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What should you always check in a patient that presents with new-onset A fib?
TSH
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Which antiarrhythmic is thyrotoxic?
Amiodarone
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Which endocrine disorder is classically associated with menorrhagia?
Hypothyroidism
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Euthyroid sick syndrome
- Temporary decline in thyroid function that can be seen in any illness
- Does not require tx
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Diagnosis of Cushing syndrome
- Free urinary cortisol
- Dexamethasone suppression test
- ACTH (elevated in Cushing disease, decreased with adrenal adenomas)
- MRI,if ACTH is increased
- Abdo CT or MRI, if ACTH is not increased and px is not on steroids
- CXR, if there are clinical indications of small cell lung cancer
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Signs and symptoms of Addison disease
- Anorexia, weight loss, weakness
- Hypotension
- Hyponatremia, hyperkalemia
- Hyperpigmentation
- Acidosis
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Patient on chronic steroid tx crashes after surgery (hypotension, shock, hyperkalemia)
Think adrenal insufficiency from long-term suppression
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Causes of adrenal insufficiency
- Iatrogenic--steroid use
- AI--Addison disease
- Neoplastic--mets to adrenals, esp from lungs
- Infectious--TB, fungal
- Drugs--ketoconazole
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Female infant with ambiguous genitalia
- Think CAH
- 90% are 21 hydroxylase deficient
- Hypo or normo tensive, with hyponatremia and hyperkalemia
- Acidosis, nausea, vomiting
- High serum 17-hydroxyprogesterone and DHEA
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Etiologies of hyperparathyroidism
- PrimaryUsually a parathyroid adenoma
- Secondary
- Low Ca (e.g renal failure)
- TertiaryPTH rises in response to longstanding low Ca, and fails to normalize when Ca is corrected (e.g. CRF)
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A child presents with tetany in the first 48 hours of life and absent thymic shadow
- Di George
- (also associated with immunodeficiency, abnormal cardiac development, and midline facial defects)
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Signs and symptoms of hypercalcemia
- Stones, bones, abdominal groans, psychiatric moans
- Short QT
- Muscle weakness
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Cancers associated with hypercalcemia
- MM
- Squamous cell carcinoma--secretes PTHrP
- Bone cancer
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Pseudohypoparathyroidism
- Genetic defect resulting in inability to respond to PTH
- Patients are hypocalcemic (tetany, prolonged QT, altered MS)
- Short stature, shortened metacarpal bones, and mental retardation
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A patient has low measured serum Ca. What's the next thing to check?
Either ionized Ca or serum albumin (since albumin binds to Ca, so low albumin can give a lab result of hypocalcemia, even if ionized Ca is normal)
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How can true precocious puberty be distinguished from pseudoprecocious puberty?
- True (idiopathic, or secondary to a CNS lesion) causes testicular or ovarian enlargement, pseudo does not
- Test with a GnRH stimulation test: if GnRH triggers an increase in LH/FSH, the precocious puberty is true
- Next step: brain MRI
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Causes of pseudoprecocious puberty
- Exogenous hormone administration
- Adrenal tumor
- CAH
- Hormone-secreting tumor
- McCune-Albright syndrome (ovarian cysts, fibrous bone dysplasia,and cafe-au-lait spots)
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Should precocious puberty be treated?
- Yes--it causes premature fusion of the growth plates
- Tx with GnRH antagonists
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Conn syndrome
- Aldosterone-secreting adrenal tumor
- Presents with hypernatremia, hypokalemia, and HTN
- Renin is low
- After lab dx, order an abdo CT to find tumor
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Hypernatremia with dilute urine
DI
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Patient cannot concentrate urine after administration of vasopressin
Nephrogenic DI
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Treatment of nephrogenic DI
- Stop offending drug (e.g. lithium)
- Thiazides (are diuretics, but work for DI because they also help concentrate the urine)
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Endocrine disorder that leads to euvolemic hyponatremia
SIADH
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Serum and urine osmolalities in SIADH
- Low serum osmolality
- High urine osmolality
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Causes of SIADH
- CNS--stroke, hemorrhage, infection, trauma
- Meds--narcotics, oxytocin, antiepileptics
- Trauma--pain normally stimulates ADH secretion. The post-op combo of pain + narcotics makes pxs especially prone to SIADH
- Lung disease--pneumonia, small cell cancer
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