-
Refers specifically to an ACTH secreting pituitary adenoma with resultant cortisol secretion
Cushing's Disease
-
General term for hypercortisolism at any level including adrenal, ectopic, or pituitary source
Cushing's Syndrome
-
Diagnosis of Cushing's syndrome involves a __
24-hour urine free cortisol
-
increased hair growth (chin, upper lip, abdomen, chest)
hirsutism
-
Polycystic Ovarian Syndrome can lead to
Hirsutism and Virilization
-
refers to the biological development of sex differences, changes which make a male body different from a female body
virilization
-
menstrual irregularity, infertility, androgen excess, hirsutism, and sometimes obesity and insulin resistance
Polycystic Ovarian Syndrome
-
abrupt onset of Hirsutism and Virilization is an indication of
an androgen-secreting adrenal carcinoma
-
Life long problem with hirsutism and virilization is an indication of __, and is also the rarer form
Androgen-secreting adrenal adenomas
-
Enzymatic defects in the adrenal steroid hormone synthesis pathways leading to: inadequate cortisol +/-mineralocorticoid, classically with an associated androgen excess
Congenital Adrenal Hyperplasia
-
mucle symptoms due to hypokalemia
cramping, weakness, periodic paralysis
-
Clinical findings of primary hyperaldosteronism
hypertension, muscle symptoms (due to hypokalemia. Often there are few clinical findings at all.
-
with primary hyperaldosteronism there will be high aldosterone but low __
renin
-
a patient with primary hyperaldosteronism will have metabolic __
alkalosis
-
Primary Hyperaldosteronism. Solitary/Unilateral Aldosterone-Producing Adenoma
Conn's Syndrome
-
the adrenal medulla produces __
catecholamines
-
epinephrine, norepinephrine, dopamine
catecholamines
-
clinical findings of pheochromocytoma
the five P's:Pain (headaches), Pallor (orthostatic hypotension), Palpitations (catecholamine release), Pressure (hypertension), Perspiration
-
the thyroid has a __ day reserve supply of thyroxine
50
-
the thyroid synthesizes __ mcg of thyroxine per day
100
-
thyroid hormone synthesis requires a minimum of __mcg of elemental iodine/day
60
-
recommended daily intake of elemental iodine __mcg
150
-
in the thyroid thyroglobulin is stored in __
folicles
-
severe illness or starvation decreases
total T3, and free T3
-
__ is increased by estrogen, decreased by androgen
TBG
-
imaging modality used to monitor thyroid cancers
PET scan
-
What can a thyroid do
overact, under-perform, enlarge
-
weight loss, heat intolerance, palpitations/tachycardia
hyperthyroid history
-
weight gain, fatigue, lethargy, cold intolerance
hypothyroid history
-
rapid pulse, onycholysis, exophthalmos, thyroid enlargement, bruit, tachycardia, brisk DTR relaxation phase
hyperthyroid examination
-
bradycardia, dry skin and hair, periorbital edema, delayed DTR relaxation phase
hypothyroid examination
-
exophthalmos is seen only in __
Graves Disease
-
Etiology: Auto-antibody reacting with the TSH receptor. Symmetric non-tender goiter (80%) (bruit is pathognomonic), Ocular findings (30%), Pretibial myxedema exam:
Graves Disease
-
medical treatment for Graves Disease
PTU, Methimazole, Beta-blocker (propranolol, or atenolol)
-
no increased cancer risk after 50 years of __ use
radioactive iodine
-
favorable prognosticators for remission
small goiter, free T3 predominance, negative TSI titer, decrease in goiter size with ethionamide therapy
-
toxic nodule can lead to what type of fingernail pathology
onycholysis
-
when the finger nail peels away from the nail bed in the absence of trauma
onycholysis
-
Thyroid hormone leakage from destruction of the thyroid gland secondary to a viral infection (? Mumps), pain in the thyroid, fever, enlarged, very tender thyroid gland
subacute thyroiditis
-
Transient autoimmune dysfunction, sudden onset of hyperthyroidism, can be seen post-partum, enlarged, nodular thyroid
silent thyroiditis
-
Pre-existing untreated or inadequately treated thyrotoxicosis, Precipitating event: infection, trauma,fever, profuse sweating, tachycardia, tremulousness/restlessness, delirium/psychosis, N/V, later stupor, coma, hypotension
Thyrotoxic Crisis (Thyroid Storm)
-
Insufficient amount of thyroid hormone, elevated TSH, hypometabolic, increased cholesterol
hypothyroidism
-
__ hypothyroidism, loss of functioning thyroid tissue
primary
-
__ hypothyroidism- impairment of hormone biosynthesis with compensatory thyroid enlargement, lithium therapy, iodine deficiency or excess
goitrous
-
__ hypothyroidism- lack of TSH, pituitary or hypothalamic failure
central
-
thyroxine therapy dose is constant except with __, at which time the dose is increased by at least 50%
pregnancy
-
thyroxine therapy dose is constant except with __, at which time the dose is decreased by 20-30%
age greater than 65
-
thyroxine therapy dose is constant except with __
menopause
-
side effects of thyroxine therapy
osteoporosis, increased cardiac contractility, increased risk of atrial fibrillation, allergic reaction to dye in tablets
-
general term for enlargement of the thyroid gland
goiter
-
diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function
nontoxic goiter
-
-- thyroid enlargement that occurs in more than 10% of a population
endemic goiter
-
result of environmental or genetic factors that do not affect the general population
sporadic goiter
-
__% of the world’s population lives in a region that has iodine deficiency (primarily in Asia, Latin American, central Africa, and regions of Europe)
29
-
treatment for thyroid carcinoma
thyroidectomy by experienced surgeon
-
-
-
Synthroid, Unithroid, Levoxyl, Levothroid
Levothyroxine
-
-
Propylthiouracil (PTU)
Generic, know abbreviation
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
CLASS: Liothyronine
Hypothyroid Agent
-
CLASS: Liotrix
Hypothyroid Agent
-
CLASS: Levothyroxine
Hypothyroid Agent
-
CLASS: Methimazole
Hyperthyroid Agent
-
CLASS: Propylthiouracil (PTU)
Hyperthyroid Agent
-
CLASS: Insulin Lispro
Rapid acting insulin
-
CLASS: Insulin Aspart
Rapid acting insulin
-
CLASS: Insulin Glulisine
Rapid acting insulin
-
CLASS: Insulin Glargine
Long acting insulin
-
CLASS: Insulin Detemir
Long acting insulin
-
CLASS: Glyburide
Sulfonylurea
-
CLASS: Glipizide
Sulfonylurea
-
CLASS: Glimepiride
Sulfonylurea
-
CLASS: Repaglinide
Meglitinide
-
CLASS: Nateglinide
Meglitinide
-
CLASS: Metformin
Biguanide
-
CLASS: Rosiglitazone
Thiazolidinedione
-
CLASS: Pioglitazone
Thiazolidinedione
-
CLASS: Acarbose
Alpha-glucosidase Inhibitor
-
CLASS: Miglitol
Alpha-glucosidase Inhibitor
-
CLASS: Sitagliptin
Dipeptidyl peptidase-4 (DPP-4) inhibitor
-
CLASS: Saxagliptin
DPP-4 inhibitor
-
CLASS: Exenatide
Incretin mimeticGlucagon-like peptide-1 (GLP-1) agonist
-
CLASS: Liraglutide
Incretin mimetic GLP-1 agonist
-
CLASS: Pramlintide
Amylin analog
-
CM complications: chronic hyperglycemia leads to:
nonenzymatic glycation of proteins & produces tissue damage
-
DM dx criteria
1 of these (A1c ≥6.5% ; FPG ≥ 126 mg/dL; 2 hour GTT ≥ 200 mg/dL (75g load); RPG ≥ 200 mg/dL PLUS DM sx (polyuria, polydipsia, wt loss, blurred vision), w/ confirmation of other criterion on another day (required for first 3)
-
Alert Values: FBS (female)
< 40 and > 400 mg/dL (DUMC = <50 and >350)
-
Prediabetes / IFG lab
FPG 100 - 125 mg/dL
-
Impaired glucose tolerance
2 hr plasma glucose (75g GTT) 140 – 199 mg/dL
-
Values assoc w/ diabetic retinopathy
FBS 126 mg/dL; 2 hr GTT 200 mg/dL; HgbA1c of 7%
-
Created when proinsulin splits into insulin & this product
C-peptide (connecting peptide)
-
C-peptide: used mostly in:
newly diagnosed diabetics
-
C-peptide: Type 1 diabetes:
decreased levels
-
C-peptide: Type 2 diabetes:
normal or high levels
-
C-peptide: can be used to identify:
gastrinoma spread or malingering (low C-peptide with hypoglycemia may reflect abuse of insulin)
-
Glucose Testing: Venous serum: benefits / reflects
Benefit of independence from hematocrit
-
Glucose Testing: Venous serum: reflects:
reflects tissue glucose
-
Glucose Testing: Capillary: benefits
Rapid, no centrifugation required, home monitoring
-
Glucose Testing: Urine: Requires:
normal renal glucose threshold
-
Random plasma glucose (RPG or RBS):
Any time of day without regard to last meal
-
Fasting blood glucose (FPG or FBS):
No caloric intake for at least 8 hours
-
Oral glucose tolerance testing (OGTT or GTT):
Timed blood draw after oral load of a specific amount of glucose
-
Meds that increase glucose
diuretics, estrogens, beta blockers, corticosteroids
-
Meds that decrease glucose:
acetaminophen, alcohol, propanolol, anabolic steroids
-
Factors affecting Glucose & Glucose Tolerance
Meds; Activity level; stress; Liver dz; Hormonal tumors; Pancreatic disorders; PG
-
Types of stress that increase glucose
trauma, acute illness, general anesthesia, burns
-
O’Sullivan or 1 hour GTT
50g oral glucose with blood draw in 1 hour (normal < 140 mg/dL)
-
2 hour GTT
75g oral glucose with blood draw in 2 hours
-
3 hour GTT
100g oral glucose with blood draw just prior to oral load (fasting) and then at 1, 2 & 3 hours
-
2 hour GTT Interp: FPG (mg/dL)
Normal GTT <100; Impaired Glucose Tolerance 100-125; DM ≥ 126
-
2 hour GTT Interp: 2 hrs after glucose load
Normal GTT <140; Impaired Glucose Tolerance 140-199; DM ≥ 200
-
3 hour GTT Interp: Normal
Fasting <95 mg/dL ; 1 hr <180 mg/dL; 2 hr <155 mg/dL; 3 hr <140 mg/dL
-
3 hour GTT Interp: Abnormal =
2 or more values above reference range
-
3 hour GTT Interp: Equivocal =
1 value above reference range
-
Diabetic control correlates highly with:
pt education & motivation
-
Monitoring Diabetic Ctrl: Urine testing (downside):
Delayed information
-
Monitoring Diabetic Ctrl: Blood glucose testing
Current status; Self-monitoring recommended by ADA; Continuous monitoring systems available
-
Monitoring Diabetic Ctrl: Glycosylated hemoglobin (A1c): upside:
Long term control
-
Monitoring Diabetic Ctrl: Fructosamine
Good for some populations
-
Home Blood Glucose Monitoring: most common =
Fingerstick; Other sites (forearm/thigh) used, but may have 20 min lag time compared to finger
-
Home Blood Glucose Monitoring: Helps guide self mgmt of:
exercise, diet & meds
-
Home Blood Glucose Monitoring: upside:
Improves blood glucose control through immediate patient feedback
-
HbA1c: In normal people:
3-6% of hemoglobin is glycosylated in the form A1c
-
HbA1c: Provides info:
that spot blood checks may miss; info about LT glycemic ctrl (previous 8-12 wks)
-
HbA1c: Normalizes:
within 3 weeks of normoglycemic levels
-
HbA1c & RBCs:
Older RBCs have higher HbA1c levels; pts w/ episodic or chronic hemolysis who have larger proportion of young RBCs might have spuriously low levels
-
HbA1c monitoring
Does not require fasting; Goal < 7% HbA1c; Lowering by any amount will improve health outcomes
-
If HbA1c if > 7% :
adjust therapy
-
HbA1c: If good DM control:
check HbA1c 1-2 times yearly
-
HbA1c: If suboptimal DM control:
check HbA1c every 3 months
-
Fructosamine reflects:
hyperglycemic period within the last few weeks
-
Fructosamine gives info about:
short term glycemic control
-
Fructosamine: useful for:
patients with chronic hemolytic anemias that cause shortened RBC life span; Limited use in pts w/ low serum albumin (nephrotic state or hepatic disease)
-
Fructosamine: Normal values:
vary in relation to serum albumin (1.5-2.4 mmol/L when serum albumin is 5 g/L)
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