Endo PANCE

Grave's Disease (90%)

Auto-immune disorder in which autoantibodies attach to TSH receptors and stimulate thyroid hyperfunctioning

Women who are 20-40 yo

HLA B8 and HLA DR3

Pernicious anemia, myasthenia gravis, DM

• Addisons
• Alopecia areata
• celiac disease
• cardiomyopathy
• hypokalemic periodic paralysis

• Toxic adenomas
• De Quervains
• postpartum thyroiditis
• pregnancy
• exogenous thyroid hormone ingestion
• trophoblastic tumors
• amiodarone

• mild: chemosis, conjunctivitis, proptosis
• severe: exophthalmos, diplopia, corneal dring

stressful illness, thyroid surgery, or radioactive iodine administration

• high fever
• tachycardia
• vomiting
• diarrhea
• dehydration
• marked weakness
• muscle wasting
• extreme restlessness, confusion, delirium, emotional lability

• Low TSH
• Elevated T4, T3, free T4, free T3 index, and thyroid resin uptake
• High ABs in graves
• High ESR in Subacute thyroiditis
• High iodine uptake in Graves and toxic multinodular goiter

MRI

• Beta blockers (propanolol) and hydrocortisone
• supportive therapy
• attempts to control ^T with a thiourea drug, followed by iodide

Methimazole or PTU x 12-24 months

PTU

agranulocytosis

• pregnant pts
• large goiters
• malignancies

• permanent  control (esp in elderly)
• preferred over surgery
• CI in pregnancy

IV methylprednisolone

• large doses of digoxin,
• anticoag with warfarin

autoimmune thyroiditis, previous thyroid surgery, or radiation therapy

fatigue, lethargy, anoxrexia, constipation, depression, menstrual abnormalities, muscle stiffness, memory impairment, cold intolerance, dry skin

• Elevated TSH
• Low total T4 and free T4, T3 may be nl
• presence of antithyroid peroxidase and antithyroglobulin Abs

Hashimoto's

• familial
• 5% in population >65 yo
• more common in women, pts with Hep C

Amiodarone, interleukins, and interferon

• May present with acute sx or silenetly
• m/c in young or middle-aged women
• usually caused by viruses, peaks in summer

Hashimotos

• autoimmune xerostomia
• keratoconjunctivitis
• mild myasthenia gravis
• IBD/celiac

• acute, painful glandular enlargement with dysphagia, low-grade fever, fatigue, and malaise
• radiation of pain to ears

manifests 1-6 months after delivery, lasts for less than 1-2 months

fever, pain, redness, fluctuant neck mass; associated with bacterial, fungal, or parasitic causes

Doppler U/S

 lifelong replacement with thyroid hormone for hypothyroidism or large goiter; watchful waiting with others

ASA

watchful waiting, propanolol for cardiac sx

papillary

anaplastic

medullary tumors

thyroidectomy

• heavy metal toxicity
• granulomas
• Ridel's thyroiditis
• tumors
• infection
• Autoimmune problems
• magnesium deficiency

hypoparathyroidism, congenital facial and cardiac anomalies

• tetant, carpopedal spasm, cramping, convulsions, circumoral and distal extremity tingling and irritability
• positive Chvostek's Sign and Trousseau's phenomenon
• cataracts
• teeth and nail defects

facial muscle contraction after tapping the facial nerve

Carpal spasm with blood pressure cuff inflation

• serum calcium, urinary calcium, parathyroid hormone levels are low
• serum mag is low
• serum phosphate is high, alk phos is normal

prolonged QT and T wave abnormalities

airway maintenance, slow administration of IV calcium

• po Ca and Vit D prep to keep serum calcium between 8 and 8.6
• mag supplementation
• measure serum and urine calcium levels

phenothiazines and furosemide

• parathyroid adenoma (m/c)
• hyperplasia
• carcinoma

• asx m/c
• polydipsia, polyuria caused by hypercalcemia
• renal stones, nephrocalcinosis, and renal failure
• bone pain, arthralgias, pathologic fx,
• bones stones abdominal groans psychic moans fatigue overtones

• malignant tumors
• multiple myeloma
• granulomatous disorders
• hyperthyroidism
• medications
• prolonged bed rest
• acute renal failure

Ca > 10.5

• Increased Ca
• decreased phos
• Elevated PTH

prolonged PR interval, shortened QT, bradyarrhythmias, haert block, and asystole

• surgical tx
• hdration
• bisphosphonates

diabetic retinopathy

neuropathy

anorexia, nausea, vomiting, dehydration, stupor, coma

• Carbs: 45-65% of diet
• protein 10-35%
• fat 25-35% (<7% saturated)

• lispor
• aspart
• glulisine

• glargine
• detemir

• peak in 1 hour
• 4 hour duration of action
• take 20 mins before meal

• take an hour before meals
• effect in 30 mins
• peaks in 60 mins
• lasts 5-7 hours

• onset in 2-4 hours
• peak in 8-10 hours
• duration 18-24 hours

17 hours

24 hours

• glyburide
• glipizide
• glimeperide

• weight gain
• hypoglycemia

sensitize peripheral tissues to insulin

heart failure, liver disease

• acarbose
• miglitol
• delay absorption of carbs from the intestine

lowers blood glucose via slowing of gastric emptying, stimulatin pancreatic insulin response to glucose, and prevents glucagon release after meals

<130/80

hx of hypoglycemic sx, fasting blood glucose of 40 mg or less, immediate recovery on administration of glucose

Addison's Disease

autoimmune destruction

• fatigue
• weakness
• anorexia/weight loss
• irritability
• myalgias, arthralgias
• amenorrhea
• hyperpigmentation

• Increased K and Ca, decreased Na and glucose
• decreased cortisol
• increased ACTH

Cosntropin

• Oral hydrocortisone or prednisone
• DHEA to women

Aggressive IV saline, glucose, and glucocorticoids

Cushing's Disease

• m/c exogenous corticosteroids
• Adrenocortical tumors
• nonpituitar ACTH producing tumors (ie, SCLC)

• excess secretion of ACTH by the pituitary, often resuling from a small, benign pituitary adenoma
• m/c cause is Cushing's syndrome

• obesity, HTN, thirst, polyuria with or without glycosuria
• most specific: proximal muscle weakness, pigmented striae

cushings

cushings

• 24 free cortisol > 125
• overnight dexamethasone suppresion test = plasma cortisol > 10 mcg

• resection of pituitary adenoma and hydrocortisol replacement
• removal of tumors

• remove tumor
• dopamine agonists if fail surgery
• somatostain analogs for persistent disease
• Pegvisomant

achondroplasia

mutation in FGFR3 gene

deficiency of or resistance to vasopressin (ADH)

hypothalamic or pituitary pathology caused by tumor, anoxic encephalopathy, surgery, accidental trauma, infection, sarcoidosis, multifocal langerhaans cell granulmatosis, or metastic disease

intense thirst, craving ice water, large volume polyuria, hypernatremia and dehydration

• glucose, BUN, Ca, uric acid, K, and Na
• 24 hour urine collection
• Confirm central DI with  vasopressin challenge test

• Desmopressin acetate for central DI and pregnancy
• Mild cases: adequate hydration

• indomethacin, alone or in combo with HCTZ
• desmopressin
• ameloride

phenytoin, carbamezapine, valproate, barbituates

osteomalacia

osteomalacia

• Ergocalciferol (50,000 PO BIW x 6-12 mo, followed by 1-2000U QD)
• phosphate supplementation and Vit D
• PO calcium

localized dysplastic bone formation

• 3/4 are sxmatic
• bone and joint pain is often the first sx
• common sites of involvement are: spine, pelvis, femur, humerus, tibia, and skull

Mixed sensorineural/conductive deafness

increases Q, can lead to heart failure

• Serum calcium and phosphate are nl, alk phos is high
• Hypercalciuria is common, urinary hydroxyproline is elevated in active disease
• Hypercalcemia occurs in pts on bed rest

• cyclic administration of bisphosphonates is tx of choice
• alternative is nasal calcitonin-salmon (miacalcin)

• gemfibrozil and fenofibrate
• reduce synthesis and breakdown of VLDL

cholelithiasis, hepatitis, myositis

blocks intestinal absorption  of dietary andbiliary choleesterol, used as monotherapy or with a statin