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133 Cards in this Set
- Front
- Back
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Sxs of hyperthyroid - skin/hair
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erythema, sweating hair loss
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Sxs of hyperthyroid - cardiovascular
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increased HR, low total and HDL cholesterol
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Sxs of hyperthyroid - respiratory
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dyspnea, obstruction secondary to goiter
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Sxs of hyperthyroid - GI
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weight loss, diarrhea, dysphagia secondary to goiter
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Sxs of hyperthyroid - GU
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amenorrhea (increased sex hormone binding globulin)
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Sxs of hyperthyroid - musculoskeletal
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increased bone resorption, fatigue
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Sxs of hyperthyroid - neuromuscular
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tremor, psych abnormalities, muscle weakness
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What does high radioactive iodine uptake indicate? Low?
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de novo synthesis
inflammation or exogenous source |
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Lab findings in hyperthyroid
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elevated FT4, diminished TSH, presence of antibodies, abnormal radioiodine uptake, elevated FT3, impaired glucose tolerance
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What is a thyroid storm
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secondary to surgery or radioiodine tx; delirium, high fever, severe tachycardia, vomiting and dehydration
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4 functions of PTH
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increases osteoclastic activity
increases renal calcium reabsorption stimulates renal 1,25-dihydrocholecalciferol synth inhibits renal phosphate reabsorption |
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Most common cause of hypoparathyroidism
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accidental parathyroid gland removal during thyroid surgery
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Features of asymptomatic hyperparathyroid
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elevated serum Ca, concurrent VitD deficiency
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Features of symptomatic hyperparathyroid
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decreased bone density, bone dz, fractures, renal insufficiency, nephrolithiasis, hypophosphatemia, psych disturbances, GI manifestations, HTN
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Mnemonic for hyperparathyroid presentation
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stones, bones, psychic overtones, and abdominal tones
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Clinical features of hypoparathyroid
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tetany, seizures, impairment of intellect, extrapyramidal manifestations, psych manif, papilledema, myopathy
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Chvostek's sign
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tap facial just anterior to ear
watch for contraction of ipsilateral facial muscles sign is positive in 10% of normocalcemic pts |
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Trousseau sign
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inflate cuff above systolic for 3 min
watch for: thumb adduction, MCP flexion, wrist flexion, and IP extension can also be induced by voluntary hyperventilation due to increased excitability of the nerve due to ischemia |
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Total Ca is measurement of what complex
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albumin-Ca complex
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Acidosis _____ albumin-Ca complex formation; alkalosis _____ it
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reduces
enhances |
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Pseudohypoparathyroidism features
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renal resistance to PTH
hypocalcemia hyperphosphatemia elevated PTH |
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Hypocalcemia - tx
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secure airways if tetany is present
administer Ca (also VitD) replace Mg if deficient |
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What are some etiologies of osteoporosis
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hormone deficiency (or excess), immobilization, malignancy, meds, genetic, malabsorption, liver dz, VitC deficiency
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Osteoporosis - mainstay of tx
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biphosphonates
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The blood in the capillaries of the pituitary portal system is rich in:
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hormones from hypothalamus
pituitary paracrines pituitary autocrines |
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The posterior pituitary is supplied by what artery
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inferior hypophyseal artery
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What are some etiologies of hypopituitarism
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mass lesions
surgery/radiation infiltrative lesions (hemochrom) infarction apoplexy genetic Empty Sella Syndrome |
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Pituitary apoplexy - aka, clinical presentation
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pituitary infarction
acute HA, ophthalmoplegia, decreased acuity, altered mental status |
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Most common presenting sxs for pituitary mass
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HA, visual problems, altered mental status
tumor is pressing against pituitary |
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Physiologic etiologies of hyperprolactinemia
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pregnancy, breast feeding, stress
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Pathophysiological causes of hyperprolactinemia
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lactotroph adenoma, hypothalamic and pituitary dz, drug use
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Hyperprolactinemia - sxs in premenopausal women
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hypogonadism
infertility oligomenorrhea galactorrhea (rare) |
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Hyperprolactinemia - sxs in postmenopausal women
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already hypogonadal
visual impairment |
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Hyperprolactinemia - sxs in men
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hypogonadotropic hypogonadism
galactorrhea |
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Pituitary tumors are better seen with _____ (CT, xray, MRI)
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MRI
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Most common etiology of pituitary masses
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pituitary adenoma
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Etiologies of pituitary masses
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pit adenoma (most common), pit hyperplasia, craniopharyngioma, meningioma, malignant tumor, cysts, abscesses
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Causes of pituitary hyperplasia
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lactotroph hyperplasia during pregnancy
thyrotroph hyperplasia due to long standing hypothyroid gonadotroph hyperplasia somatotroph hyperplasia |
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Features of craniopharyngiomas
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usually suprasellar masses
solid or mixed solid-cyst benign tumors account for 1-3% of intracranial tumors bimodal distribution (infants and >55 years) |
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Sxs of pituitary mass
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visual defect (diplopia), caused by suprasellar extension of the tumor
pit apoplexy CSF rhinorrhea hormone def |
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Tx of pituitary tumors
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trans-sphenoidal resection
hormone replacement dopamine agonists |
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Somatostatin (aka?)
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GHIH
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Peak growth velocity? At what age? 2nd highest velocity?
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2.5 cm/week
4th month puberty |
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Most common cause of acromegaly
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somatotroph pit adenoma
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Acromegaly features due to tumor
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HA, vision loss, alteration of other pit hormone levels
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Acromegaly features due to IGF-1
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soft tissue growth
bone/joint problems enlargement of visceral organs (incl thyroid) cardiovascular dz metabolic abnormalities sleep apnea neoplasias (colon) |
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Treatment of acromegaly
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trans-sphenoidal surgical resection (tx of choice but can have major complications)
somatostatin analogs, dopamine agonists, GH receptor antagonists |
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Central DI vs Nephrogenic DI
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central - no ADH produced
nephro - receptors are not binding to ADH |
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What are the 3 infiltrative disorders that can cause Central DI
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sarcoidosis
amyloidosis hemochromatosis |
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How do you diagnose DI
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water deprivation test (administer hypertonic saline)
low plasma Na points to primary polydipsia normal to high - points to DI hypernatremia during 1st year of life points to nephro DI |
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Treatment of DI
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diabenase
DDAVP (desmo) |
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SIADH
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syndrome of inapp ADH secretion
hyponatremia and elevated plasma ADH |
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Adrenal cortex produces what? Medulla?
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aldosterone, glucocorticoids, androgens, estradiol
catecholamines |
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Significance of 21-hydroxylase
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catalyzes formation of both aldosterone and cortisol
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4 fxns of aldosterone
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Na reabsorption
K and H secretion regulates blood volume regulates blood pH |
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Most common cause of hyperaldosteronism? Other causes?
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unilateral aldosterone producing adenoma (85%)
bilat idiopathic adrenal hyperplasia familial hyperaldo type I and II pure aldo-producing adrenocortical carcinomas |
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Hyperaldosteronism presentation
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HTN
hypokalemia metabolic alkalosis (from dumping K and H) |
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Hyperaldosteronism - DOC
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spironolactone
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Actions of cortisol (7)
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glycogen synth
gluconeogenesis peripheral glucose utilization lipid metabolism immunological fxn bone/mineral metabolism acts as mineral corticoid |
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Cushing Syndrome vs Disease
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syndrome - caused by high levels of cortisol in the blood; may be from taking corticosteroids or from tumors that produce ACTH
disease - refers to specific cause of the syndrome: pituitary adenoma that produces large amts of ACTH |
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Sxs of Cushing's
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central obesity
HTN thin skin osteoporosis poor wound healing leukocytosis hypokalemia psych changes hyperpigmentation |
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What is the dexamethasone suppression test used for
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to diagnose and differentiate bt the various types of Cushing syndrome
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What would indicate Cushing's dz in a dexamethasone test
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elevated ACTH
cortisol is not suppressed by low doses but is by high doses |
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Sxs of adrenal crisis
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hypotension
cardiovascular collapse |
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What 5 things must you rule out to diagnose adrenal crisis
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dehydration and hypovolemic shock
neurogenic and cardiogenic shock sepsis acute abdomen other causes of hyponatremia and hyperkalemia |
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What syndrome is associated with fulminant meningococcemia and adrenal hemorrhage
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Waterhouse-Friderichsen syndrome
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Sxs of Waterhouse-Friderichsen syndrome
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coagulopathy, petechial rash, cardiovascular collapse, DIC, coma
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Primary adrenal insufficiency also called? Causes?
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Addison's
autoimmune adrenalitis infectious adrenalitis metastatic CA adrenal hemorrhage/infarction drugs |
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Where is hyperpigmentation most frequently found in Addison's
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flexural areas
creases in palm recent scars vermilion border of lips genital skin nail beds |
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Congenital adrenal hyperplasia is caused by
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synthetic defect of 21-hydroxylase (catalyzes biosynthesis of aldosterone and cortisol)
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Classical sxs of congenital adrenal hyperplasia
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genital ambiguity
salt wasting (hypotension) precocious puberty |
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Pheochromocytoma is a neuroendocrine tumor of _____ origin
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chromaffin cell
-these are cells within the adrenal medulla that secrete epi/norepi into circulation |
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Pheochromocytoma results in
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overproduction of epi and norepi
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Pheochromocytoma: classic triad? other symptoms?
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HA, sweating, palpitations
also see HTN, anxiety, pallor, tachycardia, pulm edema, papilledema |
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Pheochromoctyoma tx
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surgical removal of tumor
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What do alpha, beta and gamma cells produce? What is the function of pancreatic polypeptide?
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glucagon
insulin somatostatin (GHIH) turns off intestinal motility |
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How does Type I diabetes happen
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immune rxn to a trigger, which causes T-cell and macrophage invasion of beta cells, causing them to release all the antigens within them into the bloodstream; the body mistakenly sees these as foreign and make autoantibodies against them
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At what percentage of remaining Beta cell mass do you see signs of glucose intolerance on the OGTT? What about when you see signs of diabetes?
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50%
10% |
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What are the most common antibodies seen at diagnosis of Type I DM
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islet cell or GAD antibodies
also IA-2A |
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What is the correct tx for DKA in Type I DM?
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***SLOW rehydration with normal saline over 24-48 hours
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Function of taurine
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the brain produces it in response to hyperglycemia to give the brain equal osmolarity as the blood
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3 risk factors for cerebral edema
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new onset
young age (under 5) low bicarb |
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DON'T EVER GIVE BICARB!!!!!! True/False
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TRUE
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What antibodies are most common in Type II DM
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Trick question, doesn't have any antibodies bc is not an autoimmune dz
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Positive urine ketones and DKA more common in Type I or II DM
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Type I
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Acanthosis nigricans more common in Type I or II DM
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Type II
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What test for diabetes is considered the "gold standard" but is a poor test? What tests are better?
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oral glucose tolerance test
hemoglobin A1c and fasting glucose and insulin |
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What is A1C
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form of hemoglobin used to estimate average blood sugar over long period of time (2-3 months)
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A1c: what is considered good, pre-diabetes, and diabetes
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good: 5.6% or less
pre: 5.7-6.4% diabetes: 6.5% or more |
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Management: insulin <40 and A1c <5.7%
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mainly diet counseling for this:
stay away from simple sugars decrease portion sizes of carbs non-carb snacks add fiber to decrease sugar rush few min of exercise a day |
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Management: insulin <40 and A1c 5.7-6.4%
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diet counseling with no meds if willing to make changes
if not, start Metformin (500mg po bid w/food; increase to 1000mg at next visit) |
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Management: insulin >40 and A1c <6.5%
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start Metformin (500mg po bid w/food, increase to 1000mg bid at next visit)
diet counseling |
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Management: insulin >40 and A1c 6.5-9%
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refer to endocrinology
start Metformin (500 mg po bid, increase to 1000mg at next visit) diet counseling this is prob Type II DM |
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Management: insulin >40 and A1c >9%
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refer to endocrinology
start Metformin diet counseling endo doc will start insulin therapy |
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Best insulin therapy for Type I? II?
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Lantus (bc is longer lasting)
Levemir |
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Humalin N / Novalin N
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starts working at 3 hrs
works alot at 6 hrs still working at 9 gone by 12 |
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Humalog/Novolog/Apidra
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starts working in 5-10 min
works alot at 1 hr gone by 2-3 |
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Humalin R / Novolin R
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starts at 1 hr
works alot at 2-3 gone by 4 cheapest, used in ER, not used much in clinical practice |
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Primary hypothyroid: TSH and T4 levels
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high
low |
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Primary hyperthyroid: TSH and T4 levels
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low
high |
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Where is T4 stored after its produced
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colloid of the follicular cell
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What are the 3 mechignisms of T4 transport
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bound to albumin, bound to TBG, and free T4
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Fetal thyroid fxn during 1st tri
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totally dependent on mom's T4 and T3
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Fetal thyroid fxn during 2nd/3rd tri
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fetus makes own TSH and T4, but mostly uses mom's
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Most common cause of congenital hypothyroid
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ectopic thyroid - thyroid gland starts in the base of the throat and then migrates down to neck during gestation; this occurs when it doesn't make it to the bottom
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Tx of congenital hypothyroid
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levothyroxine (Synthroid)
***must treat low TSH before 2-3 months or can develop mental retardation |
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What must you treat before 2-3 months or baby can develop mental retardation
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low TSH
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Hypothyroid sxs: baby and child
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baby: prolonged jaundice, constipation, umbilical hernia, wide fontanelle, poor linear growth, large tongue
child: wt gain, poor linear growth, fatigue, constip, swelling, prox muscle weakness |
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Best lab test for hypothyroid
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TSH
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Hashimoto's disease: aka? etiology? lab values? treatment?
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chronic lymphocytic thyroiditis
anti-thyroglobulin antibody high TSH, low T4, high Ab titers T4 (2-6 mcg/kg/day) |
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Graves disease: aka? etiology? symptoms?
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autoimmune hyperthyroidism
thyroid stimulating immunoglobulin attacks the gland and causes excess T4 production tremors in hand and tongue, brisk DTRs, prox muscle weakness, rapid HR, high BP, big buggy eyes, ***constant energy |
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Most common cause of hyperthyroidism
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Graves' disease
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Definitive treatment of Graves' (if methimazole fails)
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radioactive iodine; will eat up the thyroid gland from the inside, rendering them hypothyroid for life
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Treatment of Graves'
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if high BP/pulse: atenolol
standard: Methimazole if Methimazole fails, radioactive iodine to eat up the thyroid gland from the inside |
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Sick euthyroid syndrome: lab values
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low total T4, total T3, TSH
normal free T4 high reverse T3 (this is key***) |
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Simple colloid goiter: sxs? lab values? antibodies? treatment?
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asymptomatic
normal lab values no antibodies no tx needed |
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Hard nodule in the neck, ALWAYS consider ____
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thyroid cancer
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Acute suppurative and subacute thyroiditis: bacterial/viral
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acute suppurative- bacterial
subacute - viral |
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How long do you keep infant with congenital hypothyroidism on meds
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2 years
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2 criteria for pre-diabetes
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impaired fasting glucose (110-125)
OR impaired glucose tolerance (2 hr postprandial glucose of 140-199) |
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Ketoacidosis is more common in Type I or II DM
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type I (rare in II)
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Symptoms of hypoglycemia
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sweating
shaking N/V palpitations |
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Leading cause of ESRD
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diabetes
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What are some autonomic symptoms of diabetes
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gastroparesis, vomiting, diarrhea, bladder dysfunction, urinary retention, symptomatic ortho hypotension, dry skin
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Symptoms of diabetes
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asymptomatic at start
frequent infections polyuria/dipsia polyphagi muscle wasting/fatigue blurred vision (due to hyperglycemia) |
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DM type II: goals of treatment
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aimed at lowering insulin resistance
tailored to each specific pt reduce complications |
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DM type II: drug of choice, features...
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Metformin
lowers FBG and A1C lowers LDL wt loss hypoglycemia less likely |
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Side effects of Metformin
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GI (most common): metallic taste in mouth, anorexia, nausea, diarrhea
B12 deficiency Lactic acidosis (most serious) |
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Metformin: contraindications
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pts at risk for lactic acidosis (renal failure, liver dz, alcohol abuse, heart failure)
history of lactic acidosis |
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Sulfonylurea drugs: mechignism of action
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increase B-cell responsiveness to glucose and AA
increase insulin sensitivity lower blood glucose |
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Major side effect of sulfonylureas
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hypoglycemia
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Thiazolidinediones
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DM type II drugs
increase glucose utilization decrease glucose production maintain B-cell fxn |
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Side effects of thiazolidinediones
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may increase risk of bone loss
increase risk of bladder CA increase risk of MI cause fluid retention ***contraindicated in class III or IV heart failure |
