Term
| congenital hypthyroidism due to maternal hypothyroidism or infant hypopituitarism. macroglossia, haorse cry, coarse facial features, umbilical hernia, weight gain, mental dewvelopment abnormalities may all develop if not corrected. management w levothyroxine |
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Definition
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Term
| abnormal thyroid hormone levels w normal thyroid gland funciton seen w nonthyroidal illness (sugery, malignancies, sepsis, cardiac disease). diagnosis w dec free t4/T4 and dec TSH , T3 abnormally low. increased reverse T3 |
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Definition
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Term
| potentially fatal complication of untreated or partially treated thyrotoxicosis usuallya fter a precipitating event (surgery, trauma, infection, illness, pregnancy). rare. hypermetabolic state: palpitations, tachycardia, a fib, high fever, nausea, vomiting, psychosis, tremors. inc free T4T3 plus dec TSH (may be undetectable) manage w IV Propylthiouracil or Methimazole. In addition to inhibiting thyroid hormone synthesis, PTU also prevents the peripheral conversion of T4 into T3. Beta blockers: symptomatic therapy. IV glucocorticoids- inhibits conversion of T4 into T3. Antipyretics. avoid Aspirin bc it causes inc T3/T4 release. cooling blankets |
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Definition
| thyroid storm (thyrotoxicosis crisis) |
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Term
| extreme form of hypothyroidism with a high mortality rate (60%). MC seen in elderly women w long standing hypothyroidism in winter (cold weather). usually due to an acute precipitating factor (infection, CVA, CHF, sedative/narcotics) with longstanding, undiagnosed hypothyroidism, discontinuation/noncompliance with levothyroxine therapy, failure to start levothyroxine after radioactive iodine ablation of thyroid in patients c Graves. Bradycardia, obutnded (coma), hypothermia, hypoventilation, hypotensive, hypoglycemia, hyponatremia. inc TSH, dwec Free T4/T3. give IV levothyroxine/synthroid. icu admission, atibiotics if infection present. passive warming w blankets (rapid warming ocntraindicated). normal saline, corticosteroids if adrenal insufficiency is suspected |
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Definition
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Term
| autoimmune, circulating TSH receptor antibodies cause inc thyroid hormone synthesis and thyroid gland growth. worse w stress . MC cause of hyperthyroidism. thyroid bruits. opthalmopathy shows lid lag, exopthalmos/proptosis (exclusvie to Graves). treat w steroids. pertibisl myxemema on shin- nodules/pink to brown plaques. pos thyroid-stimulating immunoglobulins (Ab) most spp. +/- thyroid peroxidase and anti-TG Ab. inc FT4/FT3, dec TSH. diffuse uptake RAIU. MC therapy radioactive iodine. also methimazole or propylthiouracil. betablockers for symptomatic relief. thyroidectomy if compressive sx, no response to meds, RAI contraindicated (pregnancy) |
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Definition
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Term
| MC in elderly. autonomous functioning nodules. no skin/eye changes. dyspnea, dysphagia, stridor, hoarseness. inc FT4/T3, dec TSH. pathcy areas of both inc and dec uptake on RAIU. MC therapy radioactive iodine. surgery, methimazole or PTU. beta blockers |
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Definition
| toxic multinodular goiter (TMG) |
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Term
| one autonomous functioning nodule. no skin/eye changes, dyspnea, dysphagia, stridor, hoarseness. inc FT4/T3, dec TSH, RAIU: inc local uptake (hot nodule). radioctive iodine MC therapy. surgery, methimazole or PTU, beta blockers |
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Definition
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Term
| autonomous TSH secretion by pituitary adenoma. diffuse, enlarged thyroid. bitemporal hemianopsia, mental disturbances. inc FT4/T3, inc TSH (inappropriate TSH elevation in the settin gof elevated FT4/T3 (same direction) RAIU: diffuse uptake. pituitary MRI: adenoma. transsphenoidal surgery to remove the pituitary adenoma |
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Definition
| TSH secreting pituitary adenoma |
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Term
| anti-thyroid antibodies. painless enlarged thyroid. pos thyroid ab: tyroglobulin Ab, antimicrosomial and thyroid peroxidase Ab. TFTs (usually hypothyroid), dec radioactive I- uptake (usually not needed). Bx: lymphocytes, germinal follicles, hurthle. levothyroxine therapy |
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Definition
| hashimoto's thyroiditis (chronic lymphocytic). MC cause of hypothyroidism in US |
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Term
| anti-thyroid Ab. thyrotoxicosis->hypothyroid. pos thyroid ab: thyroglobulin Ab, antimicrosomial and thyroid peroxidase Ab. TFTs: hyper/hypothyroid (depends on when they present). dec radioactive Iodine uptake on RAIU scan. return to euthyroid state within 12-18 months without treatment. Aspirin. No antithyroid meds |
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Definition
| Slicent (Lymphocytic) thyroiditis |
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Term
| after childbirth, enlarged thyroid, thyrotixicosis -> hypothyroid. pos thyroid Ab. hyper/hypo depending on when present. dec radioactive iodine uptake on RAIU scan. return to euthyroid in 12-18 months. aspirine. no anti-thyroid meds |
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Definition
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Term
| MC post viral or viral inflammatory reaction. associated w HLA-B35. painful tender neck/thyroid. clinical hyperthyroidism. thyrotoxicosis-> hypothyroid. inc ESR. No thyroid Ab. TFTs usually hyperthyroid. dec radioactive iodine uptake on RAIU scan. return to euthyroid in 12-18 mo w/o treatmetn. aspirin for pain, inflammation, inc's T3. no anti-thyroid meds. |
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Definition
| de Quevain's thyroiditis (granulomatous) painful subacute |
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Term
| medication-induced tthyrotoxicosis-> hypothyroid |
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Definition
| amiodarone, lithium, alopha interferon. stop agen, corticosteroids |
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Term
| S. auraus MC. may have painful fluctuant thyroid. usually very ill, febrile. inc WBC count with left shift. usually euthyroid. antibiotics. drainage if abscess present |
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Definition
| acute thyroiditis (suppurative) |
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Term
| fibrous thyroid, firm hard woody nodule similar to anaplastic cancer. may develop hypothyroidism, surgery may be needed |
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Definition
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Term
| asymptomatic, difficulty swallowing or breathing, hoarseness, benign: smooth, firm, irregular, sharply outlined, discrete, painless. malignant: rapid growth, fixed in place, no movement w swallowing. most pts are euthyroid. best initial test is FNA. radioactive iodine uptake scan if FNA is indeterminate. surgery if cancer is suspected. observation of suspicious every 6-12 months often w ultrasound |
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Definition
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Term
| <20 years of age, cold nodule on RAIU |
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Definition
| inc suspicion of malignant thyroid nodule (papillary and follicular have better prognosis) |
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Term
| MC thyroid carcinoma. MC after radiation exposure, MC in young females, least aggressive. local (cervical) lymph node METS common. distant METS uncommon (when present, usually involves the lung and bone). excellent cure rate. total thyroidectomy or subtotal thyroidectomy |
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Definition
| papillary thyroid carcinoma |
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Term
| less often associated w radiation exposure, inc w iodine deficiency. MC 40-60y. more aggressive than papillary but also slow growing. local cervical lymph node invasion less common. distant METS common (due to characteristic vascular invasion) lung, brain, bone, liver, skin. excellent prognosis. total thyroidectomy or subtotal thyroidectomy |
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Definition
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Term
| not associated w radiation exposure MC associated w MEN 2. more aggressive. arises from parafollicular (C) cells secrete calcitonin. local cervical lymph node occurs early in disease. distant METS occurs late (brain, bone, liver, adrenal medulla), poorer prognosis. don't take up iodine. total thyroidectomy. calcitonin levels used to monitor |
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Definition
| medullary thyroid carcinoma |
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Term
| may occur many years after radiation exposure. MC in males >65 y. most aggressive, rapid growth (often w compressive sx) local and distant METS. may invade trachea. poor prognosis (only 10% survive 3y after dx) most don't live 1y after diagnosis. most are not amenable to surgical resection. external beam radiation. chemotherapy. palliative tracheostomy in 20% to maintain airway. |
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Definition
| anaplastic thyroid carcinoma |
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Term
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Definition
hypocalcemia stimulated inc parathyroid hormone and inc calcitriol (vit D) secretion: inc's blood Ca via inc GI/kidney Ca absorption and inc bone ca resorption via inc osteoclast acitivty. pth also inhibits phosphate reabsorpiton so phosphate is usually in the opp direction of the PTH levels in primary thyroid disorders
hypercalcemia stimulates inc calcitonin secretion: dec's blood Ca, dec Ca GI/kidney absorption and inc bone mineralization |
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Term
primary: excess inappropriate PTH production. adenoma or hyperplasia/enlargeemnt. in 20% of pts taking lithium. rarely MEN I and IIIa
secondary: inc PTH due to hypocalemia or vit D deficiency. try to compensate by inc's PTH to inc Ca towards normal. Chronic kidney failure MC cause of secondary. kidneys convert vit D to its usable form. severe calcium deficiency, severe vit D deficiency.
Tertiary: prolonged PTH stimulation after 2nd-> autonomous PTH productioon.
signs of hypercalcemia: stones, bones, abdominal groans, psychic moans, dec deep tendon reflexes.
triad: hypercalcemia/inc Ca and intact PTH and dec phosphate, inc 24h urine calcium excretion, inc it D. osteopenia on bone scan. imaging to detect adenoma. surgery to remove gland. vit D/Ca supplementation if 2rdry |
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Definition
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Term
| rare. either low PTH or insensitivity to its action. postsurgical or autoimmune. accidental damage/removal of glands during neck/thyroid surgery. autoimmune destruction of gland. radiation therapy, hypmagnesemia, congenital. signs of hypocalcemia: carpopedal spasms, trousseau's and chvostek's signs, inc deep tendon reflexes. hypocalcemia, dec intact PTH, inc phosphate. calcium supplementation and vit D (ergocalciferol, calcitriol), iv calcium gluconate if severe |
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Definition
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Term
| dec's excitation threshold for heart, nerves and muscle-> less stimulus needed for activation/contraction. finger/circumoral paresthesias, trousseau's sign, inc DTR, diarrhea, abdominal pain/cramps. caused by hypoparathyroidism (dec PTH) or chronic renal dz (inc PTH) |
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Definition
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Term
| inc's excitation threshold for heart, nerves and muscle -> stronger stimulus needed for activation/contraction. most patients are asymptomatic +/- arrhythmias. kidney stomes, polyuria (nephrogenic DI), painful bones, fractures, ileus, constipation, dec DTR, primary hyperparathyroidism MC cause or malignancy |
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Definition
| hypercalcemia (sever/symptomatic treat w furosemide (lasix0 1st line (avoid hydrochlorothiazide (causes inc Ca) |
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Term
| loss of bone density. primary: postmenopausal and senile. secondary: chronic disease or meds- prolonged high-dose corticosterooids. pathologic fractures: vertebral, colle's. spine compression: MC upper lumbar and thoracic- loss of vertebral height. kyphosis. back pain. slight elevations of alkaline phosphatase may occur following acute fractures, dec vit D; screen for thyroid, celiac disease. DEXA scan to show extent of demineralization. T scover |
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Definition
| osteoporosis. (osteopenia T score |
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Term
| genetic mutation for type I collagen (necessary for bone integrity). associated severe osteoporosis, spontaneous fractures in childhood, blue-tinted sclerae and presenile deafness |
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Definition
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Term
| failing kidneys do not eliminate phosphate properly and simultaneously poorly synthesize vit D -> hypocalcemai -> compensatory inc PTH -> osteoids (dec mineralization). bone and proximal muscle pain (in the context of uremia) +/- pathologic tx, chondrocalcinosis. dec calcium, inc phsphate, inc PTH, inc PO4, hypocalcemia. radiographs show osteitis fibrosis cystica (periosteal erosions, bony cysts, salt and pepper appearance of the skull). cystic brown "tumors" on biopsy due to appearance. treat w phosphate binders. |
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Definition
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Term
| vit D deficiency -> dec calcium and phosphate -> demineralization -> soft bones. decreased mineralization of bone osteoid only - cortical thinning. children: delayed fontanel closure, growth retardation, delayed dentition costal cartilage enlargement , long bones: bowing and fuzzy cortex. adults: asymptomatic at 1st. diffuse bone pain, muscular weakness (proximal). hip pain may cause antalgic gait. bowing of long bones. hypo calcemia symptoms. dec vit D, dec calcium, dec poshphate, inc alkaline phosphatase. radiographs show looser lines (zones): transverse pseudo-fracture lines (visible osteoids). manage w vitamin D (ergocalciferol) first line |
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Definition
| osteomalacia (adults) and rickets (children) |
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Term
| adrenal gland destruction (lack of cortisol and aldosterone). autoimmune MC cause in industrialized countries. causes atrophy. infection MC worldwide. vascular: thrombosis or hemorrhage in teh adrenal gland (waterhouse-friderichsen); trauma. metastatic disease; medications: ketaconazole, rifampin, phenytoin, barbituates. symptoms due to lack of cortisol (weakness/muscle ache, myalgias, fatigure, weight/appetite loss, anorexia, nausea, vomiting, abdominal pain, headache, salt craving, hypotension, sweating ,abnormal menstrual periords. symptoms specifically due to lack of aldosterone, lack of sex hormones and inc ACTH production. hyperpigmentation- inc ACTH stimulation of melanocyte-stimulating hormone secretion. dec aldosterone: marked orthostatic hypotension (syncope, dizziness), hyponatremia, hyperkalemia, non anion gap metabolic acidosis, hypoglycemia, low BUN, dec sex hormones in women: loss of libido; amenorrhea, loss of axillary and pubic hair. screening test for adrenal insufficiency: high dose ACTH (cosyntropin) stimulation test. normal (physiologic response) -> rise in blood/urine cortisol levels after ACTH is given. adrenal insufficiency -> little or no increase in cortisol levels. CRH stimulation test differentiates between teh causes of adrenal insufficiency. inc ACTH levels but low cortisol. manage w hydrocortisone 1st line (synthetic glucocorticoid). fludrocortisone (synthetic mineralcorticoid to maintain aldosterone) |
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Definition
| addison's disease (primary chronic adrenal cortical insufficiency |
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Term
| pituitary fialure of ACTH secretion (lack of crotisol). aldosterone intact due to FAAS. exogenous steroid use MC cause of secondary insufficiency as well as overall insufficiency. esp w abrupt cessation, patients unable to increase cortisol levels durine times of stress. hypopituitarism rare. tertiary hypothalamic disease very rare. 2ndary much MC than 1ry. symptoms due to lack of cortisol- weakness/muscle ache, myalgias, fatigue, weight/eppetite loss, anorexia, nausea, vomiting, abdominal pain, diarrhea, headache, sweating, abnormal menstrual periods, mild hyponatremia, salt craving, hypotension (less prominent than in 1ry), hypoglycemia more common in 2ry. littl or no inc in cortisol levels w high dose ACTH (cosyntropin) stimulation test. low ACTH and low cortisol w CRH stimulation test. treat w synthetic glucocorticoid (hydrocortisone 1st line) |
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Definition
| secondary chronic adrenocortical insuffieciency |
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Term
| sudden worsening of adrenal insufficiency due to a "stressful" event- surgery, trauma, volume loss, hypothermia, MI, fever, sepsis, hypoglycemia, steroid withdrawal. caused by abrupt withdrawal of glucocorticoids MC, previously undiagnosed patients w addison's disease subjected to "stress" exacerbation of known addison's (who didn't inc glucocorticoid during stress), bilateral adrenal infarction. clinical manifestation: shock -> dec blood pressure, hypotension, hypovolemia. nonspecific symptoms: abdominal pain, nausea, vomiting, fever, weakness, lethargy, coma. BMP: hyponatremia, hyperkalemia, hypoglycemia. cortisol levels, ACTH, CBC. manage w IV fluids: normal saline to correct hypotension and hypovolemia (D5NS if hypoglycemic). IV hydrocortisone if known addison's. dexamethasone if undiagnosed. reversal of electrolyte disorders. fludrocortisone. |
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Definition
| adrenal (addisonian) crisis (acute adrenocortical insufficiency) |
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Term
| high dose suppression test |
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Definition
cushing's disease (pituitary): suppression of cortisol, inc ACTH
ectopic ACTH-producting tumor: no suppression, ACTH inc.
adrenal tumor (cortisol production): no suppression. ACTH decreased
exogenous steroids: no suppression. ACTH decreased |
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Term
| symptoms secondary to excess cortisol and glucocorticoids: redistribution of fat: central (trunk) obesity, "moon facies", buffalo hump, supraclavicular fat pads. catabolism (breakdown) of protein: wasting of extremities (thin extremities, proximal muscle weakness); skin atrophy (easy bruising, striae), increased infections (ex fungal); hyperpigmentation (esp c inc ACTH). hypertension, weight gain, osteoporosis, hypokalemia, acanthosis nigricans, depression, mania, psychosis. androgen excess: hirsutism, oily skin, acneiform rash, inc libido, virilization, amenorrhea. etiology can be exogenous or endogenous. no suppression w low-dose dexamethasone suppression test. (dexamethasone is 4x more potent than cortisol, normal response is cortical suppression). inc urinary cortisol. inc salivary hortisol. no suppression to high-dose dexamethasone suppression test means adrenal or ectopic ACTH-producting. dec ACTH = adrenal tumore. normal/inc ACTH = cushing's disease or ectopic ACTH-producting tumor. cushing's disease treat w transphenoidal surgery. ectopic ACTH-secreting or adrenal tumors- tumor removal, ketoconazole. iatrogenic steroid therapy- grandual steroid taper (to prevent addisonian crisis) |
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Definition
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Term
primary is renin- independent (autonomous). idiopathic or idiopathic bilateral adrenal hyperplasion 60%, mc in women. connk's syndrome 40% in zona glomerulosa. unilatera adrenal hyperplasia rare. 2ndary due to inc renin. inc renin -> 2ry inc in aldosterone via RAAS, MC due to renal artery stenosis or dec renal perfusion (CHF, hypvolemia, nephrotic syndrome)
usually asymptomalic
hypokalemia- proximal muscle weakness, polyuria, fatigue, constipation, dec DTR, hypomagnesemia
hypertension- esp in patients w primary hyperaldosteronism. HTN may manifest as headaches, flushing of the face. although most pts are volume expanded, they are usually not edematous, diastolic pressures tend to be more elevated than systolic pressrues.
hypokalemia w metabolic alkalosis due to dumping of K and H in exchange for Na. aldosterone:renin radio >20 and plasma aldosterone >20 and low plasma renin levels = 1ry. high plasma renin level s= 2ry. saline infusion test shows no dec in aldosterone levels if 1ry. sodium loading shows high urine aldosterone in 1ry. CT/MRI to look for adrenal or extra-adrenal mass. ECF may show signs of hypokalemia )U wave).
conn's syndrome: excision of adrenal aldosteronomas + spironolacton e(blocks aldosterone). hyperplasia: spironolactone (blocks aldosterone), ACEI, CCB, correct electrolyte abnormalities. secondary (renovascular HTN): angioplasty definitive. ACE Inhibitors (blocks aldosterone) |
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Definition
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Term
catecholamine-secreting adrenal tumor (chromaffin cells). secretes norepinephrine and epinephrine autonomously and intermittently (triggers include surgery, exercise, pregnancy, meds, ex TCA, opiates, metoclopramide, glucagon, histamine). rare (0.1-0.5% of pts w hypertension). 90% benign, 10% malignant. may be associated w MEN syndrome II.
hypertension: most consistent finding (secondary HTN). PHE: Palpitations, headaches (paroxysmal), excessive sweating. chest or abdominal pain, weakness, fatigue, weight loss (despite increased appetite). inc 25 hr urinary catecholamines including metabolites (inc metanephrine and inc vaillylmandelic acid). MRI or CT of abdomen to visualize adrenal tumore. labs: hyperglycemia, hypokalemia. manage w complete adrenalectomy. preoperative nonselective alpha blockade: phenoxygenzamine or phentolamine followed by feta blockers. do not initiate therapy w beta blockade to prevent unopposed alpha constriction during catecholamine release, could lead to life threatening HTN |
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Definition
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Term
pituitary destruction or deficient hypothalamic pituitary stimulation. congenital or acquired ex tumor, infiltrative disease, bleeding into pituitary (ex Sheehan's syndrome), pituitary infarction, XRT. growth hormone deficiency: children/infancy: growth retardation, dwarfism, fasting hypoglycemia. adults: mild-moderate central obestiy, inc BP, iunc LDL, dec CO, dec bone mass, imparied concentration.
TSH deficiency: hypothyroidism (cretisnism in infancy), dec T3, dec T4 and inappropriately dec TSH
Gonadotropin deficiency: childhood: delayed pubertly, failure of epiphyseal closure -> tall individuals, eunochoid features. in adults: amenorrhea, lack of 2ry sex characteristics, infertibility, dec libido, impotence. manage w hormone replacement: if deficient in TSH -> levothyroxine; ACTH -> corticosteroids; GH -> growth hromone, TSH/LH?GnRH-> estrogen, progesterone, testosterone |
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Definition
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Term
| MC type . prolactin responsible for lactation and suppression of pregnancy during lactation, dec TSH and gonadotropin-releasing hormone. dopamine inhibits prolactin release. clinical manifestations: women: oligomenorrhea, amenorrhea, galactorrhea, infertility. men: impotence,decreased libido, hypogonadism, infertility |
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Definition
| prolactinoma, MC anterior pituitary tumor |
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Term
| growth hormone-secreting pituitary adenoma -> acromegaly/gigantism. acromegaly in adults and gigantism in children. DM and glucoose intolerance (GH is counterregulatory hormone that inc's glucose). enlargement of hands, feet, skull and jaw (macrognathia(), coarse facial features, inc spaces between the teeth, headache, deepeed voice, thickened moist skin (doughy). DM, weight gain, kidney stones |
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Definition
| somatotropinoma anterior pituitary tumor |
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Term
| secretes ACTH. clinical manifestations: cushing's disease and hyperpigmentattion due to inc ACTH, causing inc MSH (melanocyte stimulating hormone comes from the same precursor) |
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Definition
| adrenocorticotropinomas, anterior pituitary tumor |
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Term
| secretes TSH. clincal manifestations: thyrotoxicosis sx. inc T3, T4 and inappropriately inc TSH (same direction) |
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Definition
| tsh-secreting adenomas. anterior pituitary tumor |
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Term
MRI - study of choice to look for sellar lesions/pituitary tumors. endocrine studies:" prolactin, growth hormone, ACTH, TSH, FSH, LH. . most are bening Microadenomas that are 1. functional (hypersecrtetion of pituitary gland hormones) 2. nonfunctional. 3. compressive: local sx (ex optic chiasm "mass effect" -> bitemporal hemianopsia.
management:
transsphenoidal surgery (TSS): management of choice for removal of active or compressive tumors (except prolactinomas). medical treatment is first line for prolactinomas. observation if nonfunctional, small microadenomas. microadenoma = <10mm
acromegaly: TSS + bromocriptine (dopamine agonist dec's GH production). SRT. Octreotide: somatostatin analogue taht inhibits GH secretion. Pegvisomat: grrowth hormone antagonist. may be added to octeotide. Prolactinoma: Cabergoline or bromocriptime (dopamine agonists inhibit prolactin) XRT |
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Definition
| anterior pituitary tumors |
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Term
prolactinomas MC cause, hypothyroidism, acxromegaly, cirrhosis, renal failure. can be caused by dopamine antagonists (metoclopramide, promethazine, prochlorperazine) because dopamine is an inhibitor of prolactin. SSRIs, TCAs, Cimetidine, estrogen. can be caused by pregnancy, stress, exercise
inc levels inhibit gonadotropin-releasing hormone -> dec FSH/LH. women: oligomenorrhea, amenorrhea, galactorrhea, infertility, vaginal dryness. men: impotence, dec libido, hypogonadism, infertility, gynecomastia is reare.
workup includes TSH, BUN, Cr, LFTs, beta hCG, prolactin. Pituitary MRI if adenoma is suspected.
management: stop offending drugs. dopamine agonsits: cabergoline or bromocriptine (SE othostatic hypotension). surgical treatment in selected pts may need follow up radiation therapy |
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Definition
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Term
benign enlargement of the breast in males due to increased effective estrogen (inc'd production or reduced degradation) or due to dec'd androgens. seen in 3 main groups: infants due to high maternal estrogen. puberty, older males due to dec'd androgen production.
can be idiopathic, persistent pubertal, can be caused by spironolactone, ketoconazole, cimetidine, 5-alpha reductase inhibitors, digitalis/digoxin, GnRH agonists (ex leuprolide). otehrs: cirrhosis, testicular tumors (ex choriocarcinomas), hyperthyroidism, chronic renal disease, Klinefelter syndrome, alcoholism.
clinical manifestations: palpable mass of tissue >/= 0.5 cm in diameter centrally located (usually underlying the nipple), symmetrical, classically bilateral and often tender to palpation.
diagnosis: clinical, check testosterone levels. mammogram if breast cancer is suspected.
management: supportive: depends on cause ex stop offending medications, observation if early in the disease course (most regress spontaneously). ideal treatment should start within the first 6 months of onset (after 12 months, the tissue may undergo fibrosis). medical: selective estrogen modulators ex Tamoxifen, aromatase inhibitors block estrogen synthesis. androgens: used in hypogonadism. surgical: if medications fail, large breasts, cosmetically unappealing ,fibrosis ect |
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Definition
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Term
most are asymptomatic (may be an incidental finding). polyuria, polydipsia, polyphagia, weight loss.
neuropathy: sensorimotor: paresthesias, abnormal gait, dec proprioception stocking glove pattern, pain, dec DTR. autonomic: orthostatic hypotension, gastroparesis: N/V/D, constipation, impotence, incontinence. cranial nerve III palsy: pupil size remains normal unlike other causes of CN III palsy.
retinopathy: painless deterioration of small retinal vessels +/- cause permanent vision loss. dx: funduscopy, angiography: nonproliferative: hard exudates, dot or flame-shaped hemorrhages -> cotton wool spots aka soft exudates. proliferative: neovascularization: new, abnormal blood vessel growth, hemorrhage. maculopathy: maculare edema, blurred vision, central vision loss. can occur at any stage.
nephropathy: progressive kidney deterioration leading to microalbuminuria (first sign of diabetic nephropathy). dx: albuminuria, kidney bx: kimmelsteil-wilson- pink hyaline material. management: ACE inhibitors, low Na diet. most common cuase of end stage renal disease. macrovascular: atherosclerosis -> coronary artery disease, peripheral vascular disease, stroke. increased risk of infections: due to vascular insufficiency and immunosuppression from hyperglycemia
hypoglycemia: autonomic: sweating, tremors, palpitations, nervousness, tachycardia. CNS: headache, lightness, confusion, slurred speech, dizziness. |
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Definition
diabetes mellitus
Type 1: pancreatic beta cell destruction (pt is no longer able to produce insulin). most commonly presents in children/young adults (onset usually <30y) type 1A autoimmune beta cell destruction triggered by 1 or more environmental factors. type 1B: non-autoimmune beta cell destruction. type 2 DM: combo of insulin resistance and relative impairment of insulin secretion. etiology likely due to genetic and environmental factors: especially weight gain and decreased physical activity. 90% of type 2 diabetics are overweight. MC >40y. type 2 risk factors CHAOS: chronic HTN, atherosclerosis, obestiy (central), stoke). gestational diabete: during pregnancy |
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Term
| insulin deficiency->hyperglycemia, dehydration, ketonemia (high anion gap metabolic acidosis), potassium deficit. usually occurs in type I (may occur in some type II) |
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Definition
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Term
| usually occurs in patients w type 2 DM with some illness leading to reduced fluid intake (MC infection) dehydration, increased osmolarity, hyperglycemia, potassium deficit, absence of severe ketosis |
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Definition
| hyperosmolar hyperglycemic syndrome |
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Term
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Definition
IV fluids critical 1st step. isotonic NS until hypotension/orthostasis resolves -> .45% NS. hwen glucose reaches 250, switch to D5 .45 NS to prevent hypoglycemia from insulin therapy.
regular insulin
potassium
bicarbonate
aim to close the anion gap in DKA. normal mental status in HHS |
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Term
rare inherited disorder of 1 or more overactive endocrine gland tumore (3 P's): parathyroid 90%, pancreas 60%, pituitary 55%. most tumors benign. associated w gene defect.
clinical manifestations: hyperparathyroidism: MC endocrine abnormality. hypercalcemia "stones, bones, abdominal groans, psychic moans. diagnosis w hypercalcemia, inc PTH, dec phosphate, inc 24h urine calcium. management: parathyroidectomy
pancreatic tumor: : 2nd MC involvement, highest malignant potential. gastrinomas (ZES): MC of all entero-pancreatic tumors. tend to be small and multiple. clinical manifestations: multiple peptic ulcers, epigastric pain, reflux, diarrhea, weight loss, GI bleed, GI performation, poor prognosis w pancreatic, METS and high gastrin levels. Insulinomas: 2nd MC entero-pancreatic tumor. develops from pancreatic beta cells, whipple's triad: fasting or exertional hypoglycemia, blood glucose <50mg/dL during attack, symptom improvement w glucose intake, diagnose w inappropriately inc insulin w fasting, inc C-peptide and inc pro-insulin levels, CT/US, 90% solitary adn benign, manage w surgical removal. Glucagonomas: MC at the head of the pancreas, get necrolytic migratory erythema70% type II DM, muscle wasting, cachexia, DVT.PE, manage w surgical removal and octreotide to inhibit glucagon release. VIPomas: Vasoactive intestinal peptide tumors: watery diarrhea, hypokalemia, achlorhydria (=WDJA), hypovolemia, dehydration, manage by correcting dehydration, surgery. somatostatinomas: MC seen in the duodenuma nd pancreas, get triad of steatorrhea, cholelithiasis, type II DM, hypochlorhydria, manage w resent primary tumor and debulk hepatic METS if present
pituitary adenomas: prolactinomas 60% MC type: amenorrhea, galactorrhea, infertility, impotence in men. somatotropinomas 20%- acromegaly due to excessive GH. corticotropinomas 15%- cushing's disease due to excessive ACTH- diagnosis MRI preferred, manage w transsphenoidal resection, cabergoline or bromocriptine for prolactinoma
screening: genetic testing, PTH and calcium, gastrin, prolactin |
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Definition
| MEN 1: Multiple endocrine neoplasia I, Wermer's |
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Term
rare inherited autosominal dominant d/o, associated w presence of mucosal neuromas and marfan-like body haitus, have more aggressive form of medullary thyroid carcinoma (presents in infancy).
medullary thyroid carcinome: usually first feature, medullary thyroid carcinoma originates from parafollicular C cells that secrete calcitonin, palpable neck mass, haorseness, dysphagia, dyspnea, paraneoplastic syndrome: watery diarrhea and flushing, liver METS common, manage w total thyroidectomy.
pheocromocytoma- adrenal medullary tumor w intermittent secretions of catecholamines, palpitations, headache, excessive sweating, diagnosis 24h urinary metanephrines and catecholamines, manage w complete adrenalectomy, preoperative nonselective alpha-blockage 2 weeks preop.
hyperparathyroidism- only 2A, ralrely the presenting feature. hypercalcemia "stones, bones, abdominal groans, psychic moans", hypercalcemia, inc intact PTH, dec phosphate, inc 24h calcium excretion. manage w parathyroidectomy.
neuromas: only 2B, mucosal neuromas of the lips, tongue, eyelids, conjunctiva, nasal and laryngeal mucosa.
marfan-like body habitus- 2B only, includes high arched palate, pectus excavatum, scoliosis
screening:
genetic testing
calcitonin, epinephrine, PTH and calcium |
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Definition
| multiple endocrine neoplasia 2 (MEN2) |
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Term
insulin resistance. free fatty acids released that cuases an inc in triglyceride and glucose production as well as reduction in insulin sensitivity, leading to insulin resistance and hyperinsulinemia. the high levels of insulin cause sodium reapsorption lead ing to HTN
diagnosis: at least 3 of the following 5:
dec HDL <40 in men 50 in women, inc BP >/= 135 systolic or >/= 85 diastolicl. inc fasting triglyceride levels >/= 150 mg/dL. inc fasting blood sugar >/= 100 mg/dL. inc abdominal obesity >40in in men and >35 in in women.
manage: lifestyle: weight reduction, exercise and inc physical activity, diet rich in fruits, vegetables, lead poultry, fish, whole grans. weight loss can include phentermine for 3 moths, phentermine/topiramate, locaserin, orlistat, bariatric surgery. LDL treatment w diet, statins, ezetimibe, bile acid sequestrants. triglyceride treatment w fibrates. inc HDL w nicotinic acid. lower BP w diet, exercise, ACE inhibitors, ARBs, insulin resistance: biguanides (Metformin), thiazolidinediones |
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Definition
| metabolic syndrome (syndrome x, insulin resistance syndrome) |
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