endocrinology

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Author:
jstaylor
ID:
244219
Filename:
endocrinology
Updated:
2013-10-31 21:40:16
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medicine shelf
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endocrinology, medicine shelf
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  1. thyrotoxicosis
    • increased thyroid hormone levels
    • suppressed TSH levels
  2. Thyrotoxicosis with radioactive iodine uptake in one lobe
    toxic adenoma
  3. Hashimoto's thyroiditis
    • most are hypothyroid or euthyroid
    • thyroid scan shows heterogenous pattern
  4. Graves disease
    • diffusely increased radioactive iodine uptake
    • eye involvement
    • pretibial myxedema
  5. pan hypopituitarism
    clinical presentation
    • ACTH deficiency: postural hypotension, tachycardia, fatigue, weight loss, decreased libido, hypoglycemia, eosinophilia
    • Hypothyroidism: fatigue, cold intolerance, decreased appetite, constipation, dry skin, bradycardia, delayed DTR, anemia
    • Gonadotropins: (women) amenorrhea, infertility, hot flashes; (men) decreased energy and libido
  6. Pan hypopituitarism
    etiology
    • primary:
    • -pituitary mass
    • -pituitary surgery
    • -infiltrative: hemochromatosis
    • -infarction: Sheehan syndrome
    • -empty sella syndrome
    • -Apoplexy

    • Hypothalamic causes:
    • -Benign masses
    • -Malignant metastases
    • -Radiation for CNS malignancy
    • -Infiltrative sarcoidosis
    • -trauma
    • -infections (TB meningitis
  7. adrenal insufficiency
    • fatigue
    • hyperpigmentation
    • lower BPs
    • eosinophilia
    • lower sodium
    • hyperkalemia
  8. evaluation of adrenal insufficiency
    • cosyntropin stimulation test with cortisol and ACTH levels
    • Basal cortisol low, ACTH high, minimal cortisol response to cosyntropin: primary AI
    • Basal cortisol low, ACTH low, minimal or suboptimal cortisol response: secondary or tertiary adrenal insufficiency
  9. thyroid malignancy
    • most common: papillary thyroid cancer (70%)
    • worst prognosis: anaplastic carcinoma
    • medullary: parafollicular C-cells, typical in MEN 2a and 2b
  10. Familial hypocalciuric hypercalcemia
    • autosomal dominant
    • abnormal calcium-sensing receptors on parathyroid cells
    • inappropriately high-normal to borderline elevated PTH level
  11. Dehydroepiandrosterone-sulfate
    DHEA-S
    predominantly produced by the adrenal glands
  12. Hashimoto's thyroiditis
    • anti-thyroperoxidase (TPO) antibodies
    • risk: thyroid lymphoma (60x patients without)
    • patients may be euthyroid or hypothyroid, or have transient thyrotoxicosis during the initial part of the illness
  13. Gastroparesis
    • >50% of patients with longstanding type 1 or 2 DM
    • sx: anorexia, nausea, vomiting, early satiety
    • Tx: optimize diabetes control; small, frequent meals
    • Metoclopramide: prokinetic, antiemetic properties
  14. osteomalacia
    • causes: malabsorption (vitD most common), intestinal bypass surgery, celiac disease, CKD, chronic liver disease
    • Signs/symptoms: asymptomatic, bone pain, muscle cramps, difficulty walking, waddling gait
    • Dx: elevated alk phos, elevated PTH, decreased calcium and phosphorus, decreased urinary calcium, decreased vit D
    • pseudofractures
  15. Leydig tumors
    • most common type of testicular sex cord stromal tumors
    • elevated testosterone and estrogen

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