-
Kallman syndrome
- Dec GnRH leads to dec FSH and LH
- Anosmia
- Renal agenesis in 50%
-
Adult GH deficiency
- Central obesity
- Inc LDL and Chol
- Red lean muscle mass
-
Hyponatremia endocrine causes
- Hypothyroid
- Dec glucocorticoids
-
Metyrapone
- Old test for ACTH
- Inhibits 11b hydroxylase to dec adrenal gland and inc ACTH
-
Insulin stimulation test
- Insulin dec glc, GH should rise
- old test of pituitary insufficiency
-
Nephrotic DI causes
- Chronic pyelonephritis
- Amyloidosis
- myeloma
- sickle cell
- HyperCa
- HypoK
- Lithium
-
DI tests
- HyperNa if dec drinking
- Dec ur osmolality
- Dec UrNa
- Inc serum osm
- Inc ur volume
- ADH: dec central ur volime and inc osmolality. Neph - no effect
-
DI tx
- Central: desmpressin
- Neph: underlying cause, chlorothiazide, amiloride, NSAIDs
-
Acromegaly cause
- Pituitary adenoma (can be with MEN)
- Rarely, ectopic GH or GHRH from lymphoma or bronchial carcinoid
-
Acromegaly metabolisms
- Glc intolerance
- Hyperlipidemia
-
Acromegaly tests
- Initial is IGF
- Accurate is Glc suppression test
- Prolactin levels since co-secreted
- Then MRI
-
Acromegaly tx
- Cabergoline - dopamine inhs GH release
- Octreotide - somatostatin inh GH release
- Pegvisomant - GH R antagonist to prevent IGF release from liver
-
Hyperprolactinemia causes
- Acromegaly
- Hypothyroidism
- Pregnancy
- Intense exercise
- cut pituitary stalk
- Kidney disease
- Cirrhosis
- Antipsychotic meds
- Methyldopa
- Metoclopromide
- Opioids
- TCAs
- SSRIs
-
Hyperprolactinemia work up
- Thyroid fxn
- Pregnancy test
- BUN/Cr
- LFTs
- MRI
-
Dopamine agonists
- Cabergoline - better tolerated
- Bromocriptine
-
Drug induced hypothyroidism
amiodarone
-
Hyperthyroidism causes
- Graves - eyes and skin
- Subacute thyroiditis - tender
- Silent thyroiditis - painless
- Exogenous - nonpalpable gland
- Pituitary adenoma - high TSH
-
Hyperthyroidism labs
- TSH low in all but pit adenoma
- RAIU inc in Graves and dec in all else
- Ab in graves
-
Hyperthyroidism tx
- Graves - I*. Steroids or radiation for eyes.
- Subacute - ASA
- Silent- none
- Storm - propranolol, thiourea drugs (methimazole, propylthiouracil), contrast (iopanoic acid and ipodate), hydrocortisone, I*
-
Thyroid nodule workup
- Test TSH, if low - nonmalignant
- if normal - FNA
-
HyperCa causes
- Prim hyperPTH
- Malignant PTHlike
- Vit D intox
- Sarcoidosis and other granulomatous
- Thiazide diuretics
- Hyperthyroid
- Bone mets, multiple myeloma
-
HyperCa presentation
- Asymptomatic
- Confusion
- Stupor
- Lethargy
- Contipation
- Short QT
- HTN
- Osteoporosis
- Renal stones
- DI
- Renal insufficiency
- PUD (ca stimulates gastrin)
-
HypoCa causes
- HypoPTH
- HypoMg
- Renal failure
- Vit D def
- Fat malabsorption
- Low albumin (1 dec in albumin dec Ca by 0.8 - but total, not free)
-
HypoCa presentation
- asymptomatoc
- long QT
- neural hyperexcitability
-
Hypercortisolism tests
- Initial: 24 hr Ur cortisol (specific) or 1mg overnight (false positives in depression, etoh, obesity)
- ACTH - if elevated, MRI. If normal then sample petrosal sinus to detect small pituitary sources
- If all normal, scan chest
-
Hypercortisolism metabolic labs
- Hyperglycemia
- Hyperlipidemia
- Hypokalemia
- Met alkalosis
- Leukocytosis
-
Adrenal incidentaloma work up
- Metanephrines
- Renin and aldo levels
- Img overnight dexamethasone suppression test
-
Hypoadrenalism causes
- Chronic:
- Addisons
- Infection - TB
- Adrenoleukodystrophy
- Metastasis
- Acute:
- Hemorrhage
- Surgery
- Hypotension
- Trauma
- Steroid withdrawal
-
Hypoaldosterism metabolics
- Hypoglycemia
- HyperK
- Met acidosis
- HypoNa
- High BUN
- Eosinophils
-
Hypoaldosterism test
initial/specific: cosyntropin stimulation test (ACTH synthetic)
-
Hypoaldosterism tx
- Hydrocortisone
- Fludrocortisone if postural instability - mineralcorticoid
-
Primary hyperaldosteronism tests
- Intial: ratio of plasmaalgo to plasma renin. Elevated renin excludes
- Accurate: sample venous blood with high aldo
- HypoK**, high aldo while eating high salt, low plasma renin
-
Pheo tests
- Intial: free metanephrines in plasma
- Confirm with 24 hr Ur metanephrines
- More sensitive than Ur vanillylmandelic acid
- Also epi and NE
- Then CT or MRI
- MIBG for outside adrenal
-
Pheo tx
- Phenoxybenzamine - alpha blocker
- Then CCB and bblockers
- Surgery
-
DM dx
- 2 fasting >125
- Single >200 + symptoms
- Inc glc on oral glc tolerance test
- HA1C >6.5%
-
Thiazoladinediones/Glitazones contraindication
CHF
-
Nateglinide/repaglinide
Stim insulin release but non-sulfa
-
Acarbose/miglitol
Alpha glucosidase inhibitors
-
Exenatide/sitagliptin
- Incretins
- Weight loss
- Exenatide can cause pancreatitis
-
Pramlintide
- Analog of amylin
- decreases gastric emptying, dec glucagon, dec appetite
-
Onset, peak, duration of Lispro/aspart/glulisine, regular, NPH, glargine
- 5min/1hr/4hr
- 30min/2hr/8hr
- 2hr/6hr/10-20hr
- 1hr/1hr/24hr
-
ASA in DM
all DM pts above age 30yo
-
Gastroparesis tx
Metoclopromide and Erythromycin
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