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29 Cards in this Set

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Cushing's Disease
Screening test
1 mg overnight dexamethasome suppression test
24 hr urine free corticol level
midnight salivary cortisol level
Cushing Disease
rare- pituitary tumor
Cushing Syndrome
Adrenal Tumor
or
ectopic ACTH (lung cancer) very rare
or
exogenous steroid use
Cushing's DX tools
MRI pititary
CT adrenals and chest
Inferior petrosal vein sampling fot ACTH
Addison's disease
primary adrenal insufficienty
Addison's causes
autoimmue
TB
HIV, CMV
Bilateral Adrenal Gland Hemorrhage
Addison's S/S
Cortisol deficency- nausea, anorexia, weight loss, hypoglycemia, eoseinophilia, hyperpigmentation, ACTH elevation
+ Aldosterone deficiency- hypotension, hyponatremia, hyperkalemia, salt craving
polyglandular autoimmune syndrome I and II - other autoimmune diseases- virtiligo, hypothyroidism, pernicious anemia, type I diabetes, hypoparathyroidism
Addison's dx
elevated ACTH
cosyntropin stimulation test
random cortisol during stress <18 mcg/dl
TX: prednisone, fludrocortisone, increased steriod during severe stress
hydrocortisone 100 mg IV q8h
Disease of thyroid
hypothyroidism
hyperthyroidism
thyroid nodule
thyroid cancer
s/s hyperthyroidism
nervousness
palpitations
diarrhea
fine tremor
heat intolerance
diaphoresis
weight loss
muscle weakness
s/s of hyperthyoidism
fine tremor
warm and moist skin
stare
lidlag
tach
hyperreflexia
thyroid can be any size
DDX of hyperthyroidism
grave's
toxic multinodular goiter
subacute thyroiditis
exogenous thyroid hormone
rare cause
Grave's
autoimmune- thyroid stimulating immunoglobulins
Opthalmopathy
pretibial myxedema
high t3,t4, free throid
Low TSH
dx- radioactive iodine scan
usually young woman
TX of Grave's
antithyroid drug- PTU or methimazole
Radioactive Iodine
surgery

beta blockers- immediate symptomatic relief - block t4>t3 conversion
Toxic Multinodular Goiter
autoimmune nodules in the thyroid
older age
24 radioactive iodine scan- elevated uptake
rx- antithyroid drug- then RAI surgery for very large gland
subacute thyroiditis
usually following URI
Inflammation pain in the thyroid
release of stored thyroid hormone
subacte thyroiditis dx
increase t4, FTI
suppressed TSH
No uptake of radioactive thyroid scan
elevated esr
subacte thyroiditis rx
NSAIDS
prednisone
hypothyroidism
fatigue, weakness
weight increase
cold intolerance
constipation
voice change
myalgia
depression, impaired memory
menorrhagia
dysphagia from goiter
s/s hypothyroidism
bradycardia
dry skin, hair loss
nonpitting edema
delayed relaxation of DTRs
thick tongue
slow speech, gravelly voice
carpel tunnel syndrome
high cholesterol, CPK, liver enzymes
Hashimoto's Thyroidiitis
autoimmune thyroid destruction- anti thyroid peroxidase and antithroglobulin antibodies, lymphocytic infiltration
family history often positive
hypothyroidism may worsen postpartum
often underying iodine and lithium induced hypothyroidism- the injured gland cannot escape from inhibition
tx of hypothyroidism
levothyroxine (t4) replacement
begin slow in elderly
TSH followed every 6 weeks until in normal range
iron, antacids decrease absorption
thyroid nodule- risk factors for malignancy
male >female
young > old
single > multiple
hoarseness, pain, dysphagia
size > 3cm
history of radiation exposure
evaluation of thyroid nodules
TFTs - usually normal
ultrasound
biopsy
nuclear scan
thyroid nodules tx
surgery- throidectomy
RAI ablation of the thyroid remnant
T4 suppressive rx- TSH around .1
Screening for Acromegaly
IGF1 level- random
serum GH level 1 hour after a glucose load
pituitary MRI
tx of Acromegaly
transsphenoidal surgery - 80 % cure for micoadenomas
50% macroadenomas
radiation therapy - long delay in effect
somastatin analog- octreotide LAR
Bromocriptine, cabergoline
pegvisomant- GH analog that blocks GH action - does not prevent tumor growth
GH deficiency
usually with panhypopituitarism in adults
screen- GH after exercise
Confimation test: insulin- hypoglycemia, GRH injection, IGF1 level

Tx: Gh injection
Prolactin
uner inhibitory control (dopamine)
most common hormone overproducted by pituitary tumors
amenorrhea- 20 % have elevated prl
amenorr/galactorrhea- 95% have eleveated prl, pit microadenomas
galat alone- 15 % have elevated prl, often postpartum, rarely have tumors.