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Endocrine Tx
Endocrine
| Question | Answer |
|---|---|
| Secondary hypothyroidism: Do not: | replete thyroid hormone before repleting cortisol; if pt adrenal/ cortisol deficient, & replete TH first, revs up metab, can lead to adrenal crisis (won’t have enough cortisol to support metabm) |
| Hypogonadotropic Hypogonadism tx | Give Hormone Replacement |
| Management of Panhypopituitarism | Investigate / Tx Underlying Cause (MRI pit); Replace Hormones (unless CI); Cortisol First; Thyroid Hormone; Sex Steroids: Estrogen (unless postmenopause); Testosterone |
| Acromegaly Tx | Surgical; Somatostatin Analogs: Sandostatin; poss dopamine agonists; XRT |
| Hypercalcemia: nonpharm tx | Tx underlying cause; enhance calciuresis: Fluids (2-3 L / day po for mild; IV saline for severe / Ca > 13); loop diuretics (only after volume repletion); furosemide |
| Hypercalcemia: Pharm tx: Inhibit osteoclastic resorption: | bisphosphonates; calcitonin; cinacalcet |
| Hypercalcemia: Pharm tx: Inhibit osteoclast resorption/ reduce GI absorption: | Glucocorticoids (prednisone; solumedrol) |
| Hypocalcemia Tx | Vit D (25 OH D deficiency): Calcium (2000-4000 mg/day); ergocalciferol / cholecalciferol if 25 OH D deficient; Calcitriol if 25 OH D sufficient |
| Osteomalacia: Tx | Ergocalciferol (D2-Drisdol) 50K U BID x 6-12 mos; Vitamin D (25 OH D def): Ca (1500-2000 mg/day); cholecalciferol (D3); Calcitriol (for hypophosphatemic osteomalacia) |
| Pagets Dz: Tx | Inhibit osteoclast resorption/ bone formation: bisphosphonates; calcitonin |
| Skeletal response to continuously delivered PTH | inc osteoclasts, inc resorption, inc serum Ca |
| Skeletal response to once-daily delivered PTH | inc osteoblasts, inc bone formation, inc bone mass/ strength |
| Adrenal crisis tx | Tx HYPOTENSION w/ volume (2 to 3 L of NS or D5NS); Give IV DEXAMETHASONE 4mg or IV HYDROCORTISONE 100mg (Dex preferred bc it won’t interfere w/ further dx testing & is long acting) |
| Chronic adrenal insuff: maint tx | Hydrocortisone 20mg AM / 10mg PM; Dex; prednisone |
| Tx chronic primary adrenal insuff: besides cortisol, must also tx insuff of: | aldosterone: Fludrocortisone; check for postural HypoTN, orthostasis, serum K, renin; poss inc dose summer (inc persp Na loss) & dec dose in HTN (do not d/c altogether); NO K sparing diuretics for anti-HTN Rx |
| adrenal insuff Prophylaxis: Steroids in Surgery | Give pre-op hydrocortisone / continue 24 hrs; cut dose by 50% after first 24 h; cut dose by 50% each day until return to maint level (small procedures: give single dose of HC IV beforeprocedure) |
| Cushing syn: tx | Surg Resection; Transphenoidal microsurgical removal (if sure Cushing dz); Bilateral Adrenalectomy (uncommon); Pharmacologic adrenal blockade |
| Hirsutism / virilization: Tx | Stop any offending meds; Postmeno F can undergo lap bilat oophorectomy, if scans are nml; small hilar cell tumors of ovary may not be visible on scans |
| Primary hyperaldosteronism: Tx: Aldosterone Producing Adenoma: | surgical (effective only in patients with unilateral disease) |
| Primary hyperaldosteronism: Tx: IHA or poor surgical candidate: | med tx: Mineralocorticoid receptor antagonists: Spironolactone (DOC) or Eplerenone; CCB; ACEI |
| Pheochromocytoma: Tx : First: | Alpha Adrenergic-Blockade first; Beta-blockade next if nec; NEVER start before alpha-blockade (can lead to worsened hypertensive crises); CCB (may be better tolerated than alpha-blockade) |
| Pheochromocytoma: Tx: | Surgical resection is tx of choice (May req open lap); Need adequate a-blockade pre-op; Watch for post-op comps(Labile BP; Post-resection hypoTN/ shock; Hypoglycemia) |
| toxic multinodular goiter Tx | Rx RAI |
| subacute thyroiditis: Tx | ASA/ NSAIDs; prednisone |
| Multinodular goiters: tx | thyroxine suppression of TSH; surg if obstruction |
| Tx for Graves dz | PTU (esp for PG/BF)(TID); Tapazole (qd) |
| PTU works within: | 17 weeks |
| Surgery for hyperthyroid: subtotal or total thyroidectomy: indicated in: | pts with obstructions (lg goiters), malignancy, pregnancy in 2nd trimester, or those with contraindications to RAI or thioamides |
| Tx of choice for hyperthyroid in US: | radioactive I ablation (CI in PG) |
| Hyperthyroid tx adjuncts: | beta-blockers (propranolol); c'steroids (dec action of thy hormone & imm response in Graves); Iodine (blocks thy hor release) |
| Tx for thyroid storm | First: Propranolol, hydrocortisone; PTU/methimazole, Iodide; Supportive measures; mortality 20% |
| Myxedema Coma: tx | stat IV levothyroxine; then check labs |
| thyroid replacement tx dosing | <45 yo 100%; > 45 or LT/severe dz 50%; CVD or >65 25%; PG: inc dose by 50% |
| hyperthyroid ophthalmopathy tx: | IV methylprednisolone |
| hyperthyroid drug of choice for PG & breastfeeding pts = | PTU |
| hypoPTH tx: | airway, IV Ca gluconate; maintenance oral Ca, vit D, calcitriol, Mg; poss PTH tissue txp |
| diabetes insipidus tx | Central: desmopressin acetate (DDAVP). Nephrogenic: Na restriction, HCTZ w/K, +/- indocin |
| SIADH mgmt | H2O restriction (500-1000mL/day) and Na supplementation. If cannot fluid restrict (chronic dz/age): tx with demeclocycline. Consider Lasix + IVNS (for inc free water excretion). Hypertonic saline only if life-threatening dz |
Created by:
Abarnard
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