Differential Diagnosis - Endocrine And Metabolic Disease

Front 1

Purpose of the Thyroid Gland?

Back 1

Secrete hormones

Front 2

Two primary hormones that the thyroid secretes?

Back 2

1) Thyroxine (T4)
2) Triiodothyronine (T3)

Front 3

Release of the thyroid hormones is regulated by what structure?

Back 3

The pituitary gland

Front 4

Alterations in Thyroid function can affect?

Back 4

Nails, Hair, Skin, Eyes, GI tract, Resp. Tract, Heart and Blood Vessels
(SHE Gave Rob Hard Nips) - oh yea, classy

Front 5

Effect of Increased T4 on BMR?

Back 5

Increase by 4x

Front 6

Most common thyroid d/o?

Back 6

Hyperthyroidism

Front 7

non-musculoskeletal manifestations of Hyperthyroidism?

Back 7

Goiter, wt. loss, tachycardia, tremors/nervousness, heat intolerance, palpitation, sweating, diarrhea, mood swings, exophalamus

Front 8

Musculoskeletal manifestations of Hyperthyroidism?

Back 8

PAIN, Chronic periarthritis, restricted shoulder ROM, calcifications, proximal muscle weakness -> loss of balance.

Front 9

Typical treatment of hyperthyroidism for pts under 18 y.o?

Back 9

Anti-thyroid meds

Front 10

3 types of treatment for Hyperthyroidism?

Back 10

1) Thyroid Meds
2) Radio-iodine treatment
3) Surgery

Front 11

2 things the PT should do when working with a Hyperthyroid pt?

Back 11

1) Observe for heat intolerance
2) Monitor HR

Front 12

Things to avoid when working with a post-surgical thyroid patient?

Back 12

1) Avoid palpating on or around the thyroid

Front 13

Thyroid storm?
- S&Sx:

Back 13

Huge Increases of thyroid hormones in blood.
-Symptoms include: Tachycardia, hyperkinesis, fever, HTN

Front 14

Side-effects of Radioiodine Tx?

Back 14

1) Ant. neck soreness
2) Iatrogenic hypothyroidism (~50% of all cases)

Front 15

Hypothyroidism

Back 15

Decreased thyroid function

Front 16

Most common thyroid d/o in the US and CA?

Back 16

Hypothyroidism

Front 17

End result of hypothyroidism?

Back 17

Slowed body metabolism

Front 18

Primary Hypothyroidism?

Back 18

1) Decrease in functional tissue OR
2) Impairment of hormone synthesis OR
3) Impairment in the release of hormone

Front 19

Secondary cause of hypothyroidism?

Back 19

Inadequate stimulation coming from the pituitary or hypothalamus

Front 20

Incidence of hypothyroidism?

Back 20

- Women 4x > Men
~ 50yo
- 95% are primary cause

Front 21

Bodies first reaction to hypothyroidism?

Back 21

Increase the number of thyroid cells -> goiter

Front 22

Clinical manifestations of hypothyroidism?

Back 22

1) Decreased BMR (wt gain with no change in apetite)
2) Decreased GI motility
3) Decreased HR
4) Slowed neurologic functioning
5) Decreased heat production
6) Increased serum cholesterol
7) Increased serum Triglycerides
8) Increased arterial sclerosis
9) Increased CAD

Front 23

Early signs of hypothyroidism?

Back 23

1) Fatigue
2) Mild sensitivity to cold
3) Mild wt. gain

Front 24

More pronounced sign of hypothyroidism?

Back 24

1) Mixed edema (mucopolysaccharides coming through skin + non-pitting/boggy edema)
2) Decreased mentation
3) Sparce hair + thick brittle nails

MS Related -

4) Flexor tenosynovitis
5) Proximal muscle weakness
6) Increased trigger points
7) Decreased DTR

Front 25

Diagnosis of hypothyroidism?

Back 25

- Radioimmunoassay (RIA), an in vitro nuclear medicine, is a very sensitive technique used to measure concentrations of antigens (for example, hormone levels in the blood) by use of antibodies

Front 26

Tx of hypothyroidism?

Back 26

Synthetic Thyroid Hormone

Front 27

3 types of Thyroiditis?

Back 27

1) Acute
2) Sub Acute
3) Lymphocytic (Hoshimoto's Disease)

Front 28

Incidence of Thyroiditits?

Back 28

women 10x > men
Strong autoimmune disposition

Front 29

Incidence of Thyroid CA?

Back 29

Malignant is rare, benign is more common
- women 2x > men
- 40-60yo

Front 30

Parathyroid?

Back 30

Secretes Parathyroid Hormone

Front 31

Effects of PTH?

Back 31

1) Increases the release of Calcium and Phosphate from bone
2) Increases absorption of Ca from Kidneys
3) Increases absorption of Ca from GI tract

Front 32

Hyperparathyroidism?

Back 32

Increase in one or more Parathyroid glands

Front 33

Incidence of Hyperparathyroidism?

Back 33

- Women 2x > Men
- Likely > 60yo

Front 34

Mechanism of Primary Hyperparathyroidism?

Back 34

- Regulatory relationship between serum Ca and PTH is interupted
- Normal relationship: Decreased Ca -> Increase PTH -> Increase Ca

Front 35

2 common causes of Primary Hyperparathyroidism?

Back 35

1) Adenoma
2) Hyperplasia of the gland

Front 36

Underlying mechanism of Secondary Hyperparathyroidism?

Back 36

Hyperplasia d/t another pathology
- Kidney disease, Paget's disease

Front 37

Underling mechanism of Hyperparathyroidism?

Back 37

Normally PTH is increased d/t low serum Ca levels. Primary form is from a tumor of the parathyroid gland that causes autonomous secretion of PTH.s

Front 38

Non-Musculoskeletal manifestations of Hyperparathyroidism?

Back 38

1) Bone demineralization
2) Lytic bone lesions
3) Fractures
4) Pain
5) Abdominal pain, peptic ulcers, pancreatitis
6) Nephocalcinosis/Kidney stones

Front 39

Musculoskeletal manifestations of Hyperparathyroidism?

Back 39

1) Muscle cramps
2) Paresthesias
3) Loss of pain/vibratory sensation in a stocking glove distribution
4) Chronic low back pain
5) Marked mm. weakness
6) CPPD (Pseudo Gout)
7) Osteogenic synovitis

Front 40

Dx of Hyperparathyroidism?

Back 40

1) Elevated serum Ca
2) Decreased serum Phosphate
3) X-ray = diffuse demineralization

Front 41

Hypoparathyroidism?

Back 41

Insufficient release of PTH

Front 42

Clinical manifestations of Hypoparathyroidism?

Back 42

1) Decreased bone resorption
2) Hypocalcemia (the biggie!)
3) high serum phosphate
4) Possible NM irritability (d/t hypocalcemia)
5) Calcification in various organs?
6) Tetany (more pronounced symptom)

Front 43

2 types of Hypoparathyroidism?

Back 43

1) Idiopathic
-Women 2x >men
- Children 9x > Adults
2) Iatrogenic

Front 44

Dx of parathyroidism?

Back 44

History, Clinical presentation and Low serum Ca levels

Front 45

Mineral corticoids?

Back 45

Steroid responsible for the balance of fluids and minerals

Front 46

Glucocorticoids?

Back 46

Steroid important in controlling glucose metabolism

Front 47

Where are Androgens, Mineral Corticoids and Glucocorticoids released?

Back 47

Adrenal cortex

Front 48

Cushing's syndrome?

Back 48

Hypercortisolism secondary to externally administered corticosteroids

Front 49

Cushing's disease?

Back 49

Hypercortisolism secondary to excessive secretion of Adrenocorticotropic Hormone (ACTH)

Front 50

Primary cause of Cushing's disease?

Back 50

Pituitary hypersecretion (pituitary or adrenocortical tumors)

Front 51

Treatment of Cushing's disease?

Back 51

1) Radiation
2) Surgery
3) Med therapy

Front 52

Increased levels of cortisol cause (5):

Back 52

1) Increased loss of amino acids from muscle
2) Weakened protein structures
3) Protuberant abdomen + stretch marks
4) Generalized mm. weakness
5) Marked osteoporosis

Front 53

Conn's syndrome?

Back 53

Excessive secretion of Aldosterone

Front 54

Primary cause of Conn's Syndrome?

Back 54

Adrenal lesion -> Hypersecretion of Aldosterone

Front 55

Result of elevated Aldosterone?

Back 55

1) Hypernatremia
2) Hypervolemia
3) Hypokalemia
4) Metabolic Alkalosis

Front 56

S&Sx of Conn's Syndrome?

Back 56

HTN, stroke, heart failure, visual disorders, muscle weakness, excessive thirst and DM

Front 57

Treatment of Conn's Syndrome?

Back 57

1) Beta-blockers
2) Diuretic
3) Address the hypersecreting gland - Radiation/surgery

Front 58

Addison's disease is what kind of adrenal disease?

Back 58

Adrenal Insufficiency

Front 59

Possible secondary causes of Addison's Disease?

Back 59

1) Bilateral adrenectomy
2) Adrenal hemorrhage/inflammation
3) Radiation
4) Malignant neoplasm
5) Infections
6) Cytomegaly virus
7) Chemical agents

Front 60

Failure to take steroid therapy for Addison's patients results in....

Back 60

Addisonian Crisis

Front 61

Risk factors for developing a primary adrenal insufficiency?

Back 61

1) Abdominal Surgery
2) Pregnancy (post-partum hemorrhage)
3) Trauma
4) Salt loss d/t perfuse diaphoresis

Front 62

Overall outcome of adrenal insufficiency?

Back 62

Decreased cortisol -> decreased gluconeogenesis -> hypoglycemia

Front 63

S&Sx of adrenal insufficiency?

Back 63

1) Exhaustion
2) Weakness
3) Hypotensive
4) Anorexia
5) N&V
6) Wt. loss
7) Emotional disturbance
8) Increased Melanocyte Stimulating Hormone (MSH) -> Tan

Front 64

Decreased production of Aldosterone -> ?

Back 64

Excess excretion of Na -> Hyponatremia -> Hypotension

Front 65

Clinical effects of decreased Aldosterone?

Back 65

1) Decreased tolerance for even minor stresses
2) Poor coordination
3) Hypoglycemia
4) Craving salty foods
5) Slow arm pit and pub growth
6) Decreased libido
7) Amenorrhea

Front 66

Diagnosis of adrenal insufficiencies?

Back 66

Blood, Urine and hormonal assays

Front 67

Tx of adrenal insufficiencies?

Back 67

Life-long synthetically administered corticosteroids