Etiology/Pathophysiology
Pituitary adenoma causing Hypersecretion of GH. 40% of pts have a genetic mutation
What is the Etiology/Pathophysiology of Acromegaly?
Overgrowth of mandible, Enlarged togue, Increased hand size
What is the clinical presentation of Acromegaly?
Adrenal mass
CT scan of adrenals
Primary hypothyroidism vs subclinical hypothyroidism labs
Primary hypothyroidism: TSH elevated and T3/T4 low
Subclinical hypothyroidism: TSH elevated and T3/T3 normal
Hypothyroidism
Levothyroxine
Autoimmune – Grave’s Disease
What is the most common etiology of Hyperthyroidism?
Chvostek’s sign
What is the clinical sign of Hypoparathyroidism?
Medullary thyroid cancer
Thyroid Ultrasound identifies the thyroid mass greater than 1cm and Fine Needle biopsy identifies if mass is benign or malignant
Primary hyperparathyroidism vs secondary hyperparathyroidism labs
Primary hyperparathyroidism: PTH and calcium elevated
Secondary hyperparathyroidism: PTH elevated and calcium low
Hyperthyroidism
Methimazole (MMI) or Propylthiouracil (PTU)
Autoimmune thyroiditis (hashimotos’s disease), or iatrogenic (surgical removal of thyroid, thyroid gland ablation, or medications)
What are the etiologies of hypothyroidism?
Moon facies, buffalo hump, easy bruising, and truncal obesity
What is the clinical presentation of Cushing’s disease?
First line for adrenal insufficiency
Corticotropin (ACTH) stimulation test within 15-30 minutes of ACTH infusion. The normal adrenal cortex releases 2-5 times its basal plasma cortisol output. With adrenal insufficiency, cortisol will not increase.
DDx for Galactorrhea — must rule out
- Pregnancy, opioid abuse/ drug abuse, chest wall stimulation (recent surgery, piercings), hypothyroidism, consider acromegaly too
Acute Addisons crisis
Hydrocortisone IV
head trauma, a mass near the posterior pituitary, or idiopathic
What are the etiologies of Central diabetes insipidus?
muscle weakness, depression, confusion, abd pain and kidney stones
What is the clinical presentation of Primary hyperparathyroidism?
Hashimoto’s thyroiditis
Elevated levels of antithyroperoxidase anti-TPO antibodies, or antithyroglobulin antibodies (or both).
Endocrine disorder high on the differential list for secondary HTN cause
Hyperaldosteronism
Primary hyperaldosteronism due to bilateral adrenal hyperplasia
spironolactone
Hypothalamic-pituitary origin where pituitary unable to stimulate adrenal gland or suppression of HPA axis as a consequence of exogenous glucocorticoid (oral steroids)
What are the etiology/pathophysiology of Adrenal Insufficiency?
Kussmal respirations, dry mouth, n/v and fatigue
What is the clinical presentation of Diabetic Ketoacidosis?
3/5 diagnostic factors of DM
• Fasting glucose >126 =Type 2 diabetes
• Fasting glucose ->100= prediabetes
• Random glucose >200= Type 2 diabetes
• A1c result 5.7% to 6%= prediabetes
• A1c result >6.5% diagnostic for diabetes
Thyroid cancer
3 Non-insulin DM medication classes associated with weight loss
GLP-1 agonist, SGLT-2 inhibitors, and Amylin agonist