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Endocrine
PANCE Endocrine
87
Health Care
Graduate
09/23/2007

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Term
indications for sulfonylurea agents
Definition
non-obese, NIDDM2 not controlled by diet and exercise.
Term
MOA of sulfonylureas

examples:
Definition
- hypoglycemic activity

- stimulating the islet tissue to secrete insulin

ex:
2nd gen: glipizide (Glucotrol), glyburide (Micronase, Diabeta)

3rd Gen glimepiride (Amaryl)
Term
When to use insulin? (according to test)
Definition
After diet, exercise, and hypopglycemics have failed.
Term
BMI equation
Definition
BMI = [(Wt lbs/(Ht in.) x (Ht in.)] x 703

OR

BMI = [(Wt kg/(Ht m) x (Ht m)]

OR

BMI = [(Wt kg/(Ht cm) x (Ht cm)] x 10,000
Term
Albumin
Definition
3.9 to 5.0 g/dL
Term
Alkaline phosphatase:
Definition
44 to 147 IU/L
Term
ALT (alanine transaminase):
Definition
8 to 37 IU/L
Term
AST (aspartate aminotransferase):
Definition
10 to 34 IU/L
Term
BUN (blood urea nitrogen):
Definition
7 to 20 mg/dL
Term
Calcium - serum:
Definition
8.5 to 10.9 mg/dL
Term
Serum chloride:
Definition
101 to 111 mmol/L
Term
CO2 (carbon dioxide):
Definition
20 to 29 mmol/L
Term
Creatinine:
Definition
0.8 to 1.4 mg/dL
Term
Direct bilirubin:
Definition
0.0 to 0.3 mg/dL
Term
Direct bilirubin:
Definition
0.0 to 0.3 mg/dL
Term
Direct bilirubin:
Definition
0.0 to 0.3 mg/dL
Term
Gamma-GT (gamma-glutamyl transpeptidase):

((GGT))
Definition
0 to 51 IU/L
Term
Glucose test:
Definition
64 to 128 mg/dL
Term
LDH (lactate dehydrogenase):
Definition
105 to 333 IU/L
Term
Phosphorus - serum:
Definition
2.4 to 4.1 mg/dL
Term
Potassium test:
Definition
3.7 to 5.2 mEq/L
Term
Serum sodium:
Definition
136 to 144 mEq/L
Term
Total bilirubin:
Definition
0.2 to 1.9 mg/dL
Term
Total cholesterol:
Definition
100 to 240 mg/dL
Term
Total protein:
Definition
6.3 to 7.9 g/dL
Term
Uric acid:
Definition
4.1 to 8.8 mg/dL
Term
acid-base in ASA OD
Definition
initially high respiratory alkalosis, subsequent high anion gap acidosis.
Term
lithium, phenobarbitol, and acetaminophen do not cause an increase in ______ ______
Definition
anion gap
Term
How do you tell solid vs. cystic thyroid nodules?
Definition
US
Term
Best way to assess a (solid) thyroid nodule for malignancy?
Definition
fine-needle aspiration
Term
When do I care about antithyroglobulin antibodies?
Definition
they are elevated in Hashimoto throiditis which often co-exsists with malignancy.
Term
Explain 123 I imaging for me...
Definition
Iodine is tagged and scanned to assess uptake of the thyroid.

- Malignancy is hypocfunctioning (cold)

- Benign is hyperfunctioning (hot)

- HOT NODULES ARE GOOD!!!
Term
Drug of choice for hyperthyroid sx. Why?
Definition
Beta-blocker (Propranolol) relieves tachycardia, diaphoresis, and anxiety associated with Graves Dz.
Term
MOA propylthiouracil (PTU)
Definition
inhibits thyroid hormone synthesis
Term
What are the group of sx associated with hyperthyroid?
Definition
adrenergic (use a beta-blocker to reduce them)
Term
Hypothyroid is associated with which menstrual irregularity? Why?
Definition
Menorrhagia (increased menstrual flow)

- altered metabolism of sex steroid hormones.
Term
Hyperthyroid is associated with which menstrual irregularity?
Definition
Oligomenorrhea (decreased menstrual flow) or even amenorrhea.
Term
Menorrhagia vs. Oligomenorrhea
Definition
Menorrhagia (increased menstrual flow)

Oligomenorrhea (decreased menstrual flow)
Term
Why are ACE inhibitors nephroprotective in diabetics?
Definition
With elevated SBP, there is an increase in microalbuminuria, normotensive diabetics may have nocturnal HTN, ACE inhibitors impede this progression.
Term
When are thyroid antibodies elevated?
Definition
Graves dz and Hahsimoto's thyroiditis.
Term
metabolic thyroid molecule
Definition
T3

- derived from T4
Term
What races have an increased prevelence of DM2?
Definition
African-Americans, Hispanics, and Pima Indians.
Term
Is gender a factor of DM2?
Definition
No
Term
When is most likely to be dx with DM2?
Definition
middle aged/older people who are overweight
Term
intense thirst, polyuria, hyperuricemia, low urine osmolality, low urine sodium. NML serum sodium.
Definition
central diabetes insipidus
Term
MOA of desmopressin
Definition
synthetic arginine vasopressin (antidiuretic hormone) analogue; exerts antidiuretic effects and increases plasma factor VIII and von Willebrand factor levels
Term
diabetes insipidus
Definition
Vasopressin normally limits the amount of urine the body produces. Normally, the hypothalamus gland in the brain makes vasopressin, and the pituitary gland stores the hormone. Without vasopressin, the kidneys do not work properly. The result is a rapid loss of water from the body in the form of dilute urine.
Term
Test for diabetes insipidus
Definition
vaspressin challenge (causes resolution of sx)
Term
What does water restriction do to diabetes insipidus?
Definition
leads to dehydration and hypernatremia
Term
class and MOA of dopamine
Definition
- Class: Inotropes/Pressors

- Mechanism Of Action: stimulates alpha- and beta1-adrenergic and dopaminergic receptors
Term
What does dopamine do to a normotensive person?
Definition
Makes them HTN
Term
Connection of Beta=blockers and glycemic control.
Definition
beta-blockers are known to precipitate and mask sx of hypoglkycemia in diabetic pts.
Term
skin warm and dry, pulse 52, BP 128/62

- lethargic, disoriented without focal neurologic findings.
Definition
hypoglycemia
Term
inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase
Definition
"Statins"
Term
DM2 tx for obese pt with normal serum creatinine. (after diet and exercise)
Definition
metformin (Glucophage)
Term
MOA metformin (glucophage)
Definition
- decreases hepatic glucose production
- decreases intestinal glucose absorption
- increases insulin sensitivity
Term
When is insulin attempted in DM2?
Definition
After oral tx fails.
Term
sx adrenal insufficiency
Definition
- Weakness (99%)
- Pigmentation of skin (98%)
- Weight loss (97%)

and

- Abdominal pain (34%)
- Salt craving (22%)
- Diarrhea (20%)
Term
BP of pt with adrenal insufficiency
Definition
postural hypotensive
Term
- what is widened pulse pressure?

- When is it seen?
Definition
- 80 mm Hg difference between systolic and diastolic.

- seen in elderly persons with isolated HTN.
Term
signs of autonomic neuropathy (when is it seen?)
Definition
- orthostatic hypotension
- gastroparesis
- impotence
- alternating diarrhea/constipation
- incomplete bladder emptying

--seen in DM
Term
ataxia =
Definition
cerebellar dz
Term
first sign of peripheral neuropathy
Definition
decreased vibratory sense
Term
abd pain, altered bowel habits, and bloating.
Definition
IBS
Term
episodic palpitations with sweating, weight loss and nervousness.
Definition
pheochromocytoma
Term
hyperactivity, irritability, heat intolerance, increased appetite, weight loss, altered bowel habits, weakness, a-fib
Definition
hyperthyroidism
Term
weakness, abd pain, fever, confusion, N/V/D
Definition
adrenocorticoid insufficiency
Term
DM1, hyperglycemia > 250 mg/dL, blood pH < 7.3
Definition
Diabetic ketoacidosis
Term
Dx criteria for diabetic ketoacidosis
Definition
DM1, hyperglycemia > 250 mg/dL, blood pH < 7.3
Term
dx of hyperglycemic hyperosmolar coma
Definition
blood pH > 7.3 (no assiciated acidosis), this is nonketotic
Term
glycosylated hemoglobin
Definition
HgA1c
Term
Why is HgbA1C so cool?
Definition
GLYCOSATED Hgb is found in RBCs and coorelates to the amount of glucose available to the cell over the cell's 2-3 month lifespan.
Term
a polypeptide hormone secreted by the alpha cells of the islets of Langerhans in response to hypoglycemia, acetylcholine, some amino acids, and growth hormone; it stimulates glycogenolysis in the liver and stimulates the release of insulin by the pancreat
Definition
glucagon
Term
a protein hormone secreted by the beta cells of the pancreatic islets, serving as a hormonal signal of the fed state; it is secreted in response to elevated blood levels of glucose and amino acids and promotes efficient storage and use of these fuel molec
Definition
insulin
Term
- a rebound phenomenon occurring in diabetes mellitus

- overtreatment with insulin induces hypoglycemia, which initiates the release of epinephrine, corticotropin, glucagon, and growth hormone, which stimulate lipolysis, gluconeogenesis, and glycogenol
Definition
Somogyi phenomenon (effect)
Term
Somogyi phenomenon (effect)
Definition
- a rebound phenomenon occurring in diabetes mellitus

- overtreatment with insulin induces hypoglycemia, which initiates the release of epinephrine, corticotropin, glucagon, and growth hormone, which stimulate lipolysis, gluconeogenesis, and glycogenolysis, which in turn result in hyperglycemia.
Term
Tx Somogyi phenomenon (effect)
Definition
reduce evening insulin
Term
the dawn phenomenon
Definition
- Can occur in Type 1 or 2 diabetes.

- morning mild hyperglycemia caused by reduced tissues sensitivity to insulin.

- The insensitivity is cause by spikes of growth hormone release at the onset of sleep.
Term
myxedema coma
Definition
- often fatal complication of long-term hypothyroidism in which the patient is comatose with hypothermia, depression of respiration, bradycardia, and hypotension; usually seen in elderly patients during cold weather.
Term
myxedema (define and sx)
Definition
1. hypothyroidism in adults.

- weight gain
- fatigue
- puffy appearance
- dry, waxy swelling of the skin with abnormal deposits of glycosaminoglycans in skin (mucinosis) and other tissues, associated with primary hypothyroidism. The edema is nonpitting, and there are distinctive facial changes including swollen lips and a thickened nose.
Term
s/s myxedema coma
Definition
- cause by prolonged hypothyroidism

- comatose
- hypothermia
- depression of respiration,
- bradycardia
- hypotension
Term
- weight loss
- fatigue
- diarrhea
- vomiting
- anorexia
- salt craving
- postural dizziness
- pigmentation of buccal mucosa
- pale face and extensor surfaces
- hyponatremia
- hyperkalemia
- hypoglycemia
Definition
- adrenal insufficiency
Term
s/s adrenal insufficiency
Definition
- weight loss
- fatigue
- diarrhea
- vomiting
- anorexia
- salt craving
- postural dizziness
- pigmentation of buccal mucosa
- pale face and extensor surfaces
- hyponatremia
- hyperkalemia
- hypoglycemia
Term
s/s adrenal insufficiency
Definition
- weight loss
- fatigue
- diarrhea
- vomiting
- anorexia
- salt craving
- postural dizziness
- pigmentation of buccal mucosa
- pale face and extensor surfaces
- hyponatremia
- hyperkalemia
- hypoglycemia
Term
the big 3 s/s to remember on the PANCE for adrenal insufficency
Definition
- salt craving
- pigmentation of buccal mucosa
- pale face and extensor surfaces
Term
Na, K and Glu in adrenal insufficiency
Definition
- hyponatremia
- hyperkalemia
- hypoglycemia
Term
- fatigue
- HA
- inappropriate sweating

+/- orthostatic hypotension
Definition
pheochromocytoma
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