiditis

hyperthyroidism + really high fever + diaphoresis

thyroid storm

tx thyroid storm

APAP, IVF, propranolol, PTU

m/c type of thyroid nodule

follicular adenoma

pt has mass in thyroid that is smooth, soft, freely mobile. benign or malig

benign

pt has mass that is rapidly growing, hard mass, fixed in one place

malignant potential

if a pt that has a thyroid nodule has abnl TSH what is the next test done

radioactive scan uptake

if a pt with a thyroid nodule has normal or high TSH what is the next step of evaluation

FNA w biopsy

m/c type of thyroid cancer

papillary thyroid cancer

RF for papillary thyroid cancer

ionizing radiation exposure of head and neck

more aggressive but slow growing thyroid cancer. distant mets to lung and other areas

follicular thyroid cancer

neuroendocrine tumor from calcitonin synthesizing C cells of thyroid gland. can cause MEN2 sx. pts have diarrhea and face flushing. can have cushing appearance if the ca is ACTH secreting

medullary thyroid cancer

characteristic feature of MTC

calcitonin production

highly aggressive malignant tumor in thyroid. mets early on. pt shave fast growing rock hard neck mass

anaplastic thyroid cancer

first line tx for metformin

lifestyle changes. med = metformin

AE of metformin

GI complaints, vit b12 def, lactic acidosis

CI to metformin

pts with renal or liver impairment

AE of sulfonylureas (glyburide)

weight gain, hyponatremia, disulfiram rxn

rosiglitazone has what AE

Cv events like Mi or stroke

pioglitazone has the AE of

bladder ca

GLP 1 drugs end in

tide

what is the AE of GLP-1s

GI issues, MTC

what DM2 med causes UTIs

SGLT 2 inhibitors (flozins)

rapid acting insulins

LAG - lispro, aspart, glulisine

long acting insulin

glargine, detemir, degludec

manage DKA

SIPS - saline, insulin (regular), potassium repletion, search for underlying cause

tx diabetic neuropathy

glucose control, duloxetine

main causes of the progression of diabetic nephropathy

uncontrolled HTN and poor glycemic control

pt has very concentrated urine and has neuro sx leading to suspected cerebral edema.

SIADH

what are the labs to dx SIADH

normovolemic hypotonic hyponatremia. dec s osmolality, inc urine osmolality, hi urine sodium

tx SIADH

water and fluid restriction if mild dz. IV hypertonic solution if severe

labs for dx DI

inc serum osmolality, dec urine osmolality, hypernatremia, dec specific gravity

dx DI

fluid deprivation test —> DI if even when dehydrated pt still has large amounts of dilute urine

desmopressin stim test —> if central DI then a dec in urine output shows. if nephrogenic then body still produces diluted urine

tx central DI

desmopressin

tx nephrogenic DI

low solute diet, thiazide diuretic

when the blood has low calcium how does it inc it

inc PTH which inc Vit D which inc Ca in serum via osteoclast activity. dec PO4

when the blood has high calcium how does it dec it

inc calcitonin to dec serum Ca

sx of hypercalcemia

stones (kidney stone), bones (fx), groans (abd ileus), psychiatric moans (dpression), thrones (inc vascular tone aka HTN)

what lab values dx hypercalcemia bc of primary hyperparathyroidism

elevated PTH with hypercalcemia, low PO4

EKG findings of hypercalcemia

shortened QTi

tx moderate hypercalcemia

IVF, calcitonin and bisphosphonates if severe

how to identify if a pt has hypocalcemia

inc muscle contractions, GI sx, chvostek sign and trousseau sign

EKG findign of a pt with hypocalcemia

prolonged QTi

PTH levels of a pt with hypocalcemia bc of hypoparathyroidism

normal or low PTH

tx hypocalcemia

oral calcium and Vit D initial. if severe give calcium gluconate