Endocrine - IM Quick Notes

arold001's version from 2015-12-27 18:44

Section 1

Question Answer
whats the most common cause of hyperthyroidism?graves disease = thyroid-stimulating immunoglobulin
what are 4 causes of hyperthyroidism?1) Graves disease
2) multinodular toxic goiter (plummers)
3) toxic adenoma
4) hashimotos thyroiditis (transient hyperthyroidism)
How do you treat hyperthyroidism?beta-blockers, methimazole/PTU, sodium ipodate
whats the tx of hyperthyroidism in PREGNANCYPTU
whats the most common cause of hypothyroidism?hashimotos disease = rubbery nontender goiter
hypothyroidism after viral infectionsubacute thyroiditis
positive antimicrosomal antibodieshashimotos disease
pt presents with tetany, perioral numbnessHYPOparathyroidism
low urinary cAMP, low calcium, high phosphate, low PTHhypoparathyroidism
whats the tx for hypoparathyroidism?vitamin D and calcium supplements
whats the most common cause of PRIMARY hyperparathyroidism?parathyroid adenoma >> hyperplasia or carcinoma
whats the tx of hyperparathyroidism due to: hyperplasia resect all 4 glands and put parathyroid tissue in forearm
whats the tx of hyperparathyroidism due to: parathyroid adenomaresect only adenoma
whats the tx of hyperparathyroidism due to: parathyroid carcinomaresect tumor, ipsilateral thyroid and lymph nodes
what are 3 most common causes of SECONDARY hyperparathyroidism?chronic renal failure
vitamin D deficiency
renal hypercalciuria

Section 2

Question Answer
What is cushings syndrome? vs cushings diseasecushings syndrome: excess glucocorticoids
cushings disease: ACTH-secreting pituitary adenoma
whats the most common cause of cushings syndromeiatrogenic
pt presents with central obesity, hirsutism, moon facies, dorsal fat pad, striae, acne, bruisingcushing syndrome
whats the screening test for cushing syndrome?24 hour urine cortisol and ACTH level
whats the overnight dexamethasone suppression test?1) if low cortisol in the morning (<5), cushings is excluded 2) if high cortisol in the morning, its cushings syndrome!
whats the HIGH-dose dexamethasone suppression test?1) <50% suppression of cortisol --> ectopic ACTH
2) >50% suppression of cortisol --> cushings disease
whats the CRH stimulation test?1) increase in ACTH/cortisol --> cushings disease 2) no increase in ACTH/cortisol --> ectopic ACTH or adrenal tumor
another name for addisons disease?primary adrenal insufficiency
low cortisol, high ACTH, no response to ACTH infusionprimary adrenal insufficiency = Addisons disease
whats the most common causes of primary adrenal insufficiency (addisons disease)autoimmune, TB, iatrogenic, lung/breast cancer
low cortisol, low ACTH, positive response to ACTH infusionSECONDARY adrenal insufficiency = due to hypopituitarism or long-term steroid use
whats the most common cause of secondary adrenal insufficiency?long-term steroid therapy
wheres the problem in primary vs secondary vs tertiary adrenal insufficiency? (LOW CORTISOL)primary (adrenal gland), secondary (pituitary), tertiary (hypothalamic disease)
clinically, how can you tell the difference btw primary vs. secondary adrenal insufficiency?primary adrenal insufficiency (high ACTH, low cortisol) = hyperpigmentation and hypoaldosteronemia. secondary adrenal insufficiency (low ACTH and low cortisol) = NO hyperpigmentation
whats the tx of adrenal insufficiency?glucocorticoid (hydrocortisone, prednisone). If primary insufficiency, also need to provide mineralocorticoid (fludrocortisone)
whats the tx for PRIMARY adrenal insufficiency?prednisone or hydrocortisone + fludrocortisone (mineralocorticoid)
whats adrenal crisis a/w adrenal insufficiency?life threatening adrenal insufficiency with severe hypotension, abd pain, acute renal failure
whats the tx of adrenal crisis (severe hypotension, abd pain, ARF)IV hydrocortisone, IVF (D5NS)

Section 3

Question Answer
urine shows increased metanephrine, VMA, homovanillic acid and normetanephrinepheochromocytoma
whats the tx of pheochromocytoma?alpha blocker (phenoxybenazmine) --> then beta-blocker --> later surgical resection
pheochromocytoma is a/w what 4 disease?MEN IIA/IIB, von Hippel Lindau, neurofibromatosis type 1
pt presents with hypertension, hypernatremia, hypokalemia, metabolic alkalosisprimary hyperaldosteronism
what are 2 causes of primary hyperaldosteronism?adrenal adeoma (will see increased aldosterone level on ONE side with adrenal venous sampling) and adrenal hyperplasia (equal aldosterone levels bilaterally with venous sampling)
how do you tx primary hyperaldosteronism due to adrenal adenoma vs. adrenal hyperplasia?adrenal adenoma = tx with RESECTION
adrenal hyperplasia = tx with spironolactone
whats the tx for type 2 DM?sulfonylureas, metformin, thiazolidinediones, acarbose
how do you screen for diabetic nephropathy?microalbuminuria
how do you tx diabetic nephropathy?tight BP and glucose control, ACEI/ARBs
how do you tx diabetic peripheral neuropathy?gabapentin or TCAs
whats the most common cause of death in diabetics pts?CAD
what causes DKA in type 1 DM?insulin deficiency and glucagon excess lead to hyperglycemia and ketogenesis; precipitated by stress or illness
Hyperglycemia (400s-800s), serum/urine ketones, anion gap metabolic acidosisDKA
whats unique about the potassium level in pts with DKA?hyperkalemia may be present but total body potassium levels are LOW
whats the tx for DKA?IVF --> once blood glucose reaches 250, add glucose --> IV insulin (caution for hypokalemia) --> replete potassium, mag, phosphate
what causes hyperosmolar hyperglycemic nonketotic syndromeInsulin deficiency leads to hyperglycemia, which leads to osmotic dieresis and dehydration / hyperosmolarity. However the presence of some insulin prevents ketogenesis
Hyperglycemia (>900s), hyperosmolarity, no acidosis/ketosis hyperosmolar hyperglycemic nonketotic syndrome
Whats the treatment for hyperosmolar hyperglycemic nonketotic syndromeIVF and IV insulin

Section 4

Question Answer
What makes up MEN I? (3 P's)parathyroid hyperplasia, pancreatic islet cell tumor (ZES, insulinoma), pituitary tumors
What makes up MEN IIA? (2 P's)medullary thyroid carcinoma, Pheochromocytoma, hyperParathyroidism
what makes up MEN IIB? (1 P)medullary thyroid carcinoma, pheochromocytoma, MARFINOID BODY HABITUS OR MUSCOSAL NEUROMAS
how does hyperprolactinemia present in men?men = hypogonadism, decreased libido, impotence, galactorrhea/gynectomastia
how does hyperprolactinemia present in women?women = menstrual irregularities, dyspareunia, osteoporosis, galactorrhea
whats the most common cause hyperprolactinemia?prolactinoma
if FNA is undeterminate or if TSH is low in pts with thyroid nodule, whats the next test?radioactive iodine scan --> cold nodule = surgical resection
whats whipples triad for insulinoma?hypoglycemic symptoms, blood glucose < 50 at time of symptoms, symptoms relieved with glucose
whats the tx of hypoglycemia?sugar containing foods and D50W
what are 4 common causes of hypoglycemia?drug-induced (insulin), factitious (low c-peptide), insulinoma, adrenal insufficiency

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