Endo Step2

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Author:
gm1147
ID:
166148
Filename:
Endo Step2
Updated:
2012-08-15 13:57:40
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Endo Endocrine step2
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kaplan
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  1. Kallman syndrome
    • Dec GnRH leads to dec FSH and LH
    • Anosmia
    • Renal agenesis in 50%
  2. Adult GH deficiency
    • Central obesity
    • Inc LDL and Chol
    • Red lean muscle mass
  3. Hyponatremia endocrine causes
    • Hypothyroid
    • Dec glucocorticoids
  4. Metyrapone
    • Old test for ACTH
    • Inhibits 11b hydroxylase to dec adrenal gland and inc ACTH
  5. Insulin stimulation test
    • Insulin dec glc, GH should rise
    • old test of pituitary insufficiency
  6. Nephrotic DI causes
    • Chronic pyelonephritis
    • Amyloidosis
    • myeloma
    • sickle cell
    • HyperCa
    • HypoK
    • Lithium
  7. 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
  8. DI tx
    • Central: desmpressin
    • Neph: underlying cause, chlorothiazide, amiloride, NSAIDs
  9. Acromegaly cause
    • Pituitary adenoma (can be with MEN)
    • Rarely, ectopic GH or GHRH from lymphoma or bronchial carcinoid
  10. Acromegaly metabolisms
    • Glc intolerance
    • Hyperlipidemia
  11. Acromegaly tests
    • Initial is IGF
    • Accurate is Glc suppression test
    • Prolactin levels since co-secreted
    • Then MRI
  12. Acromegaly tx
    • Cabergoline - dopamine inhs GH release
    • Octreotide - somatostatin inh GH release
    • Pegvisomant - GH R antagonist to prevent IGF release from liver
  13. Hyperprolactinemia causes
    • Acromegaly
    • Hypothyroidism
    • Pregnancy
    • Intense exercise
    • cut pituitary stalk
    • Kidney disease
    • Cirrhosis
    • Antipsychotic meds
    • Methyldopa
    • Metoclopromide
    • Opioids
    • TCAs
    • SSRIs
  14. Hyperprolactinemia work up
    • Thyroid fxn
    • Pregnancy test
    • BUN/Cr
    • LFTs
    • MRI
  15. Dopamine agonists
    • Cabergoline - better tolerated
    • Bromocriptine
  16. Drug induced hypothyroidism
    amiodarone
  17. Hyperthyroidism causes
    • Graves - eyes and skin
    • Subacute thyroiditis - tender
    • Silent thyroiditis - painless
    • Exogenous - nonpalpable gland
    • Pituitary adenoma - high TSH
  18. Hyperthyroidism labs
    • TSH low in all but pit adenoma
    • RAIU inc in Graves and dec in all else
    • Ab in graves
  19. 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*
  20. Thyroid nodule workup
    • Test TSH, if low - nonmalignant
    • if normal - FNA
  21. HyperCa causes
    • Prim hyperPTH
    • Malignant PTHlike
    • Vit D intox
    • Sarcoidosis and other granulomatous
    • Thiazide diuretics
    • Hyperthyroid
    • Bone mets, multiple myeloma
  22. HyperCa presentation
    • Asymptomatic
    • Confusion
    • Stupor
    • Lethargy
    • Contipation
    • Short QT
    • HTN
    • Osteoporosis
    • Renal stones
    • DI
    • Renal insufficiency
    • PUD (ca stimulates gastrin)
  23. 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)
  24. HypoCa presentation
    • asymptomatoc
    • long QT
    • neural hyperexcitability
  25. 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
  26. Hypercortisolism metabolic labs
    • Hyperglycemia
    • Hyperlipidemia
    • Hypokalemia
    • Met alkalosis
    • Leukocytosis
  27. Adrenal incidentaloma work up
    • Metanephrines
    • Renin and aldo levels
    • Img overnight dexamethasone suppression test
  28. Hypoadrenalism causes
    • Chronic:
    • Addisons
    • Infection - TB
    • Adrenoleukodystrophy
    • Metastasis
    • Acute:
    • Hemorrhage
    • Surgery
    • Hypotension
    • Trauma
    • Steroid withdrawal
  29. Hypoaldosterism metabolics
    • Hypoglycemia
    • HyperK
    • Met acidosis
    • HypoNa
    • High BUN
    • Eosinophils
  30. Hypoaldosterism test
    initial/specific: cosyntropin stimulation test (ACTH synthetic)
  31. Hypoaldosterism tx
    • Hydrocortisone
    • Fludrocortisone if postural instability - mineralcorticoid
  32. 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
  33. 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
  34. Pheo tx
    • Phenoxybenzamine - alpha blocker
    • Then CCB and bblockers
    • Surgery
  35. DM dx
    • 2 fasting >125
    • Single >200 + symptoms
    • Inc glc on oral glc tolerance test
    • HA1C >6.5%
  36. Thiazoladinediones/Glitazones contraindication
    CHF
  37. Nateglinide/repaglinide
    Stim insulin release but non-sulfa
  38. Acarbose/miglitol
    Alpha glucosidase inhibitors
  39. Exenatide/sitagliptin
    • Incretins
    • Weight loss
    • Exenatide can cause pancreatitis
  40. Pramlintide
    • Analog of amylin
    • decreases gastric emptying, dec glucagon, dec appetite
  41. Onset, peak, duration of Lispro/aspart/glulisine, regular, NPH, glargine
    • 5min/1hr/4hr
    • 30min/2hr/8hr
    • 2hr/6hr/10-20hr
    • 1hr/1hr/24hr
  42. ASA in DM
    all DM pts above age 30yo
  43. Gastroparesis tx
    Metoclopromide and Erythromycin

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