IM endo

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IM endo
2013-06-10 19:15:41
im endo

key concepts for endocrine for internal medicine
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  1. Dx of DMII based on:
    1) Fasting plasma glucose of at least 126mg/dL
    2) Random plasma glucose of at least 200 mg with polyuria, polydipsia, or blurred vision
    3) Plasma glucose >200 mg/dL after 2-hr oral glucose tolerance test
    4) HbA1C > 6.5%
    Tx prediabetes with diet and exercise
  2. Secondary diabetes can result from diseases of exocrine pancreas, endocrinopathies, genetic syndromes, and drugs or chemicals
    Metformin is recommended as initial pharmacologic therapy for DMII
  3. Basal-bolus of insulin regimen consisting of long-acting insulin and rapid-acting insulin analogue before meals is recommended for hospitalized pt with uncontrolled DM
    Laser photocoagulation of the retina can help perserve vision in pt with proliferative diabetic retinopathy and/or macular edema
  4. Combo of basal and rapid-acting insulin analogues reduces the risk of hypoglycemia
    DKA dx based on blood glucose level <250mg/dL, anion gap metabolic acidosis (arterial pH<7.3), serum CO2 <15meq/L, and positive serum or urine ketone concentrations
  5. Dx of hyperglycemic hyperosmolar syndrome: plasma glucose >600mg/dL, arterial pH>7.3, serum bicarb >15 meq/L, serum osmolality >320mosm/kg, and absent urine or serum ketones
    Management of hyperglycemic hyperosmolar syndrome involves ID'ing underlying precipitating illness and restoring plasma volume with IV fluids
  6. Ketoacidosis can develop in insulin-deficient pt with only moderate plasma glucose elevations; insulin drip is most effective tx of DKA
    Xanthelasma is char by soft, nontender, nonpruritic plaques localized to eyelids and may be associated with familial dyslipidemias
  7. Pt with isolated low HDL cholesteral should be managed first with lifestyle modifications (exercise, tobacco cessation, and weight management)
    LCL goal is <160mg/dL in pt with zero or one cardiovascular risk factor (cigarette smoking, htn, age >45 in men and >55 in women, HDL <40, and family hx of CAD)
  8. Pt with DMII or who have had MI have LDL goal <100; statin is first line tx (40 mg of simvastatin)
    Pt who have had stroke or TIA have LDL goal <100 mg/dL
  9. Hashimoto disease is most common cause of hypothyroidism and does not require additional testing with TPO antibody to initiate tx with levothyroxine
    Any thyroid nodule >1 cm should be bx; nodules >1cm should be bx in pt with cancer risk factors (age <20 or >60, male sex, hx of neck irradiation, FHX thyroid cancer, rapid nodule growth, or hoarseness)
  10. Managing hypothyroidism during pregnancy can be done by monitoring TSH levels; levothyroxine requirements may incr 30-50% during first trimester
    Tx Graves disease with atenolol and methimazole
  11. Postpartum thyroiditis can cause postpartum thyrotoxicosis, hypothryoidism, or a period of both
    Severe illness can cause euthyroid sick syndrome, associated with abnormal results of thyroid function tests that normalize after recovery
  12. Hypersecretion of glucocorticoids and catecholamines should be evaluated in all pt, including asx pt, with incidentially discovered adrenal adenoma
    Best screening test for primary hyperaldosteronism is ratio of serum alodsterone to plasma renin activity; ratio >20 is consistent with dx
  13. ACTH-dependent hypercorticolism is most commonly cuased by pituitary tumor or ectopic ACTH source (carcinoid tumor)
    CT has sensitivites of 93-100% in detecting adrenal pheochromocytoma and approx 90% in detecting extra-adrenal catecholamine paraganliomas
  14. Secondary adrenal insufficiency due to exogenous corticosteroids may be associated with suppression of both adrenocorticotropic hormone and cortisol levels and with clinical findings of excess glucocorticoids
    Treat adrenal insufficiency during stress with IV stress doses of hydrocortison (10x the normal daily replacement dosage)
  15. Prevention and tx of osteoporosis includes vitamin D and calcium supplementation
    Screening for osteoporosis recommended for women age 65 yrs and in women 60-64 if they are at incr risk (weight >70 kg)
  16. Bisphosphanates are class of drugs that can lower fracture rate in pt with osteoporosis
    Once yearly IV infuction of zoledronate is potent therapy for tx postmenopausal osteoporosis of spine and hip
  17. Osteoporosis is dx by presence of fragility fractures or by bone mineral density T-score < -2.5 in pt who have not experience fragility fracture