Term
| Initial basal insulin dose |
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Definition
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Term
| Initial prandial insulin dose |
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Definition
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Term
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Definition
| Bolus of 0.15 U/kg, drip at 0.1 U/kg/h with goal of glucose drop of 50-100/h |
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Term
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Definition
| ONly after volume replacement. 0.1 U/kg bolus and drip at 0/1 U/kg/h. D/c drip and change to SQ at glucose of 200 |
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Term
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Definition
| <130/80, Type 1 with proteinuria,start with an ACE. Type 2 with microalbuminuria (30-300), use an ACE or ARB, or if macroalbuminuria (>300) use an ARB. |
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Term
| Pituitary tumor apoplexy is... |
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Definition
| hemorrhagic infacts, characterized by sudden HA, stiff neck, fever, ophthalmoplegia (sometimes) and hypopituitarism |
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Term
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Definition
| silent pituitary infarct, assoc. with obstetric hemorrhage and hypotension. Presents with amenorrhe, no post-partum lactation, fatigue 2/2 central hypothyroidism or secondary adrenal insufficiency. |
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Term
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Definition
| Destructive lymphocytic infiltration, causing hypopituitarism and symptoms of a mass lesion. Associated with ACTH and adrenal insufficiency. Occurs after pregnancy. |
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Term
| Synthroid replacement in hypopituitarism |
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Definition
| Adjust by measuring free T4 levels |
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Term
| ACTH replacement in hypopituitarism |
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Definition
| hydrcortisone or prednisone BID, adjust clinically. |
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Term
| LH / FSH replacement in hypopituitarism |
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Definition
Men testosterone gel or patch daily, IM 1-3 weeks, adjust with testosterone levels. Need LH/FSH/GnRH injection for spermatogenesis.
Women estrogen, progesterone or OCPs / patches. Need LH/FSH injection for ovulation / in vitro. |
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Term
| GH replacement in hypopituitarism |
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Definition
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Term
| Vasopressin in hypopituitarism |
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Definition
| Desmopressin, nasal spray, tablets, IM, SC, IV |
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Term
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Definition
| Increased fat, decreased muscle and bone density, decreased strength, endurance and well being. Test is GH stimulation test. |
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Term
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Definition
| Aldosterone, fludricortisone (used for replacement) |
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Term
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Definition
| Prednisone, dexamethasone, betamethasone, triamcinolone |
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Term
| Equal mineralo- and glucocorticoid |
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Definition
| Hydrocortisone - used for replacement in adrenal insufficiency |
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Term
| Low free T4 without elevated TSH |
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Definition
| Central hypothyroidism. Adjust T4 to clinical s/s - TSH is unreliable. |
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Term
| Surgery is primarily indicated for all pituitary tumors except... |
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Definition
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Term
| Hyperprolactinemia causes |
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Definition
Non-prolactinoma serum PRL <150 - from dopamine interference from antipsychotics, verapamil, reglan, pregnancy, hypothyroidism, renal dz, hypothalamic dz.
Multiple mass lesions from pituitary stalk effects, PRLoma, other masses.
All must be evaluated with CT or MRI. |
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Term
| Hyperprolactinemia symptoms and tx |
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Definition
Galactorrhea, oligomenorrhea, amenorrhea, EC, decreased libido, infertility, osteopenia.
Tx with dopamine agonist - cabergoline or bromocriptin. Taper to off. If poorly responsive, transsphenoidal surgery or gamma knife. |
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Term
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Definition
IGF-1 levels are best test.
Inverse relationship with glucose. Insulin suppression should raise it in hypoGH and glucose administration should suppress it. |
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Term
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Definition
| Octreotide and lanreotide work in 60% of patients but only modestly reduce tumors. |
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Term
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Definition
| water deprivation test. Inability to concentrate urine with desmopressin administration indicated central DI. |
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Term
| Pregnant women and prolactinomas, acromegaly, cushing dz |
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Definition
| D/c dopamine agonists, somatostatin analogues. Keep synthroid. Cushing disease has high risk of prematurity and stillbirth - surgery to correct if not near term. |
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Term
| T3 is checked to evaluate |
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Definition
| Thyrotoxicosis, where T3 > t4 |
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Term
| Thyroglobulin levels are elevated in |
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Definition
| hyprtthyroid and destructive thyroiditis |
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Term
| Use of TSH, TSI or Thyrotropin stimulating IgG anitibodies |
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Definition
| Rarely used - euthyroid Graves ophthalmopathy, Graves in pregnancy, atyipcal hypo/hyper thyroid dz. |
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Term
| Free or total T3 level when... |
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Definition
| Suppressed TSH with normal T4 |
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Term
| Hyperthyroid treatment in pregnancy |
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Definition
| PTU. Methimazole has negative effects on embryogenesis. |
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Term
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Definition
| Tests adrenal insufficiency. Normal persons increase serum cortisol to 18.5 one hour after receiving 250 ng of cosyntropin. Use 1 ng for those suspected to have partial deficiency. |
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Term
| Medications to treat Cushings syndrome |
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Definition
| Ketoconazole, metyrapone (cortisol inhibition), mifepristone (steroid effect inhibition) mitotane (toxic to adrenal cells) |
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Term
| MRI indications of malignant adrenal lesions |
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Definition
| > 6 cm, high CT attenuation (mets >20 HU), irregular borders (primary), necrosis (primary), vascular and hyperintense. |
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Term
| Removal of adrenal tumors |
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Definition
| All functioning tumors, all > 6 cm, and some 4-6cm. |
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Term
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Definition
| Clonidine 0.3 mg suppression test - norepi < 500 is negative for pheo. Urine is specific. |
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Term
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Definition
| Surgery. Pre-treat with Alpha-blockers, THEN BB / CCB. |
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Term
| Diagnosing primary aldosteronism |
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Definition
Clinically - HTN, hypokalemia, metabolic alkalosis.
Tests - aldosterone : renin ratio > 20 is positive ( > 10 if on ACE / ARB ). Salt loading test (PO or IV) is confrimation. |
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Term
| In hyperaldosteronism, surgery is indicated for... |
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Definition
| solitary nodule. B/l adrenal hyperplasia is treated with spironolactone or eplerenone. |
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Term
| Progestin challenge in amenorrhea |
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Definition
| bleeding means normal estrogen and outflow tract, no bleeding means low estrogen and / or anatomic defect. |
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Term
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Definition
| Dexamethasone suppression test, PM salivary cortisol, 24-cortisol |
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Term
| Dexamathasone suppression test |
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Definition
Give 1mg dexamathasone. Measure next AM cortisol - < 2 is normal, > 5 is Cushing, 2-5 needs salivary or free cortisol measurements.
Can also suppress with 0.5 q6 x 48h. |
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Term
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Definition
| ovulatory dysfunction, evidence of hyperandrogenism, US of polycystic ovaries (2 of 3). DOes not cause virilazation or cushingoid. Test total serum testosterone. |
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Term
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Definition
| Spironolactone + prgestin OCP, metformin, clomiphine (for live births) |
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Term
| Types of destructive thyroiditis |
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Definition
| subacute (deQuervain), postpartum, silent / painless. Tx with BB and steroids, then synthroid if neeed |
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Term
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Definition
| Methimazole, except 1st trimester. Then PTU (LFT abnormalities). |
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Term
| Amiodarone induced thyrotoxicosis |
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Definition
| Type 1 - iodine induced (iodine deficient, meth / PTU tx) and Type 2 - destructive (prednisone tx) |
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Term
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Definition
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Term
| TSH goal with synthroid replacement tx |
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Definition
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Term
| Thyroid US findings in malignancy |
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Definition
| Microcalcifications, incr central vasc, hypoechogenic, irregular border, taller |
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Term
| Thyroid US findings for benign mass |
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Definition
| comet tail, inc peripheral vasculature, hyperechoic, halo, cystic |
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Term
| Management of follicular thyroid neoplasm |
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Definition
| remove nodule - cannot distinguish malignant vs benign except on histology |
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Term
| When to biopsy a thyroid nodule |
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Definition
| > 1 cm, risk factors, US characteristics. Must biopsy > 3cm multiple times to reduce sample error. |
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Term
| Anti actetlycholine receptor |
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Definition
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Term
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Definition
| 46, xxy. Assoc with primary hypogonadism. Infertile. |
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Term
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Definition
| FSH (ovarial failure if > 35), PRL, TSH, Free T4. |
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Term
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Definition
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Term
| Serum testosterone levels |
|
Definition
> 350 ng/dL - normal
200- 350 additional testing for level of free / bioavailable testosterone level required
< 200 - hypogonadism |
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Term
| PSA in testosterone replacement |
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Definition
| Get baseline, if doubles or is >4 or continues to increase after 6 months, stop therapy and start urology w/u |
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Term
| Treat male infertility with... |
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Definition
| GnRH or HCG, with FSH added for lack of spontaneous puberty |
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Term
| DDx in secondary amenorrhea |
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Definition
| PCOS, Ashermans (endometrial scarring), hyperprolactinemia, mosaic Turner, autoimmune oopharitis, hypothalmic, stress, pregnancy, hyperprolactin, Cushing. |
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