Pancreatically Challenged
What is used to treat hyperprolactinemia?
Cabergoline (dopamine agonist)
What is the next step in evaluation of suspected hypercortisolism?
Late-night salivary cortisol
What is the initial treatment of DKA?
Administration of IV regular insulin
What is the single best screening tool for hypothyroidism?
Serum TSH
How often should HbA1c measurement be evaluated in patients?
Every 3-4 months
What is the next step for a patient with a palpable thyroid nodule and normal TSH?
Thyroid ultrasound
Night time bone pain is usually the first symptom of which disease?
Paget's Disease
What is the drug of choice for hypothyroidism?
Bonus: What does this drug simulate?
Levothyroxine
-Synthetic thyroxine (T4)
If TSH is Elevated and/or Decreased what is next lab you should check?
FT4
What disease would you suspect in a patient presenting with hyperpigmentation at stress/crease points on the skin?
Adrenal insufficiency
What will you see the TSH level as in a patient who is hypothyroid?
What will you see the TSH level as in a patient who is thyrotoxic?
1. TSH will be high
2. TSH will be low
What labs would you see in primary hyperparathyroidism?
1. high parathyroid hormone level
2. High calcium level
3. Low phosphorus level
What is the most common symptom that can happen in thyrotoxicosis in patients over the age of 50?
Atrial fibrillation
What is the graves disease triad?
1. The thyroid gland in enlarged
2. Exopthalmos
3. Pretibial myxedema
What are patients with known hosimotos at an increased risk of developing?
B cell NHL and other autoimmune diseases
What are the posterior pituitary hormones and their target organs?
1. ADH --> Kidney
2. Oxcytocin --> Mammary gland
What thyroid disease is commonly found with fever, leukocytosis and increased ESR?
Bonus: How do you treat this?
Painful subacute (Dequervain) thyroiditis
Tx: aspirin, support or inhibit the thyroid as needed
What are the tests for GH deficiency?
1. IGF-1 (neither specific nor sensitive)
If need provocative GH stimulation testing....
2. Macimorelin (GH secretogogue) when fasting
or...
2. Glucagon stimulation test
A 31 year old male pt presents with anxiety, difficulty sleeping, 30lb weight loss, difficulty concentrating and feelings of being "too warm" and "shaky". No other pertinent medical history. What is the most likely diagnosis?
Graves Disease
What are major differences clinically in Primary and secondary Adrenal insufficiency?
Primary: ACTH high, Aldosterone low, hyponatremia, hyperkalemia, renin high and hyperpigmentation
Pituitary: ACTH low, alsodterone normal, no hyponatremia, no hyperkalemia, normal renin and no hyperpigmentation
A patient with late night salivary cortisol level was normal. Overnight dexamethasone suppression test shows elevated morning serum cortisol. What is the next step in treatment for this patient?
Bonus: what disease are you doing the work up for?
1. CT of the adrenals
Bonus: hypercortisolism
What are the hypothalmic hormones and their target organs?
1. GnRH--> FSH/LH--> Gonads
2. CRH--> ACTH--> Adrenal cortex
3. TRH--> TSH--> Thyroid
4. PRH +Dopamine --> Prolactin --> Mammary Gland
5. GHRH + Somatostatin --> GH --> Liver (and all body)
What is Osteopenia/Osteoporosis treatment?
1. Everyone gets calcium and vit D
2. Initial drug of choice is Bisphosphonate
A 55 yr old obese patient presents with concerns of low libido and fatigue. He has decreased exercise tolerance PE shows loss of body hair in the axillary, body and pubic regions. Labs show normal TSH, LH and serum testosterone. What is the most likely diagnosis?
Aquired hypogonadotropic hyogonadism
What are the three types of functional pituitary adenomas?
Bonus: what is the most common cause of hyperprolactinemia?
1. Lactotroph (prolactinoma)
2. SOmatotroph (too much GH)
3. Corticotroph (too much ACTH)
Bonus: Medications/Drugs