The flashcards below were created by user Anonymous on FreezingBlue Flashcards.

  1. Metabolic syndrome dx
    • 3/5:
    • Abdominal obesity >40 in men, >35 in women
    • Triglycerides >150
    • HDL <40 men <50 women
    • BP >130/85
    • fasting glu >100
  2. Graves dz
    • Exophthalmos, pretibial myxedema and thyroid bruits are specific
    • Autoimmune, thyroid stim Ab, inc T3, T4, dec TSH
    • RAI uptake high and diffuse
    • Rx: Symptomatic propanolol, methimazole or PTU
    • Definitive rx: radioactive I thyroid ablation
  3. Thyroiditis
    • postpartum, postviral and subacute
    • transient inflammation of thyroid gland with release of previously synth thy hormone causing temp inc in circ T3/T4, RAI uptake low
  4. Thyroid storm
    • acute life threatening thyrotoxicosis, treat with iv propanolol, PTU and CST
    • Sx: AF, fever, delirium
  5. Hasimoto thyroiditis
    • hypothyroidism, autoimmune, assoc with antithyroglobulin and antimicrosomal ab (anti TPO) that destry thyroid
    • Dry puffy skin, edema, bradycardia, delayed relaxation of DTRs
    • BIT: TSH
    • Rx: levothyroxine
  6. Myxedema coma
    severe hypothyroidism with dec mental status, hypothermia and other parasym sx, mortality 30-60%, admit to ICU and rx with levothyroxine and iv hydrocortisone
  7. Thyroiditis
    • inflammation of thyroid gland, types: subacute granulomatous, radiation induced, ai, postpartum and amiodarone induced
    • Dx: usu thyrotoxicosis then hypothyroid state with dec RAI uptake
    • Rx: B blockers if hyper, levothyrox if hypo
    • If severe, use NSAID/oral CST but most self limited
  8. Thyroid cancer factors assoc with inc malignancy risk
    Cold nodules, hx of childhood neck radiation, male, <20 or >70, firm and fixed solitary nodule, fhx, rapidly growing with hoarseness
  9. Thyroid cancer Dx steps
    • 1st: TFT to detect hyperfunctioning nodules, if normal do US to determine solid vs cystic-cystic usu benign then do FNA on solid¬†
    • If TFTs shows hyperfine do RAI scan to show hot nodule- not cancerous, if cold- FNA
  10. Types of thyroid cancer
    Papillary: psammoma body, 75-80% of CA, slow growing, good prognosis

    • Medullary: Calcitonin producint C cells, consider MEN 2A or B
    • Follicular: good prognosis
  11. Pagets dz bone
    • inc bone turnover, mosaic lamellar bone pattern on Xray
    • Sx: usually asx but may have joint or bone pain, can effect one or many bones
    • Dx: inc alk phos but nml Ca and phosphate
    • Imaging: bone scan: thick cortex, thickened trabeculae
    • Rx: most require no rx, no cure, can treat with bisphos. or calcitonin
  12. Hyperparathyroidism: types
    • Primary: most are single hyperfxn adenoma rest are parathyroid hyperplasia
    • Inc PTH, Ca, dec PO4
    • Secondary: inc PTH in response to renal insuff, Ca def, or vit D def
    • Inc PTH, NL or Dec Ca, inc PO4
    • Tertiary: dialysis patient
    • Inc PTH, NL/Dec Ca, inc PO4
    • Ectopic PTHrp: dec PTH, inc Ca, dec PO4
  13. Acute hypercalcemia rx and sx
    • Sx: bones,stones, moans, and psych overtones
    • IV fluid, loop diuretic and IV bisphosphonate

    Loops: furosemide
  14. Cushings syndrome
    • Elevated cortisol, most freq iatrogenic due to prolonged rx with exogenous corticosteroids
    • VS DISEASE: endogen hypersec of ACTH from pit adenoma
    • Sx: HRTN, DM2, depression, weight gain, hirsutism, central obesity, moon facies, fat pads, striae
  15. Cushings test algorithm
    • Being with screen: 2/3: elevated 24 hour free urine cortisol, elevated midnight salivary cortisol on 2 nights or 1mg dexamethasone supp test
    • + supp test if AM cortisol is still elevated after dexa admin. suggesting cushings disease: due to ectopic production or adenoma
    • If dz suggested get pituitary MRI
  16. Acromegaly
    • elevated growth hormone usually due to GH secreting adenoma
    • Enlargement of skull/hand/feet
    • inc risk carpal tunnel, diastolic dysfxn, sleep apnea, DM2,¬†Bitemporal hemianopsia, glucose intol
    • Labs: IGF-1 inc, confirm dx with oral glucose supp test: GH remains elevated Rx: surg, if it fails octreotide supp GH secretion
  17. Central DI
    • ADH deficiency, post pituitary fails to make ADH causes: tumor, sheehans, pit hemorrhage, TBI, inf, met dz, AI dz
    • Polydipsia, polyuria, dilute urine, thirst
    • Dx: water dep test:will have high vol of dilute urine
    • Desmopressin replacement test, with Central will have dec urine output and inc osmolarity
    • Rx: MRI, DDAVP
  18. nephrogenic DI
    • ADH resistance, renal disease, lithium, demeclocycline, amyloidosis
    • Desmopressin replacement: no change in urine output or osmolarity
    • Rx: salt restriction and water intake because will have hypernatremia, can use thiazides to promote volume depletion to stim inc water reabs
  19. SIADH
    • CNS disease, pulm dz (sarcoid, COPD), ectopic tumor: sm cell lung carc, antipsychotics, antidepressants
    • Too much water abs out of urine, will be hyponatremic
    • Rx: restrict fluid, if severe hyponatremia give hypertonic saline but monitor
    • Can try demeclocycline-ADH R antag
  20. Adrenal insufficiency
    • No glucocorticoids and mineral corticoids
    • Primary: most due to AI destruction-addisons, can be due to n.meningitis, adrenal hemor, TB
    • 2/3: dec ACTH made by pituitary, usu due to cessation of CST
    • Sx: weak, fatigue, anorexia, hypogly, hypotension, hyperpig
    • Hyponatremia and eosinophilia, hyperkalemia in primary
    • Confirm with 8 am plasma cortisol and ACTH stim test, 8 am <3=AI, ACTH with failure of cortisol to rise>18= confirms dx
    • Rx:primary: mineral/glucocort replacement, 2/3: glucocort replacement
  21. Adrenal crisis
    IV steroids, correct electrolyte abnormalities, 50% dextrose to correct hypogly and cvolume ressuc
  22. Pheochromocytoma
    • chromaffin tumor, adrenal medulla or 10% extra adrenal, assoc with MEN 2A and @b
    • Paroxysmal tachy/htn, tremor, anx
    • R/o familial: men2a/b, VHL, neurofibro
    • BIT: elevated plasma metaneph or 24 hr urine metal/catechol
    • Then do CT/MRI
    • Rx: surg, ALPHA BLOCK first then B block!! never do B first- unopposed alpha stim will lead to refract. HTN
  23. Hyperaldosteronism
    • Excessive sec ald from adrenal cortex, usually adrenocortical hyperplasia or unilat adrenal adenoma(COnns)
    • Sx: HTN, headache, polyuria, tetany
    • Hypokalemia, hypernatremia, met alk, hypoMG
    • BIT: Ald/plasma renin ratio (INC!)
    • MAT: adrenal venous sampling
    • Rx: resect tumor or treat hyperplasia with spironolactone or eplerenone
  24. MEN
    • MEN 1: pancreatic islet cell tumor, parathyroid hyperplasia, pituitary adenoma
    • 2a: medullary carc thy, pheo, parathy, mut RET
    • 2b: med carc thy, pheo, int ganglioneuromatosis, marfanoid
Card Set:
2013-07-09 14:26:57
Endocrine mm

Show Answers: