Endocrinology
Content
ENDOCRINOLOGY
Hypothyroid Weight gain, Lethargy, Coarse hair & dry skin, irregular menses, cold intolerance, myxedema; Acquired = Hashimoto's; Congenital = cretinism, severe I deficiency = hoarse cry; resp distress, cyanosis, poor feeding, decr bone growth, Bl T4 incr. TSH Wolff Chaikoff effect = inhibition of thyroid hormone release due to high doses of I during thyroid scan Hyperthyroid 1. GRAVES: most common, autoimmune, antibodies bind to TSH receptors; incr thyroid hormone, pretibial myxedema, Incr radio I uptake
2. SUBACUTE THYROIDITIS: tender, enlarged, Decr Radio I uptake, Sed
Rate up, maybe followed by period of hypothyroid
3. SILENT LYMPHOCYTIC THYRODITIS: transient, postpartum, no pain or
fever, Radio I uptake decr, lymphocytic infiltration, Tx ß blockers
4. TOXIC ADENOMA: multinodular goiter; nodules function autonomously,
Excess T3 & T4; Scan shows a few hot spots with cold background
5. THYROTOXICOSIS FACTITIA: exogenous thyroid hormone, no goiter 6. PLUMMERS: multinodular goiter, nodules become autonomous and secrete
thyroxine Sick Euthyroid acutely ill patients; T3&T4 decr due to chgs in hormone metabolism; TSH not decreased => not truly hypothyroid Thyroid CA Papillary = most common, best prognosis, Follicular = older, hematogenous spread to bone, lung, brain, liver; Anaplastic = worse prognosis, local invasion, hoarse & dysphagia; Medullary= Calcitonin producing Cells, MEN Type II(parafollicularC cells) Diabetes Dx: elevated random glucose sx, fasting BS > 140 x 2 days; Oral challenge >200 after 2 hrs; Type I: alpha islet cells, HLADR3, HLADR4, HLADQ, ketoacidosis Type II: insulin resistance; no HLA association, endogenous production enough so no ketoacidosis but do get hyperosmolar coma(dehydrated, glucose 600-2000
Parathyroid Hormone incr. Ca mobilization from bones, incr. Vit D production decr. phos reabsorption in distal tubules = decr. serum phos. Hypoparathyroidism ßPTH, ßCa, incr. Phos, Tingling, tetany, Chvostek's sign (tap on face & get muscle spasm) ; Trousseau's Sign (BP cuff up 3min => carpal tunnel sx; decr. Mg in alcoholics can lead to decr. Ca due to ßPTH secretions Hyperparathyroid Bones, stones, abd. groan and psychic moans; 1o = excess PTH; 80% benign adenoma; 2o due to decr. serum Ca=> vit D defic, renal tube prob and Ca loss Diabetes Insipidus Lack of ADH, polyuria and polydypsia Kallman's Syndrome Male, anosmic, small testicles, azospermic d/t head trauma; decr. FSH & LH, no GNRH SIADH Excess ADH, Tumor, trauma, pulm disease, drugs; Hyponatremia, Conc. urine; Acromegaly Excess GH; bone & tissue enlargement; glucose intolerance, osteoarthritis Addison's Disease Decreased cortisol (aldosterone) Wt loss, fatigue, skin pigmentation, eosinophilia; Decr aldosterone, decr Na, incr K; Give ACTH if cortisol doesn't increase Dx made Cushing's Syndrome Incr cortisol, Buffalo hump, moon facies, central obesity, Osteoporosis, #1 Cushing disease due to pit. Adenoma, #2 Ectopic- ACTH from lung tumor, #3 Adrenal Cortical tumor- incr. cortisol, ACTH suppressible, cortisol not #4 Chronic glucocorticoid Tx Waterhouse Friedrickson Syndrome hemorrhagic infarct of adrenals, assoc w/ meningococcemia Pheochromocytoma Episodic HTN, Dx by urinary catecholamines Familial Hypercholesterolemia
Autosomal dominant, Xanthomas (lipid on tendons) Xanthelasmas (lipids on eyelids) MI's in 40's, Homozygous usually has incr. total cholesterol Familial Hypertriglyceridemia Trig incr. , LDL normal, Autosomal dominant, Pancreatitis, milky serum Familial Combined Hyperlipidemia Auto dominant, incr. trig and cholesterol; no xanthomas Familial Dysbetalipo-proteinemia rare, problem with lipoproetin catabolism; palmar or tuberous xanthomas, incr. risk periph vasc disease & CAD, Abn VLDL, cholesterol & triglycerides MEN I Parathyroid , pituitary & Pancreatic tumors MEN II Pheochromocytoma, Parathyroid & medullary thyroid tumors Hemochromatosis Auto recessive, incr. GI absorption of Fe; Excessive Fe, incr. Ferritin, incr. Transferrin saturation, cirrhosis, diabetes, bronze skin Wilson's Disease Auto recessive, excessive Cu accumulation, ataxia & dementia, Kayser Fleisher rings on cornea Hyperaldosteronism Aldosterone works on distal renal tubule to facilitate incr. Na retention and incr. K loss excretion due to decr. Na, decr. BP (renin angio), incr. K 1o Conn's Syndrome = adrenal hyperplasia, adrenal adenoma Tx: spironolactone 2o incr. renin angiotensin system activity => decr. BP
Hypothyroid Weight gain, Lethargy, Coarse hair & dry skin, irregular menses, cold intolerance, myxedema; Acquired = Hashimoto's; Congenital = cretinism, severe I deficiency = hoarse cry; resp distress, cyanosis, poor feeding, decr bone growth, Bl T4 incr. TSH Wolff Chaikoff effect = inhibition of thyroid hormone release due to high doses of I during thyroid scan Hyperthyroid 1. GRAVES: most common, autoimmune, antibodies bind to TSH receptors; incr thyroid hormone, pretibial myxedema, Incr radio I uptake
2. SUBACUTE THYROIDITIS: tender, enlarged, Decr Radio I uptake, Sed
Rate up, maybe followed by period of hypothyroid
3. SILENT LYMPHOCYTIC THYRODITIS: transient, postpartum, no pain or
fever, Radio I uptake decr, lymphocytic infiltration, Tx ß blockers
4. TOXIC ADENOMA: multinodular goiter; nodules function autonomously,
Excess T3 & T4; Scan shows a few hot spots with cold background
5. THYROTOXICOSIS FACTITIA: exogenous thyroid hormone, no goiter 6. PLUMMERS: multinodular goiter, nodules become autonomous and secrete
thyroxine Sick Euthyroid acutely ill patients; T3&T4 decr due to chgs in hormone metabolism; TSH not decreased => not truly hypothyroid Thyroid CA Papillary = most common, best prognosis, Follicular = older, hematogenous spread to bone, lung, brain, liver; Anaplastic = worse prognosis, local invasion, hoarse & dysphagia; Medullary= Calcitonin producing Cells, MEN Type II(parafollicularC cells) Diabetes Dx: elevated random glucose sx, fasting BS > 140 x 2 days; Oral challenge >200 after 2 hrs; Type I: alpha islet cells, HLADR3, HLADR4, HLADQ, ketoacidosis Type II: insulin resistance; no HLA association, endogenous production enough so no ketoacidosis but do get hyperosmolar coma(dehydrated, glucose 600-2000
Parathyroid Hormone incr. Ca mobilization from bones, incr. Vit D production decr. phos reabsorption in distal tubules = decr. serum phos. Hypoparathyroidism ßPTH, ßCa, incr. Phos, Tingling, tetany, Chvostek's sign (tap on face & get muscle spasm) ; Trousseau's Sign (BP cuff up 3min => carpal tunnel sx; decr. Mg in alcoholics can lead to decr. Ca due to ßPTH secretions Hyperparathyroid Bones, stones, abd. groan and psychic moans; 1o = excess PTH; 80% benign adenoma; 2o due to decr. serum Ca=> vit D defic, renal tube prob and Ca loss Diabetes Insipidus Lack of ADH, polyuria and polydypsia Kallman's Syndrome Male, anosmic, small testicles, azospermic d/t head trauma; decr. FSH & LH, no GNRH SIADH Excess ADH, Tumor, trauma, pulm disease, drugs; Hyponatremia, Conc. urine; Acromegaly Excess GH; bone & tissue enlargement; glucose intolerance, osteoarthritis Addison's Disease Decreased cortisol (aldosterone) Wt loss, fatigue, skin pigmentation, eosinophilia; Decr aldosterone, decr Na, incr K; Give ACTH if cortisol doesn't increase Dx made Cushing's Syndrome Incr cortisol, Buffalo hump, moon facies, central obesity, Osteoporosis, #1 Cushing disease due to pit. Adenoma, #2 Ectopic- ACTH from lung tumor, #3 Adrenal Cortical tumor- incr. cortisol, ACTH suppressible, cortisol not #4 Chronic glucocorticoid Tx Waterhouse Friedrickson Syndrome hemorrhagic infarct of adrenals, assoc w/ meningococcemia Pheochromocytoma Episodic HTN, Dx by urinary catecholamines Familial Hypercholesterolemia
Autosomal dominant, Xanthomas (lipid on tendons) Xanthelasmas (lipids on eyelids) MI's in 40's, Homozygous usually has incr. total cholesterol Familial Hypertriglyceridemia Trig incr. , LDL normal, Autosomal dominant, Pancreatitis, milky serum Familial Combined Hyperlipidemia Auto dominant, incr. trig and cholesterol; no xanthomas Familial Dysbetalipo-proteinemia rare, problem with lipoproetin catabolism; palmar or tuberous xanthomas, incr. risk periph vasc disease & CAD, Abn VLDL, cholesterol & triglycerides MEN I Parathyroid , pituitary & Pancreatic tumors MEN II Pheochromocytoma, Parathyroid & medullary thyroid tumors Hemochromatosis Auto recessive, incr. GI absorption of Fe; Excessive Fe, incr. Ferritin, incr. Transferrin saturation, cirrhosis, diabetes, bronze skin Wilson's Disease Auto recessive, excessive Cu accumulation, ataxia & dementia, Kayser Fleisher rings on cornea Hyperaldosteronism Aldosterone works on distal renal tubule to facilitate incr. Na retention and incr. K loss excretion due to decr. Na, decr. BP (renin angio), incr. K 1o Conn's Syndrome = adrenal hyperplasia, adrenal adenoma Tx: spironolactone 2o incr. renin angiotensin system activity => decr. BP
