Endocrine ER

Here's the question-answer format for T1DM:

T1DM (Type 1 Diabetes Mellitus)

1. What is Type 1 Diabetes Mellitus (T1DM)?
Answer: T1DM is an insulin-dependent form of diabetes mellitus, where 90% of cases are autoimmune (AI) with the destruction of beta cells, leading to insulin deficiency.

2. What are the different types of autoimmune mechanisms associated with T1DM?
Answer:

  • T1DM A: Autoantibodies to beta cells (HLA-DR3/4).

  • T1DM B: Zinc autoantibodies positive.

  • LADA: Latent Autoimmune Diabetes in Adults.

3. What are the three initial symptoms of T1DM?
Answer:

  1. Polydipsia (excessive thirst)

  2. Polyuria (excessive urination)

  3. Weight loss with hyperglycemia and ketonemia.

4. What are other common symptoms associated with T1DM?
Answer:

  • Perineal candidiasis

  • Visual disturbances.

5. What are the symptoms of Diabetic Ketoacidosis (DKA)?
Answer:

  • Acute dehydration

  • Polyuria, polydipsia

  • Fatigue, headache, altered mental status (AMS)

  • Nausea, vomiting, abdominal pain.

6. What physical examination findings are common in DKA?
Answer:

  • Tachycardia, tachypnea

  • Hypotension

  • Decreased skin turgor

  • Fruity (acetone) breath

  • Kussmaul respirations (deep, labored breathing).

7. What is the Dawn Phenomenon?
Answer: A glucose spike between 2-8 am.

8. What is the Somogyi Effect?
Answer: Nocturnal hypoglycemia followed by hyperglycemia.

9. What is Insulin Waning?
Answer: A progressive rise in glucose levels during the night.

10. What are the diagnostic criteria for T1DM?
Answer: One of the following:

  1. Fasting plasma glucose ≥126 mg/dL on more than one occasion.

  2. Random plasma glucose ≥200 mg/dL with symptoms.

  3. OGTT: Plasma glucose ≥200 mg/dL after 2 hours.

  4. HbA1c ≥6.5%, confirmed by repeat testing.

11. What are some autoantibodies commonly seen in T1DM?
Answer:

  • Zinc autoantibodies

  • Tyrosine kinase autoantibodies (Tyr-K)

  • Islet cell antibodies (ICA)

  • GAD65 (glutamic acid decarboxylase)

  • IA-2 (Insulinoma-associated antigen 2)

  • Insulin autoantibodies.

12. What lab value is important to monitor in T1DM?
Answer: C-peptide levels (indicates endogenous insulin production).

13. What is the potassium shift in DKA?
Answer: Potassium is depleted as it shifts from intracellular to extracellular space.

14. What is the blood glucose level range in DKA?
Answer: Blood glucose levels typically range between 250-500 mg/dL.

15. What is the general treatment for T1DM?
Answer: Insulin therapy, which can be:
a) Multiple daily injections (MDI)
b) Insulin pump therapy.

16. What is the management protocol for DKA (SIPS)?
Answer:

  • S: Saline (fluid resuscitation)

  • I: Insulin (to lower glucose)

  • P: Potassium (to correct potassium levels)

  • S: Search for the underlying cause.

17. How should potassium be managed in DKA?
Answer:

  • Potassium < 3.3: Hold insulin therapy.

  • Potassium 3.3-5.3: Continue insulin and maintain potassium levels.

  • Potassium > 5.3: Hold potassium.

18. When is sodium bicarbonate indicated in DKA treatment?
Answer: If the pH is less than 6.9.

Here's the question-answer format for the provided conditions:

T2DM (Type 2 Diabetes Mellitus)

1. What is Type 2 Diabetes Mellitus (T2DM)?
Answer: T2DM involves insulin insensitivity and insulin resistance. The body becomes less responsive to insulin, leading to increased blood glucose levels.

2. What are the risk factors for T2DM?
Answer:

  • Obesity

  • Decreased physical exercise

  • Family history (genetics)

  • Metabolic syndrome.

3. What are the three "P"s commonly seen in T2DM?
Answer:

  1. Polyuria (excessive urination)

  2. Polydipsia (excessive thirst)

  3. Polyphagia (excessive hunger).

4. What are some other symptoms of T2DM?
Answer:

  • Poor wound healing

  • Increased infections.

5. What is Hyperosmolar Hyperglycemic State (HHS)?
Answer: HHS develops more insidiously and is characterized by:

  • Polyuria, polydipsia, weight loss, profound dehydration

  • Neuro symptoms like mental obtundation, coma, and seizures

  • Fatigue, weakness, nausea, and vomiting.

6. What physical examination findings are associated with HHS?
Answer:

  • Tachycardia

  • Hypotension

  • Decreased skin turgor

  • Increased capillary refill time.

7. What are the stages of Diabetic Retinopathy?
Answer:

  • Non-proliferative: Microaneurysms, cotton wool spots, hard exudates, blot & dot hemorrhages, flame-shaped hemorrhages.

  • Proliferative: Neovascularization (growth of new vessels that can cause hemorrhages).

  • Maculopathy: Macular edema or exudate leading to blurred vision.

8. How is T2DM diagnosed?
Answer: Diagnosis is similar to T1DM, with additional findings:

  • High insulin levels

  • C-peptide levels.

9. What are the lab findings in HHS?
Answer:

  • Blood glucose >600 mg/dL, often >1000 mg/dL

  • Plasma osmolality >320

  • pH >7.3, bicarbonate >18

  • Small ketones.

10. What is the initial treatment approach for T2DM?
Answer:

  • Lifestyle changes: Diet, exercise, weight management.

  • Pharmacological treatment:

    • Asymptomatic: Metformin is the most common initial therapy.

    • If intolerant/contraindicated: GLP-1 receptor agonists, SGLT2 inhibitors.

11. How is HHS treated?
Answer:

  • Primary: IV fluids (0.9% NaCl at 1L/h).

  • Once glucose reaches 300 mg/dL, switch to 5% dextrose with 0.45% NaCl.

  • Insulin: Initial bolus of 0.1 units/kg, then continuous infusion at 0.1 units/kg/h.

  • Potassium: Managed according to the same guidelines as in T1DM.

12. What is the treatment for diabetic retinopathy?
Answer:

  • Bevacizumab (anti-VEGF therapy)

  • Laser therapy.

Hypoglycemia

1. What is hypoglycemia?
Answer: Hypoglycemia is when blood sugar levels drop too low, impairing brain function, which requires glucose for normal activity.

2. What is the Whipple triad for hypoglycemia?
Answer:

  1. Plasma glucose <50 mg/dL (fasting).

  2. Symptoms of hypoglycemia.

  3. Symptoms resolve after glucose administration.

3. How is hypoglycemia monitored?
Answer:

  • Fingerstick glucose measurement 4 times per day.

  • A1C target: <7%, measured every 3 months.

  • Blood glucose goals:

    • Before meals: 80-130 mg/dL

    • Bedtime: 80-140 mg/dL.

Hyperparathyroidism

1. What is the most common cause of hyperparathyroidism?
Answer: Parathyroid adenoma.

2. What are the symptoms of hyperparathyroidism?
Answer:

  • Hypercalcemia: Nephrolithiasis (kidney stones), bone pain, fractures, ileus, nausea, vomiting, constipation

  • Decreased deep tendon reflexes (DTR).

3. What is the diagnostic triad for hyperparathyroidism?
Answer:

  1. High calcium levels

  2. High parathyroid hormone (PTH) levels

  3. Low phosphate levels.

4. What is the treatment for hyperparathyroidism?
Answer:

  • Parathyroidectomy (surgical removal of the parathyroid gland)

  • Cinacalcet (used when surgery is not an option).

  • If calcium is very high: IV fluids and furosemide.

Hypoparathyroidism

1. What is the most common cause of hypoparathyroidism?
Answer: Neck surgery (e.g., thyroidectomy) and autoimmune conditions.

2. What are the symptoms of hypoparathyroidism?
Answer:

  • Hypocalcemia: Carpopedal spasm, perioral numbness.

  • Increased deep tendon reflexes (DTR).

  • Special tests:

    • Trousseau sign (biceps contraction when inflating BP cuff).

    • Chvostek sign (twitching of facial muscles when tapping the facial nerve).

3. What is the diagnostic triad for hypoparathyroidism?
Answer:

  1. Low calcium levels

  2. Low PTH levels

  3. High phosphate levels.

4. What is the treatment for hypoparathyroidism?
Answer:

  • Calcium supplements

  • IV calcium gluconate if severe.

Cushing Syndrome

1. What are the causes of Cushing syndrome?
Answer:

  1. Exogenous: Steroid use.

  2. Endogenous:

    • Cushing disease (high ACTH from pituitary)

    • Ectopic ACTH production (e.g., from lung tumors)

    • Adrenal tumors (e.g., cortisol-producing).

2. What are the common symptoms of Cushing syndrome?
Answer:

  • Moon face

  • Buffalo hump

  • Thin extremities

  • Striae (skin marks)

  • Acanthosis nigricans

  • Androgen excess symptoms

  • Hypertension.

3. What are the 3 screening tests for Cushing syndrome?
Answer:

  1. 24-hour urine free cortisol

  2. Nighttime salivary cortisol

  3. Low-dose overnight dexamethasone suppression test.

4. How is Cushing syndrome diagnosed?
Answer:

  • Cushing’s disease: High ACTH with suppression of cortisol

  • Ectopic ACTH-producing tumor: High ACTH with no suppression

  • Adrenal tumors/steroids: Low ACTH with no suppression

  • Syndrome: Cortisol with no suppression.

5. What imaging is needed for Cushing syndrome?
Answer:

  • Cushing disease: Pituitary MRI

  • Adrenal tumors: Abdominal CT

  • Ectopic ACTH: Chest X-ray (lung tumors).

6. What is the treatment for Cushing syndrome?
Answer:

  • Resection of the pituitary or adrenal tumors

  • Gradual tapering of corticosteroid use.

Chronic Adrenal Insufficiency (Addison's Disease)

1. What are the causes of adrenal insufficiency?
Answer:

  • Primary (Addison's Disease): Autoimmune, tuberculosis, HIV.

  • Secondary: Due to pituitary dysfunction or steroid use.

2. What are the symptoms of Addison’s disease?
Answer:

  • Darkened skin

  • Hypotension

  • GI symptoms (nausea, vomiting, diarrhea)

  • Salt craving, low glucose

  • Amenorrhea in women.

3. What are the diagnostic features of Addison’s disease?
Answer:

  • Primary: Low cortisol, low aldosterone, high ACTH.

  • Secondary: Low cortisol, low ACTH.

  • Screening: High-dose ACTH stimulation test.

    • First: No cortisol response.

    • Second: Cortisol response indicates secondary insufficiency.

4. What is the treatment for Addison’s disease?
Answer:

  • Hydrocortisone (first-line treatment)

  • Fludrocortisone (if primary Addison's disease)

  • In times of stress, administer 3x the normal dose

.

Adrenal Crisis

1. What is the most common cause of adrenal crisis?
Answer: Stress events or failure to taper off steroids.

2. What are the symptoms of adrenal crisis?
Answer:

  • Shock

  • Hypotension

  • Hypovolemia

  • Abdominal pain

  • Peripheral vascular collapse.

3. What is the treatment for adrenal crisis?
Answer:

  • Isotonic fluids (e.g., normal saline)

  • IV hydrocortisone.

Pheochromocytoma

1. What is pheochromocytoma?
Answer: A catecholamine-secreting adrenal tumor that produces norepinephrine, epinephrine, and dopamine.

2. What are the symptoms of pheochromocytoma?
Answer:

  • Hypertension (most common)

  • Palpitations

  • Headache

  • Excessive sweating.

  • Chest pain, weight loss, pallor.

3. How is pheochromocytoma diagnosed?
Answer:

  • Urine tests: High levels of metanephrines and vanillylmandelic acid.

  • Imaging: MRI/CT of the abdomen and pelvis.

  • MIBG scanning (for detecting metastatic disease).

4. What is the treatment for pheochromocytoma?
Answer:

  • Surgical resection (complete adrenalectomy)

  • Medications: Phenoxybenzamine or phentolamine (alpha-blockers), Beta-blockers or calcium channel blockers for blood pressure control.

Diabetes Insipidus

1. What are the two types of diabetes insipidus?
Answer:

  • Central DI: No ADH production from the pituitary.

  • Nephrogenic DI: The kidneys do not respond to ADH.

2. What are the causes of nephrogenic diabetes insipidus?
Answer:

  • Lithium use is the most common cause.

3. What are the symptoms of diabetes insipidus?
Answer:

  • Polyuria

  • Polydipsia

  • High volume nocturia

  • Hypernatremia (leading to confusion, lethargy, seizures, and coma).

4. How is diabetes insipidus diagnosed?
Answer:

  • Serum osmolality: High in DI.

  • Urine osmolality: Low in DI.

  • Fluid deprivation test: Low urine osmolality indicates DI.

  • ADH stimulation test:

    • Central DI: Responds to ADH.

    • Nephrogenic DI: Does not respond to ADH.

5. What is the treatment for diabetes insipidus?
Answer:

  • Central DI: Desmopressin (DDAVP).

  • Nephrogenic DI: Hydrochlorothiazide, sodium restriction.

Thyroid Storm

1. What is thyroid storm?
Answer: A life-threatening exacerbation of hyperthyroidism.

2. What are the symptoms of thyroid storm?
Answer:

  • Fever

  • Cardiovascular dysfunction (e.g., tachycardia, arrhythmias)

  • CNS dysfunction (e.g., agitation, delirium).

3. How is thyroid storm treated?
Answer:

  • IV fluids

  • Beta-blockers (e.g., propranolol)

  • Antithyroid medications (e.g., PTU)

  • Sodium iodide for rapid reduction of thyroid hormones.

  • Steroids to reduce inflammation.

  • Aspirin should be avoided (can increase thyroid hormone release).

Myxedema Coma

1. What is myxedema coma?
Answer: An extreme form of hypothyroidism, often occurring in elderly patients during winter months.

2. What are the symptoms of myxedema coma?
Answer:

  • Bradycardia

  • Hypothermia

  • Hypotension.

3. How is myxedema coma treated?
Answer:

  • Levothyroxine (IV)

  • IV fluids

  • If adrenal involvement: corticosteroids.