Term
| congenital condition due to lack of thyroid secretion, characterized by arrested physical and mental development, dystrophy of the bones and soft parts, and lower basal metabolism. |
|
Definition
|
|
Term
| condition resulting from hypofunction of the thyroid gland. |
|
Definition
|
|
Term
| a complication of thyrotoxicosis that if untreated is almost uniformly fatal. Consists of abrupt onset of fever, sweating, tachycardia, pulmonary edema or congestive heart failure, tremulousness, and restlessness. Occurs in a patient in whom existing thyrotoxicosis has been poorly treated or not at all. It usually is precipitated by infection, trauma, or surgical emergency. |
|
Definition
|
|
Term
| toxic condition due to hyperactivity of the thyroid gland. Symptoms include rapid heart rate, tremors, elevated basal metabolism, enlarged glands, exophthalmos, nervous symptoms, and loss of weight. |
|
Definition
|
|
Term
| toxic condition due to hyperactivity of the thyroid gland. Symptoms include rapid heart rate, tremors, elevated basal metabolism, enlarged glands, exophthalmos, nervous symptoms, and loss of weight. |
|
Definition
|
|
Term
| Role of TBG (thyroid Binding Globulin) (thyroxine binding globulin)in thyroid function? |
|
Definition
| 99% of the circulating thyroid hormones are bound to serum proteins mostly TBG |
|
|
Term
| Role of TSH in thyroid function |
|
Definition
| secreted by pituitary and stimulates several of the steps of thyroid hormone production |
|
|
Term
| role of TRH (Thyrotropin Releasing Hormone) in thyroid function |
|
Definition
| secreted by the hypothalamus to stimulate the production of TSH |
|
|
Term
|
Definition
| ♦ Iodine deficiency ♦ Graves disease ♦ Goitrogen in diet/certain foods such as sorghum, millet, maize, and cassava ♦ Lithium Carbonate ♦ Hashimoto’s Thyroiditis ♦ Subacute Thyroiditis ♦ Neoplasm ♦ Hypothyroidism |
|
|
Term
| measures used in the USA to prevent goiter. |
|
Definition
| Iodine Deficiency or Endemic goiters are prevented in the USA by iodine supplementation of salt. |
|
|
Term
| Describethepathophysiologyofsimplegoiters |
|
Definition
| begin as diffuse enlargement with nodularity developing later, compensatory hypertrophy and hyperplasia of follicular epithelium secondary to impaired production of thyroid hormones. |
|
|
Term
raising of arms above the neck causing facial congestion, jugular
venous distention, dizziness |
|
Definition
| Pemberton’s sign- sign of goiter |
|
|
Term
| laboratory findings commonly seen in simple goiter. |
|
Definition
♦ T4 - normal ♦ TSH - normal or elevated ♦ Serum thyroglobulin elevated ♦ Radioiodine uptake of gland more useful if hyperthyroidism exists ♦ CT, MRI, ultrasound to demonstrate tracheal compression, impingement upon other
neighboring structures |
|
|
Term
| List the treatment for adult hypothyroidism/myxedema. |
|
Definition
| Levothyroxine – dosage based upon clinical assessment and TSH levels |
|
|
Term
| pathophysiology of hypothyroidism. |
|
Definition
♦ A hypometabolic state caused by deficiency of thyroid hormones ♦ Pathophysiology- agenesis or loss of thyroid parenchyma, and /or enzyme defects,
loss of TRH/TSH, or peripheral resistance to thyroid hormone |
|
|
Term
| List the laboratory findings in adult hypothyroidism. |
|
Definition
T4 and free T4 below normal in primary hypothyroidism Elevated TSH (Primary hypothyroidism) other abnormalities may be seen such as: Increased serum cholesterol, liver enzymes, creatine kinase and serum prolactin
hyponatremia, hypoglycemia, and anemia |
|
|
Term
| (Chronic thyroiditis)- progressive, painless enlargement of the gland; patient are generally euthyroid during the early stages with slow progressive hypothyroidism developing later. related to genetically conditioned defect in antigen specific suppressor T cells with formation of autoantibodies. |
|
Definition
| Hashimoto’s thyroiditis (Chronic thyroiditis)- progressive, painless enlargement of the gland; patient are generally euthyroid during the early stages with slow progressive hypothyroidism developing later |
|
|
Term
| (Acute thyroiditis)-fever, acute usually painful enlargement of the gland with dysphagia. Pain may radiate to the ears. May be without pain known as silent thyroiditis. May also have hyperthyroidism. |
|
Definition
|
|
Term
| thyroiditis- rare-causing severs pain, tenderness, redness, and fluctuation in the region of the thyroid gland |
|
Definition
|
|
Term
| thyroiditis- stony hard gland adherent to other neck structures, signs of compression, dysphagia, dyspnea, and hoarseness. May have hypothyroidism. |
|
Definition
|
|
Term
| Thyroiditis-more common in females ages 30-50 |
|
Definition
|
|
Term
|
Definition
| levothyroxine 0.1-0.15 mg daily for hypothyroidism. Observe euthyroid patients. |
|
|
Term
| treatment of Subacute thyroiditis |
|
Definition
| aspirin, thyrotoxicosis can be treated with propranolol 10-40 mg q 6 hours; hypothyroidism- treat with thyroxine. |
|
|
Term
| treatment of Suppurative thyroiditis |
|
Definition
| antibiotics and surgical drainage |
|
|
Term
| Treatment of Reidel's Thyroiditis |
|
Definition
| partial thyroidectomy to relieve pressure |
|
|
Term
| What is the most common thyroid cancer? |
|
Definition
|
|
Term
| differential diagnoses for thyroid carcinoma. |
|
Definition
| ♦ Lymphocytic thyroiditis ♦ multinodular goiter ♦ colloid nodule ♦ follicular adenoma |
|
|
Term
|
Definition
| binds thyroid hormones until they are secreted into blood. storage of thyroid hormone |
|
|
Term
| small particle of fat in the blood. |
|
Definition
|
|
Term
| syndrome of disordered metabolism and significant hyperglycemia due to either a deficiency of insulin secretion or a combination of insulin resistance and decreased insulin secretion. |
|
Definition
|
|
Term
| involuntary discharge of urine after an age by which bladder control should be established. |
|
Definition
|
|
Term
| the presence of glucose in the urine. |
|
Definition
|
|
Term
| acidosis due to an excess of ketone bodies |
|
Definition
|
|
Term
| acetone bodies in the blood which cause the characteristic fruity breath odor in keto-acidosis. |
|
Definition
|
|
Term
The accumulation in the body of ketone bodies: acetone, betahydroxybutyric acid, and acetoacetic
the result of incomplete metabolism of fatty acids in inadequately controlled DM.acid; frequently associated with acidosis. |
|
Definition
|
|
Term
|
Definition
| very deep gasping type of respiration associated with severe diabetic acidosis and coma. |
|
|
Term
| condition in which retinal vessels appear reddish white or white. Found in cases of hyperlipidemia. |
|
Definition
|
|
Term
o Due to pancreatic islet B cell destruction o 90% is immune-mediated o 10% is idiopathic o HLA are Human Leukocyte Antigens. 95% of type 1 DM patients have either
HLA-DR3 or HLA -DR4. HLA-DQ genes also influence susceptibility to type 1 DM. |
|
Definition
| causes of Type 1 DM. What are HLA and how are they associated with type 1 DM? |
|
|
Term
| oral hypoglycemic classes of drugs that stimulate insulin secretion |
|
Definition
Sulfonylureas Glyburide (DiaBeta, Micronase)
Meglitinide analogs Repaglinide (Prandin)
D-Phenylalanine Derivative Nateglinide (Starlix) |
|
|
Term
| oral hypoglycemic that alters insulin action |
|
Definition
Thiazolidindediones
Rosiglitazone (Avandia) Pioglitazone (Actos) |
|
|
Term
| Oral hypoglycemic that afffects absorption of glucose |
|
Definition
Alpha-glucosidase inhibitors
Acarbose (Precose) Miglitol (Glyset) |
|
|
Term
| oral hypoglycemics that amplify glucose induced insulin release |
|
Definition
Incretins
Exenatide (Byetta) |
|
|
Term
| oral hypoglycemics that delays gastric emptying, suppresses glucagons secretion and decreases appetite |
|
Definition
|
|
Term
| What is the first test you always get for thyroid function? |
|
Definition
TSH
when people are very ill TSH is not always adequate ICU patients |
|
|
Term
| With Goiter what is the next test after TSH? |
|
Definition
Ultrasound to check if solid or fluid filled
then echo
then FNA |
|
|
Term
| Always remember that small changes in thyroid function leads to ________changes in TSH |
|
Definition
|
|
Term
| Free T4 is the test of choice for monitoring what? |
|
Definition
therapy for hyperthyroidism
always do TSH first |
|
|
Term
| small particle of fat in the blood. |
|
Definition
|
|
Term
| syndrome of disordered metabolism and significant hyperglycemia due to either a deficiency of insulin secretion or a combination of insulin resistance and decreased insulin secretion. |
|
Definition
|
|
Term
| involuntary discharge of urine after an age by which bladder control should be established. |
|
Definition
|
|
Term
| acetone bodies in the blood which cause the characteristic fruity breath odor in keto-acidosis. |
|
Definition
|
|
Term
| is the result of incomplete metabolism of fatty acids in inadequately controlled DM.The accumulation in the body of ketone bodies: acetone, betahydroxybutyric acid, and acetoacetic acid; frequently associated with acidosis. |
|
Definition
|
|
Term
| very deep gasping type of respiration associated with severe diabetic acidosis and coma. |
|
Definition
|
|
Term
|
Definition
| tissue insensitivity to insulin or reduced insulin secretion |
|
|
Term
| Patients with type 1 may develop nocturnal hypoglycemia, which may in turn stimulato produce high blood glucose levels by 7:00 a.m.te a surge of counter regulatory hormones |
|
Definition
|
|
Term
| – A creamy appearance of the retinal blood vessels that occurs when the concentration of lipids in the blood surpasses five percent |
|
Definition
|
|
Term
|
Definition
ymptoms of diabetes plus random plasma glucose 200 mg/dL*
or
FPG 126 mg/dL*
or
2-h PG during a 75-g OGTT 200 mg/dL*
or
Hb A1c ≥6.5% |
|
|
Term
| What drugs stimulate insulin secretion |
|
Definition
o Sulfonylureas
o Meglitinide analogs
o D-Phenylalanine Derivative |
|
|
Term
| what drugs alter insulin action |
|
Definition
o Biguanides • Metformin (Glucophage)
o Thiazolidindediones
• Rosiglitazone (Avandia)
• Pioglitazone (Actos) |
|
|
Term
| • drugs Affect absorption of glucose |
|
Definition
o Alpha-glucosidase inhibitors
• Acarbose (Precose)
• Miglitol (Glyset) |
|
|
Term
| Drug Amplify glucose-induced insulin release |
|
Definition
o Incretins
Exenatide (Byetta) |
|
|
Term
| drug • Delays gastric emptying, suppresses glucagons secretion, decreases appetite |
|
Definition
| o H. Pramlintide (Symlin) |
|
|
Term
| • Rapid-acting insulin analogs |
|
Definition
| : lispro, aspart, glulisine |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| factors which may give rise to acute adrenal insufficiency (crisis). |
|
Definition
| Stress (trauma, surgery, infection); sudden withdrawal of adrenocortical hormone in pt with chronic insuffieciency due to exogenous corticosteroids; bilateral adernalectomy; sudden destruction of the pituitary gland; injury to both adrenals via trauma, hemorrhage, anticoagulation therapy, thrombosis, infection. |
|
|
Term
| symptoms and signs found in acute adrenal insufficiency. |
|
Definition
| , hypotensive, hypoglycemia, cyanosis, dehydration, skin hyperpigmentation, Headache, N/V, lassitude, abdominal pain, diarrhea, confusion, coma, feve |
|
|
Term
| how the diagnosis for acute adrenal crisis is determined |
|
Definition
| High eosinophil count, hyponatremia, hyperkalemia, hypoglycemia, hypercalcemia, bacterial infection of blood, urine, or sputum; diagnosed by cosyntropin stimulation test, normal serum rises 20 mcg/dL |
|
|
Term
therapeutic measures used in the acute and convalescent phase of
Acute Adrenal Insufficiency. |
|
Definition
• Acute; give hydrocortisone (100-300mg) IV, and saline immediately, then give hydrocortisone phophate or sodium succinate 100 mg IV immediately and continue IV infusion 50-100 mg every 6 hrs for the first day,
• Convalescent; when pt can eat give oral hydrocortisone (10-20 mg) every 6 hrs, and reduce to maintenance levels prn |
|
|
Term
| adrenal gland does not produce enough steroid hormones (glucocorticoids and often mineralocorticoids…cortisol, aldosterone, and adrenal androgens) |
|
Definition
|
|
Term
| hormone disorder caused by high levels of cortisol in the blood. This can be caused by taking glucocorticoid drugs, or by tumors that produce cortisol or adrenocorticotropic hormone (ACTH) or CRH [1] |
|
Definition
|
|
Term
| refers to one specific cause of the syndrome, a tumor (adenoma) in the pituitary gland that produces large amounts of ACTH, which in turn elevates cortisol. It is the most common cause of Cushing's syndrome, responsible for 70% of cases excluding glucocorticoid related cases.[ |
|
Definition
|
|
Term
| Weakness, fatiguability, anorexia, weight loss, N/V/D, abd pain, muscle and joint pains, amenorrhea, increased skin pigment, decreased Axillary hair, hyponatremia, potassium/calcium/BUN elevated, neutropenia, mild anemia, eosinophilia, lymphocytosis, low plasma cortisol, plasma ACTH level is elevated |
|
Definition
|
|
Term
| diagnosis for chronic adrenal insufficiency (Addison’s disease) is determined. |
|
Definition
| Low plasma cortisol (< 3 mcg/dL) at 8 am is diagnostic esp when accompanied with elevation of ACTH (> 200 pg/mL) |
|
|
Term
| treatment of Addison's disease |
|
Definition
| Replacement therapy with hydrocortisone (15-25mg) daily in two doses; those who don’t respond need fludrocortisones acetate (.05-.3 mg) po daily or every other day; some women are given DHEA 50 mg if they have adrenal insufficiency |
|
|
Term
| symptoms, signs and laboratory changes associated with Cushing's syndrome/disease. |
|
Definition
| Central obesity, muscle wasting, thin skin, hirsutism, purple striae, psychological changes, osteoporosis, hypertension, poor wound healing, hyperglycemia, glycosuria, leukocytosis, lymphocytopenia, hypokalemia, elevate serum cortisol and urinary free cortisol. Impaired glucose tolerance, polyuria |
|
|
Term
| complications of Cushing's syndrome. |
|
Definition
| Morbidity and death when not treated, complications of HTN or DM, increased susceptibility to infection, compression fractures, nephrolithiasis, psychosis, can lead to nelson’s syndrome. : A syndrome characterized by hyperpigmentation of the skin and enlargment of the sella turcica and caused by the development of a pituitary tumor following adrenalectomy for Cushing's syndrome. Also called postadrenalectomy syndrome. |
|
|
Term
| the treatment of Cushing's disease. |
|
Definition
| Transsphenoidal resection of the pituitary adenoma (6-36 mo recovery) hydrocortisone/prednisone replacement therapy OR radiosurgery |
|
|
Term
| primary hyperaldosteronism |
|
Definition
Cortical adenoma or hyperplasiaCaused by an adrenal cortical adenoma (aka Conn’s syndrome)
Accounts for 5-10% of HTN |
|
|
Term
| presenting signs and symptoms of primary hyperaldosteronism? |
|
Definition
| Fatigue, Headache, some patients have only diastolic HTN, hypokalemia, muscle spasms, muscle weakness, polyuria, polydipsia, hypernatremia, metabolic alkalosis, elevated plasma and urine aldosterone levels and low plasma rennin level |
|
|
Term
| What tests should be done during the evaluation of primary hyperaldosteronism |
|
Definition
Rennin to aldostrone ratio.
give a high sodium diet then do a 24 hr urine test for aldosterone, free cortisol and creatinine (indicated by urine aldosterone > 20mcg) then assay plasma for 18-hydroxycorticosterone and aldosterone |
|
|
Term
| imaging studies can be used to evaluate primary hyperaldosteronism? |
|
Definition
| Thin section CT of the adrenals to rule out carcinoma |
|
|
Term
| treatment for primary hyperaldosteronism? |
|
Definition
| Laproscopic adrenalectomy, life long spiranolactone therapy is an option, and sometimes dexamethasone suppression |
|
|
Term
| A neuroendocrine tumor of the medulla of the adrenal glands (originating in the chromaffin cells), or extra-adrenal chromaffin tissue that failed to involute after birth and secretes excessive amounts of catecholamines, usually adrenaline and noradrenaline |
|
Definition
|
|
Term
| What is the “rule of tens |
|
Definition
pheochromocytomas
RULE OF 10s= 10% arise outside adrenal as paragangliomas, 10% are bilateral, 10% in children, 10% malignant, 10% associated with other endocrine neoplasms such as MEN syndromes= multiple endocrine neoplasia) |
|
|
Term
| Rare neoplasm that can be found in the abdomen, thorax, and in the head and neck region. They are usually considered benign and complete surgical removal results in cure. However, in about 3% of cases they are malignant and have the ability to metastasize. Paragangliomas are still sometimes called glomus tumors (not to be confused with glomus tumors of the skin) and chemodectomas, |
|
Definition
|
|
Term
| A neuroendocrine tumor, arising from any neural crest element of the sympathetic nervous system or SNS. It most frequently originates in one of the adrenal glands, but can also develop in nerve tissues in the neck, chest, abdomen, or pelvis. Almost exculsively in young children. Neuroblastoma is one of the few human malignancies known to demonstrate spontaneous regression from an undifferentiated state to a completely benign cellular appearance |
|
Definition
|
|
Term
| treatment for pheochromocytoma? |
|
Definition
| Tx htn and arrythmias prior to surgery. Laparoscopic removal of the tumor/tumors is the treatment of choice with phenoxybenzamine given preoperatively and pos |
|
|
Term
| use of aspirin therapy in patients with DM |
|
Definition
| • The American Diabetes Association has concluded that low-dose aspirin therapy may be helpful, not only in patients with diabetes who have had heart attacks, but also in patients with diabetes who are at high risk for future heart and artery disease. This includes both men and women with a family history of heart disease, or who smoke, have high blood pressure, or are obese. |
|
|
Term
| importance of personal hygiene and foot care in the diabetic patient. |
|
Definition
• All infections provoke the release of high levels of insulin antagonists such as catecholamines or glucagon and thus bring about a marked increase in insulin requirements.
• Supplemental regular insulin is often required to correct hyperglycemia during infection |
|
|
Term
| more common presenting signs and symptoms of pheochromocytoma |
|
Definition
| “Attacks” of headaches, perspiration, palpitations, anxiety, HTN, elevated urinary catecholamines or their metabolites, normal serum T4 and TSH |
|
|
Term
| test of choice for diagnosing pheochromocytoma |
|
Definition
| Plasma fractionated free metanephrines; High levels are indicative of pheochromocytoma. measuring catecholamines and metanephrines in plasma or through a 24-hour urine collection |
|
|
Term
| role of exercise in the management of the diabetic patient and whether insulin doses should be changed for the diabetic patient who exercises. |
|
Definition
| • Exercise increases the effectiveness of insulin, and moderate exercise is an excellent means of improving utilization of fat and carbohydrate in diabetic patients and stabilizing the insulin dosage. |
|
|
Term
first line in Type 2 DM
• lowering glucose without risk of hypoglycemia and lower triglycerides and promotes weight loss
• can not be used in patients with renal failure |
|
Definition
|
|
Term
| is defined as an increase in the blood sugar in the morning and is typically invoked in the context of diabetes |
|
Definition
• Dawn phenomenon
It is different from Chronic Somogyi rebound in that dawn effect is not associated with nocturnal hypoglycemia |
|
|
Term
signs and symptoms of what?
1. Diminished libido and erections
2. Decreased growth of body hair
3. Testes may be small or normal in size. Serum testosterone is usually decreased.
4. Serum gonadotropins (LH, FSH) are decreased or increased |
|
Definition
Male hypogonadism
4. Serum gonadotropins (LH, FSH) are decreased in hypogonadotropic hypogonadism; they are increased in testicular failure (hypergonadotropic hypogonadism) |
|
|
Term
1. Deficiency of LH and FSH leading to decreased secretion of testosterone from the testicles
2. Due to pituitary hormone abnormalities – Cushing syndrome or adrenal insufficiency, growth hormone excess or deficiency, thyroid hormone excess or deficiency, hyperprolactinemia, or idiopathic
3. Can occur in men receiving GnRH agonist therapy for prostate cancer |
|
Definition
| A. Hypogonadotropic hypogonadism |
|
|
Term
1. Failure of testicular secretion of testosterone, causes rise in LH
2. Due to viral infections, irradiation, cancer chemotherapy, autoimmunity, myotonic dystrophy, uremia, XY gonadal dysgenesis, partial 17-ketosteroi |
|
Definition
| B. Hypergonadotropic hypogonadism |
|
|
Term
| 3. How should male hypogonadism be diagnosed? |
|
Definition
A. Hormones levels
1. Morning serum testosterone or free testosterone measurement
a. Levels decrease throughout the day
2. Low serum testosterone follow-up by serum LH and FSH
a. High in hypergonadotropic
b. Low or normal in hypogonadotropic
a. Evaluate for pituitary abnormalities
B. CBC – mild anemia common b/c lower testosterone levels to stimulate erythropoiesis
C. Hypogonadotropic – may want to test PRL, adrenal insufficiency, elevated estradiol, tumors
D. Hypergonadotropic – karyotyping for Klinefelter or testicular biopsy in young patients with unknown cause |
|
|
Term
| Conditions that can lead to hypogonadotropic hypogonadism |
|
Definition
| alcohol, Cushings, drugs, marijuana, obesity |
|
|
Term
| some causes of Hypergonadotropic hypogonadism |
|
Definition
| chemotherapy, Klinefelter, mumps, trauma |
|
|
Term
| treatment for male hypogonadism |
|
Definition
| A. Testosterone replacement |
|
|
Term
normal rate of bone formation, increased bone reabsorption resulting in a greater loss of trabecular bone accounting for the “crush” fractures of the vertebrae, fractures of the neck of the femur, and fractures of the distal end of the radius.
most common metabolic bone disease in America |
|
Definition
|
|
Term
| treatment for osteoporosis |
|
Definition
• Vitamin D and calcium
• Bisphosphonates-
o MOA: inhibit osteoclast-induced bone resporption, increase bone density, and reduce fractures (vertebral and non vertebral).
• Sex hormones
o Estrogen- for PREVENTION of postmenopausal osteoporosis
• Selective estrogen receptor modulators
o Roloxifene- 60mg |
|
|
Term
Disordered bone remodeling
- Often asymptomatic and discovered incidentally on x-ray
- Pain is usually first symptom
- Bones become soft leading to kyphosis, bowed tibias, increased hat size with changes in the skull, Deafness, Warmth over bones due to increased vascularity
- Labs: markedly elevated alk phos with normal, Ca++ and phosphoru
- order x-ray |
|
Definition
|
|
Term
| Treatment for paget's disease |
|
Definition
| : bisphosphates, hearing aid |
|
|
Term
Inadequate mineralization of newly formed bone matrix
- Vitamin D deficiency decreases intestinal absorption of calcium
Symptoms: Painful proximal muscle weakness Especially the pelvis, Bone pain and tenderness,
- Lab abnormalities: Increased: alk. Phos., ?PTH, Decreased Vit D, Ca++ in blood and urine, PO4
- Classic radiological findings – pseudofractures
- DEXA |
|
Definition
|
|
Term
| treatment for osteomalacia |
|
Definition
|
|
Term
what am I?
Increased: alk. Phos., , Decreased Vit D, Ca++ in blood and urine, PO4 |
|
Definition
|
|
Term
What am I?
markedly elevated alk phos with normal, Ca++ and phosphoru |
|
Definition
|
|
Term
| • Used to evaluate diabetic patients to distinguish Type 1 and Type 2 and to identify patients who secretly self-administer insulin; also helpful in patients with insulinomas (tumors of insulin-secreting ccells of the islets of Langerhans) |
|
Definition
|
|
Term
| • Used to assist in the diagnosis of DM when patient has elevated FBG of > 126 on more than one occasion |
|
Definition
Glucose Tolerance (oral
Normal
o Fasting: <110 mg/dL
o 30 minutes: <200 mg/dL
o 1 hour: <200 mg/dL
o 2 hours: <140 mg/dL
o 3 – 4 hours: 70-115 mg/dL |
|
|
Term
• Used to monitor diabetes treatment; measures the amount of HbA1c in the blood
• Accurate long term index of the patient’s average blood glucose level |
|
Definition
. Glycosylated Hemoglobin
• Normal:
o Nondiabetic adult: 2.2% - 4.8%
o Good diabetic control: 2.3%-5.9%
o Poor diabetic conrol: > 8% |
|
|
Term
| causes of nondiabetic hyperglycemia |
|
Definition
| (cushing’s, acute stress response, pheochomocytoma, corticosteroid therapy) |
|
|
Term
| drug that inhibits osteoclast-induced bone resportion |
|
Definition
|
|
Term
| Classic radiological findings with osteomalacia |
|
Definition
|
|
Term
| overgrowth of cartilage causing the sternum to buckly forward. May be caused by a congenital abnormality. |
|
Definition
|
|
Term
| AKA Paget’s disease)- Chronic disorder that results in enlarged and deformed bones. There is an excessive breakdown and formation of bone tissue that occurs that can cause bone to weaken, resulting in bone pain, arthritis, deformities, and fractures. |
|
Definition
|
|
Term
| (AKA brittle bone disease)- a genetic disorder where people are born with defective connective tissue or without the ability to make it usually due to a deficiency in type 1 collogen. This causes bone brittleness. |
|
Definition
| • Osteogenesis imperfecta |
|
|
Term
| AKA Albright’s disease)- fibrous dysplasia affecting more than one bone |
|
Definition
|
|
Term
| AKA Albright’s disease)- fibrous dysplasia affecting more than one bone |
|
Definition
|
|
Term
| form of fibrous dysplasia ( disease that causes bone thininning and growths or lesions in one or more bones. It leads to bone weakness and scar formation within the bones) where only one bone is involved |
|
Definition
|
|
Term
|
Definition
wt (lbs) x 704.5 / inches sq
Underweight: BMI < 18.5
Normal Weight: BMI 18.5 - < 25
Overweight: BMI 25 - < 30
Obese: BMI 30 - < 40
Morbidly Obese : BMI > 40 |
|
|
Term
| Body Mass Index (BMI) of 30 or higher. |
|
Definition
|
|
Term
| Features of Metabolic Syndrome |
|
Definition
Central Obesity
Hypertriglyceridemia
Low HDL cholesterol
Hyperglycemia
Hypertension |
|
|
Term
| Criteria for Metabolic Syndrome |
|
Definition
Central Obesity : Waist Circumference > 102 cm (40 in.)for males, > 88 cm (35 in.)females
Triglycerides > 150 mg/dl
HDL cholesterol: < 40 mg/dl males; < 50 mg/dl females
Hypertension: SBP > 130; DBP > 85
Fasting Plasma glucose > 100 mg/dl
Three or more of the above |
|
|
Term
| etiology of metabolic syndrome |
|
Definition
Insulin Resistance
Increased Waist Circumference
Dyslipidemia
glucose intolerance
hypertension
pro-inflammatory cytokines |
|
|
Term
| Associated DZ with Metabolic syndrome |
|
Definition
CVD
DM
Non-alcholoic fatty liver
Hyperuricemia due to defects in insulin
Polycystic ovary syndrome
Obstructive sleep apnea |
|
|
Term
| Diagnosing Metabolic Syndrome |
|
Definition
Labs
Fasting lipid profile
Fasting glucose
Testosterone, LH, FSH if suspect PCOS
Other biomarkers for insulin resistance:
Apo b, CRP, fibrinogen, uric acid, urinary microalbumin, liver function tests
Other Studies
Sleep study if symptoms/hx of OSA |
|
|
Term
Diagnosing Metabolic Syndrome
PE |
|
Definition
Blood pressure
Waist circumference
Acanthosis Nigricans
Lipodystrophy |
|
|
Term
| Treatment for Metabolic Syndrome |
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Definition
Fibrates (gemfibrozil or fenofibrate) drug of choice to Decrease Triglycerides
Lower LDL - Statins, ezetimibe |
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Term
| primary hyperparathyroidism. |
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Definition
a. Chronic poorly regulated excessive secretion of PTH by one or more PTH glands that results in hypercalcemia.
Usually caused by single PT adenoma
Serum phosphate low is primary with hypercalcemia |
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Term
| “Bones, Stones, Groans, and Moans |
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Definition
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Term
| chronic renal failure: causes hyperphosphatemia that kicks in PTH to break down bone for Ca.. And kidneys cant activate vit D. |
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Definition
| normal to low calcemia and high phosphate levels. |
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Term
| Parathyroid glands are stimulated and may enlarge (2ndary HyperPT) and may become autonomous you fix the kidney of causing 2ndary parathyroidism but the Pthyroid doesn't fix itself... this is called |
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Definition
Tertiary hyperparathyroidism.
Bone dz → “renal osteodystrophy”; less common in diabetes. |
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Term
Brown Tumors or cysts of the jaw are skeletal
Bone pain and arthralgias
manifestations of |
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Definition
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Term
| - mental status changes, depression, Polyuria, polydipsia due to hypercalcemia induced diabetes insipidus, Constipation, Fatigue, Muscle Atrophy |
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Definition
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Term
| thyroidectomy**MOST COMMON CAUSE of |
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Definition
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Term
| Familial Hypoparathyroidism |
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Definition
Barakat or HDR ( hypoparathyroidism, deafness and renal dysplasia)
and
Autosomal Dominant Hypocalcemia with Hypercalciuria (ADHH) |
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Term
Target organ insensitivity to PTH
Renal resistance to PTH with hypocalcemia
PTH levels are HIGH |
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Definition
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Term
Target organ insensitivity to PTH
Renal resistance to PTH with hypocalcemia
PTH levels are HIGH |
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Definition
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Term
Congenital cardiac and facial anomalies
Hypocalcemia with tetany in infancy |
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Definition
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Term
What is the following constellation of symptoms called???
Cramps
Irritability
Carpopedal spasm
Convulsions |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| squeeze with the cuff they have jerking of bicep |
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Definition
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Term
| Symptoms of chronic hypoparathyroidism |
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Definition
Brittle, thin nails
Dry, scaly skin
Loss of eyebrows
Hyperactive DTR |
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Term
| primary role of adrenal glands? |
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Definition
| to help body adapt to stress |
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Term
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Definition
| glucocorticoids (cortisol), mineralcorticoids (aldosterone), androgens (DHEA), and catecholamines (epinephrine and norepinephrine) |
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Term
| Cortisol effects on body? |
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Definition
Causes gluconeogenesis and glyconeogenesis
Works with epinephrine to vasoconstrict (incr. BP), inhibiting peripheral glucose utilization in favor of the brain
Mobilizes fatty acids from adipose tissue for energy for the brain
Suppresses immune reaction and limits inflammation to lessen stress of disease or injury |
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Term
| cause of Cushing's Disease |
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Definition
| ACTH releasing pituitary tumor |
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Term
| diagnostic tests for cushing syndrome |
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Definition
Dexamethasone Suppression Test (high and low doses) then measurement of ACTH and Cortisol.
24 your Cortisol
cortisol > 125mg/dl is diagnostic |
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Term
| treatment of Cushing's syndrome |
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Definition
surgical removal
resupplementation of cortisol if necessary |
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Term
| Acute adrenocortical crisis |
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Definition
Acute Adrenal insufficiency:
Withdrawal of corticosteroid therapy
Waterhouse-Friderichsen Syndrome
Acute bilateral adrenal infarction
Sudden worsening of chronic adrenal insufficiency |
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Term
| Causes of Primary Adrenal insufficiency |
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Definition
Adrenal cause
Autoimmune disease, infection, tumor
Known as Addison’s Disease
Also causes deficiency of other adrenal secretions |
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Term
| Cause of Secondary Adrenal Insufficiency |
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Definition
Pituitary cause
Caused by hypopituitarism, steroids from meds or tumor |
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Term
| Diagnosis of Adrenal Insufficiency |
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Definition
ACTH Stimulation Test
If cortisol increases less than 25%, then primary
If cortisol doubles or more, secondary |
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Term
| Treatment of Adrenal Insufficiency |
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Definition
Acute
IV fluids, IV Steroids, rest
Chronic
Oral gluco- and mineralocorticoids |
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Term
What does Aldosterone do?
What regulates aldosterone release? |
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Definition
Maintains Na ion balance
Renin – Angiotensin –Aldosterone mechanism
Stimulated by high K, low Na; inhibited by low K
By ACTH under times of stress
Atrial Natriuretic Peptide |
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Term
| Primary Hyperaldosteronism |
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Definition
(Conn’s Syndrome
Caused by adrenal tumors
Causes hypertension and edema due to Na
Causes accelerated loss of K |
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Term
| Secondary Hyperaldosteronisn is caused by? |
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Definition
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Term
| Diagnosis of Hyperaldosteronism? |
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Definition
Test blood for plasma aldosterone concentration (PAC) and plasma renin activity (PRA)
Saline Suppression Test
If aldosterone levels are increased, its primary
If renin levels are increased, its secondary |
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Term
| Treatment of Hyperaldosteronism |
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Definition
| Surgery, or spironolactone to suppress aldo. |
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Term
| Congenital Adrenal Hyperplasia |
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Definition
Involves enzyme deficiencies (21-hydroxylase)
21-hydroxylase allows steroid production
ACTH is high (in vain), but stimulates androgen production |
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Term
Effects of
Congenital Adrenal Hyperplasia |
|
Definition
Salt-wasting with vomiting due to lack of aldosterone
Virilization , acne, oligomenorrhea due to increased androgen production (women only)
Stunted growth due to closing of long bone epiphyseal plates |
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Term
| Treatment of Congenital Adrenal Hyperplasia |
|
Definition
Sex Assignment (if necessary)
Hormone supplementation
Androgen Suppression in females
Growth management |
|
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Term
| Diagnosis of Phenochromocytoma |
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Definition
24 hr urine catecholamines
Plasma free metanephrines
Localized by MRI or CT |
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Term
| Phenochromocytoma Treatment |
|
Definition
| Alpha and beta blockade until surgery |
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Term
| Too little Aldosterone and Too little Cortisol is? |
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Definition
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Term
| Too much Catecholamines is |
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Definition
|
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Term
| most common cause of death in children and adolescents with Type 1 DM |
|
Definition
DKA
affects both type 1 and 2
generally acute in onset |
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Term
|
Definition
Infections!!!!!!
discontinue insulin therapy
Unknown primary diagnosis of DM
Medications
eating disorder
active cocaine use
Myocardial infarction
Cerebrovascular accident |
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Term
| Hyperosmolar Hyperglycemic State (HHS) |
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Definition
Hyperglycemia is associated with a severe inflammatory state
All parameters return to normal within 24 hours of insulin and hydration therapy
Endogenous insulin is secreted
Inadequate to overcome insulin insensitivity in tissues
Adequate to prevent lipolysis and subsequent ketogenesis
Onset over days to weeks |
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Term
|
Definition
Infection
Dehydration or Volume Contraction
Inadequate source
Reduced thirst response in the elderly
Unknown primary diagnosis of DM
Medications: corticosteroids, diuretics, pentamidine, IV medications mixed with dextrose, atypical antipsychotics |
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Term
|
Definition
Infection
Dehydration or Volume Contraction
Inadequate source
Reduced thirst response in the elderly
Unknown primary diagnosis of DM
Medications: corticosteroids, diuretics, pentamidine, IV medications mixed with dextrose, atypical antipsychotics |
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Term
| Anion gap >10-12 indicated increased ? |
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Definition
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Term
| Treatment Targets in DKA and HHS |
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Definition
Correction of dehydration or volume contraction
Correction of hyperglycemia
so if you have K of < 3.3 you have to correct this before correcting sugar
Correction of electrolyte imbalance
Identification and correction of precipitating event(s) |
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Term
Direct positive correlation between osmolality and mental obtundation.
The lower the osmolality |
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Definition
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|
Term
Direct positive correlation between osmolality and mental obtundation.
The lower the osmolality |
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Definition
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Term
| Only use Bicarbonate in DKA when pH is |
|
Definition
SEVERE acidosis (pH < 6.9) and mental status changes
ICU monitoring |
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Term
| Correction of target of Glucose in DKA |
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Definition
Treatment targeted to serum glucose <250 and ketoacidosis
pH >7.30, bicarb >18, gap <12 mEq/L
Once the serum glucose is <200, 5% dextrose should be added to IVF
Hyperglycemia is corrected faster than ketoacidosis |
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Term
| Name 3 diabetic emergencies |
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Definition
DKA, HHS and Hypoglycemia are Emergencies
Correct what is going to kill the patient first
You need water
You need sugar
You need a heart (functioning properly) |
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Term
| If you suspect Hypoglycemia what should you do |
|
Definition
give glucose
Then find the underlying cause and correct
Reactive hypoglycemia can be treated with acarbose
Sulfonylurea induced: octreotide or 50% dextrose
Ketosis/starvation: high carb diet |
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|
Term
Symptoms
Sweating
Nervousness or shakes
Fatigue
Hunger
Tachycardia
Mental status changes or confusion |
|
Definition
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