Sleep Disorders and Endocrine Jeopardy

S/S

100

hyponatremia, weakness, cramps, myalgias, constipation, dyslipidemia, decreased exercise capacity, anemia, periorbital edema, thin skin, non-pitting edema (myxedema), vitiligo, alopecia

What are S/S of hypothyroidism?

200

emotional lability, anxiety, weakness, tremor, palpitations, heat intolerance, increased perspiration, weight loss with normal or increased appetite, hyper-defecation (not diarrhea), urinary frequency, menstrual abnormalities, ED, gynecomastia

Older adults: a fib, myopathy, dyspnea, edema, unexplained weight loss

What are S/S of hyperthyroidism?

300

decreased libido, central obesity, weight gain, piethora (reddish complexion), moon face, menstrual changes s/t suppression of LH/FSH axis by excess cortisol, hirsutism s/t androgen excess, HTN, ecchymosis (loss of subcut connective tissue), lethargy, depression, dorsal fat pad, elevated glucose (gluconeogenesis from cortisol), muscle wasting of extremities (catabolic effects of excess glucocorticoids), purple striae, skin pigmentation (if ACTH secretion), impaired immune fx

What are S/S of Cushing's Syndrome?

Diagnosis/Testing

300

bedtime salivary cortisol, 24-hour urinary free cortisol, dexamethasone suppression test (give 1 mg dexamethasone at 11pm-12am, test cortisol at 8am, TIME SENSITIVE)

What are tests for Cushing's Syndrome?

Treatment

300

Treat the root cause: pituitary, cancer, adrenal adenoma, etc

What is the treatment for Cushing's Syndrome?

500

Considerations: decreased metabolism, excessive sedation, cognitive impairment, balance problems

Beers list: benzodiazepine receptor agonists (BRAs)

OTC antihistamines: highly anticholinergic, may cause confusion

Trazodone: may CAUSE insomnia, commonly prescribed, not FDA approved for insomnia

What considerations for treating insomnia in older adults?

Referrals

500

Resect tumor (transsphenoidal surgery)

Somatostatin analog (Octreotide, lanreotide) OR Growth Hormone receptor antagonist (pegvisomant) OR Dopamine agonist (cabergoline)

May consider stereotactic radiation therapy

What is the treatment for acromegaly?

Differential Dx

100

Resistance to TSH or thyroid hormone (cells may not express receptors, resulting in increased TSH)

Recovery from non-thyroidal illness (illness may result in transient elevation of TSH for 4-6 weeks)

TSH-secreting pituitary adenomas

Medications such as amiodarone

Differential diagnosis for Hypothyroidism?

400

Non-parathyroid mediated (hypercalcemia of malignancy, vitamin D intoxication, granulomatous disorders)

Medications (thiazide diuretics, lithium decreasing parathyroid sensitivity to Ca)

Differential diagnosis for hyperparathyroidism?

500

Volitional movements

Akathisia

Nocturnal leg cramps

Positional discomfort

Leg pain

Psychologic leg movements during sleep

Differential diagnosis for Restless Leg Syndrome?