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Kallman syndrome
- Dec GnRH leads to dec FSH and LH
- Anosmia
- Renal agenesis in 50%
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Adult GH deficiency
- Central obesity
- Inc LDL and Chol
- Red lean muscle mass
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Hyponatremia endocrine causes
- Hypothyroid
- Dec glucocorticoids
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Metyrapone
- Old test for ACTH
- Inhibits 11b hydroxylase to dec adrenal gland and inc ACTH
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Insulin stimulation test
- Insulin dec glc, GH should rise
- old test of pituitary insufficiency
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Nephrotic DI causes
- Chronic pyelonephritis
- Amyloidosis
- myeloma
- sickle cell
- HyperCa
- HypoK
- Lithium
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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
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DI tx
- Central: desmpressin
- Neph: underlying cause, chlorothiazide, amiloride, NSAIDs
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Acromegaly cause
- Pituitary adenoma (can be with MEN)
- Rarely, ectopic GH or GHRH from lymphoma or bronchial carcinoid
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Acromegaly metabolisms
- Glc intolerance
- Hyperlipidemia
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Acromegaly tests
- Initial is IGF
- Accurate is Glc suppression test
- Prolactin levels since co-secreted
- Then MRI
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Acromegaly tx
- Cabergoline - dopamine inhs GH release
- Octreotide - somatostatin inh GH release
- Pegvisomant - GH R antagonist to prevent IGF release from liver
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Hyperprolactinemia causes
- Acromegaly
- Hypothyroidism
- Pregnancy
- Intense exercise
- cut pituitary stalk
- Kidney disease
- Cirrhosis
- Antipsychotic meds
- Methyldopa
- Metoclopromide
- Opioids
- TCAs
- SSRIs
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Hyperprolactinemia work up
- Thyroid fxn
- Pregnancy test
- BUN/Cr
- LFTs
- MRI
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Dopamine agonists
- Cabergoline - better tolerated
- Bromocriptine
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Drug induced hypothyroidism
amiodarone
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Hyperthyroidism causes
- Graves - eyes and skin
- Subacute thyroiditis - tender
- Silent thyroiditis - painless
- Exogenous - nonpalpable gland
- Pituitary adenoma - high TSH
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Hyperthyroidism labs
- TSH low in all but pit adenoma
- RAIU inc in Graves and dec in all else
- Ab in graves
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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*
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Thyroid nodule workup
- Test TSH, if low - nonmalignant
- if normal - FNA
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HyperCa causes
- Prim hyperPTH
- Malignant PTHlike
- Vit D intox
- Sarcoidosis and other granulomatous
- Thiazide diuretics
- Hyperthyroid
- Bone mets, multiple myeloma
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HyperCa presentation
- Asymptomatic
- Confusion
- Stupor
- Lethargy
- Contipation
- Short QT
- HTN
- Osteoporosis
- Renal stones
- DI
- Renal insufficiency
- PUD (ca stimulates gastrin)
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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)
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HypoCa presentation
- asymptomatoc
- long QT
- neural hyperexcitability
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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
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Hypercortisolism metabolic labs
- Hyperglycemia
- Hyperlipidemia
- Hypokalemia
- Met alkalosis
- Leukocytosis
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Adrenal incidentaloma work up
- Metanephrines
- Renin and aldo levels
- Img overnight dexamethasone suppression test
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Hypoadrenalism causes
- Chronic:
- Addisons
- Infection - TB
- Adrenoleukodystrophy
- Metastasis
- Acute:
- Hemorrhage
- Surgery
- Hypotension
- Trauma
- Steroid withdrawal
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Hypoaldosterism metabolics
- Hypoglycemia
- HyperK
- Met acidosis
- HypoNa
- High BUN
- Eosinophils
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Hypoaldosterism test
initial/specific: cosyntropin stimulation test (ACTH synthetic)
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Hypoaldosterism tx
- Hydrocortisone
- Fludrocortisone if postural instability - mineralcorticoid
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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
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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
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Pheo tx
- Phenoxybenzamine - alpha blocker
- Then CCB and bblockers
- Surgery
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DM dx
- 2 fasting >125
- Single >200 + symptoms
- Inc glc on oral glc tolerance test
- HA1C >6.5%
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Thiazoladinediones/Glitazones contraindication
CHF
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Nateglinide/repaglinide
Stim insulin release but non-sulfa
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Acarbose/miglitol
Alpha glucosidase inhibitors
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Exenatide/sitagliptin
- Incretins
- Weight loss
- Exenatide can cause pancreatitis
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Pramlintide
- Analog of amylin
- decreases gastric emptying, dec glucagon, dec appetite
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Onset, peak, duration of Lispro/aspart/glulisine, regular, NPH, glargine
- 5min/1hr/4hr
- 30min/2hr/8hr
- 2hr/6hr/10-20hr
- 1hr/1hr/24hr
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ASA in DM
all DM pts above age 30yo
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Gastroparesis tx
Metoclopromide and Erythromycin
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