Endocrine disorders
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| ACTH deficiency | reduces adrenal secretion of cortisol, testosterone, and epinephrine (aldosterone secretion remains intact)
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| GH deficiency | causes short stature in children; adults experience asthenia (weakness), and increased cardiac mortality
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| Prolactin deficiency | inhibits postpartum lactation
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| TSH deficiency | causes secondary hypothyroidism
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| LH and FSH deficiency | causes hypogonadism and infertility in men and women
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| ADH deficiency | causes central diabetes insipidus with polyuria and polydipsia; hypernatremia occurs if fluid intake is inadequate
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| Oxytocin deficiency | causes lactation failure in postpartum women
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| ADH deficiency | causes central diabetes insipidus with polyuria and polydipsia; hypernatremia occurs if fluid intake is inadequate
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| Oxytocin deficiency | causes lactation failure in postpartum women
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| Acromegaly and gigantism | exessive growth (hands, feet, jaw, organs); coarse face, deeper voice, amenorrhea, HA, visual field loss, sweaty, weak,
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| Acromegaly and gigantism labs | serum GH is not suppressed following oral glucose; elevated IGF-1; imaging (terminal phalangeal "tufting;" pituitary tumor on CT or MRI
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| Hyperprolactinemia in women | menstrual cycle disturbances (oligomenorrhea, amenorrhea); galactorrhea, infertility
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| Hyperprolactinemia in men | hypogonadism, dec libido, erectile dysfunction, infertility
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| Hyperprolactinemia labs | elevated prolactin; CT or MRI shows pituitary adenoma
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| Thyroid screening tests | Serum TSH (most sensitive for primary hypo and hyper); Free thyroxine (T4)
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| Hypothyroidism tests | Serum TSH (hi in Primary, low in Secondary); Antithyroglobulin and antithyroperoxidase Abs (elevated in Hashimotos hyroiditis)
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| Hyperthyroidism tests | serum TSH (suppressed except in TSH-secreting pituitary tumors or pituitary hyperplasia); Triiodothyrone-T3 (elevated); 123-I uptake (increased; diffuse vs "hot"); Antithyroglobulin/Antimicrosomal Abs; Thyroid stim Ig (TSI)/TSH receptor Ab (hi in Graves)
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| Thyroid nodule testing | fine needle aspiration biopsy - FNAB (best diagnostic for cancer); 123-I uptake (cancer is usu "cold"); 99mTc uptake (vascular vs avascular); Ultrasonography (assists FNAB; monitors pts after surgery)
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| Thyroid nodules and multinodular goiter | single or multiple are found on careful thyroid exams; must get thyroid function test; biopsy for single or dominant nodules or for a Hx of prior head/neck radiation; ultrasound for Bx and follow-up
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| Thyroid nodules with high index of suspicion | Hx of radiation to head/neck/chest; hoarse; Young men, solitary nodule; big nodes; distant metastatic lesions; papillary carcinoma, follicular neoplasm, medullary or anaplastic carcinoma; "cold" solid punctate calcification; Growth with thyroxine therapy
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| Thyroid cancer | painless swelling of thyroid; thyroid fxn tests usu normal; past Hx of irradiation to head/neck; positive thyroid needle aspiration
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| Endemic goiter | common in areas w/low iodine diets; a/w high rate of congenital hypothyroidism (w/impaired cognition & hearing) and cretininsm; may be multinodular and big; most adults are euthyroid (some are hypo or hyper)
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| Hypothyroidism and myxedema (hard, mucin PG filled) | weak, fatigue, cold intolerance, constipation, wt change, depression, menorrhagia, hoarse, dry skin, bradycardia, slow reflexes, anemia, hyponatremia, Low T4 and RAI uptake, Elevated TSH if primary
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| Hyperthyroidism/thyrotoxicosis | sweating, wt loss or gain, anxiety, loose stool, heat intolerance, irritable, fatigue, weak, menstrual irregularity, tachycardia, warm/moist skin, tremor, stare; Graves (goiter w/bruit, opthalmopathy); Suppressed TSH in primary, hi T4, FT4, FT4I
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| Thyroiditis | swelling of thyroid gland (can cause pressure in acute/subacute forms) painless enlargement/rubbery if chronic; variable thyroid fxn tests; Serum antithyroperoxidase & antithyroglobulin Abs high in Hashimotos
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| Hypoparathyroidism & Pseudohypoparathyroidism | tetany, carpopedal spasms; tingling of lips and hands; muscle/abdominal cramps; psychological changes; Positive Chvostek's sign & Trousseau's phenomenon; defective nails/teeth; cataracts; Serum Ca low/PO4 high; Alk phos normal; Urine Ca low; Serum Mg lo
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| Hyperparathyroidism | asymptomatic (detected by screening); renal stones, polyuria, hypertension, constipation, fatigue, mental changes; Bone pain; rare cystic lesions & pathologic fxs; Serum/urine Ca elevated; urine PO4 hi, serum PO4 low-nml; Alk phos nml-high; Elevated PTH
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| Osteoporosis | asymptomatic to severe backache from vertebral fractures; Spontaneous incidental fx findings; loss of height; NORMAL Serum PTH, 25(OH)2, Ca, PO4, AlkPhos; Demineralization of spine, hip, pelvis
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| Paget's Disease of Bone (osteitis deformans) | often asymptomatic; bone pain may be 1st Sx; kyphosis, bowed tibias, large head, deaf, frequent fxs; NORMAL Serum Ca & PO4; HIGH AlkPhos & urinary hydroxyproline; Dense, expanded bones on x-ray
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| Acute adrenocortical insufficiency (adrenal crisis) | weakness, abdominal pain, fever, confusion, N/V/D; Low BP, dehydration; Inc skin pigmentation; HIGH Serum K, BUN; LOW Na; ACTH canot stimulate normal increase in serum cortisol
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| Chronic adrenocortical insufficiency (Addision's disease) | weak, fatigue, anorexia, wt loss, N/V/D, pain, amenorrhea; Sparse axillary hair, inc skin pigment (creases/pressure/nipples); Hypotension, sm heart; LOW Na; HIGH K, Ca, BUN; Neutropenia, LOW Plasma cortisol (no change w/corticotropin admin); HIGH ACTH
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| Cushing's syndrome | central fat, wasting, thick skin, bruisable, psych changes, hirsutism (excess hair), purple striae; osteoporosis, HTN, poor healing; Hyperglycemia, glycosuria, leukocytosis, lymphocytopenia, hypokalemia; HIGH cortisol/free in urine; not suppr. w/dexameth
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| Hirsutism & virilization | menstrual probs, hair growth, acne, inc muscles, androgenic alopecia, deep voice, enlaged clitoris; a/w palpable pelvic tumor; urine 17-ketosteroids & serum DHEAS/androstenedione HIGH in adrenal disorders (variable in others); HIGH serum testosterone
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| Primary hyperaldosteronism | HTN, polyuria, polydipsia, muscular weakness; Hypokalemia, alkalosis; HIGH plasma/urine Aldosterone; LOW plasma renin
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| Pheochromocytoma | "attacks" of HA, sweat, palpitations, nausea, abd pain; chest pain, weakness, dyspnea, tremor, visual disturbances, anxiety, wt loss, heat intolerance; HTN, freq sustained but often paroxysmal; HIGH urine catecholamines/metabolites; NORMAL serum T4, TSH
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| Islet cell tumors | 50% of tumors are non-secretory; pts present with wt loss, abdominal pain, jaundice; Secretory tumors cause a variety of manifestations depending on the hormones secreted (insulin, gastrin, glucagon, somatostatin, VIP)
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| Male hypogonadism | diminished lipido/erection; dec growth of body hair; small or nml testes; LOW serum testosterone; HIGH serum LH and FSH in testicular failure; LOW LH and FSH in hypogonadic hypogonadism
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| Causes of Primary Amenorrhea | Hypothalamic-Pituitary (low-nml FSH); Hyperandrogenism (low-nml FSH); Ovarian dysgenesis/Turners (high FSH); Pseudohermaphroditism (high LH); No uterus (nml FSH); Pregnancy (high hCG)
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| Causes of Secondary Amenorrhea & menopause | Pregnant (hi hCH); Hypothal-pituitary causes (low-nml FSH; low frequency GnRH pulses; Hyperandrogenism (nml-low FSH, polycystic ovary excess FSH favors favors LH); uterine infxn/sclerosis (nml FSH); Premature ovarian failure (high FSH); menopause (hi FSH)
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| Turners syndrome | gonadal dysgenesis; 45 XO; primary hypogonadism, short stature; primary amenorrhea & early ovarian failure; High FSH and LH; Risk of DM, HTN, dyslipidemia, osteoporosis, reduced life expectancy
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| Multiple Endocrine Neoplasia: MEN1 - Wermer's Syndrome | mc multiglandular syndrome; hyperparathyroidism (hypercalcemia d/t hyperplasia or adenoma); pancreatic islet cell tumors (gastrinomas; PUD, diarrhea); pituitary adenoma (usu nonfxnl)
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| Multiple Endocrine Neoplasia: MEN2a - Sipple's Syndrome | multiglandular hypersecretion; auto dom (ret protooncogene); medullary thyroid carcinoma; pheochromocytoma; or Hirschsprung's disease
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| Multiple Endocrine Neoplasia: MEN2b | syndrome characterized by mucosal neuromas, pheochromocytomas, medullary thyroid carcinoma; prophylactic thyroidectomy in pts w/mucosal neuromas
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| Type I Diabetes | polyuria, polydipsia, wt loss a/w plasma glucose >200mg/dL; plasma glucose >126 after overnight fast; Ketonuria/ketonemia; Islet autoantibodies
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| Type II Diabetes | Most pts >40yo & obese; Polyuria, polydipsia; initial manifestation may be candidal vaginitis; Plasma fasting glucose >126 & >200 after 75g oral glucose; HTN, dyslipidemia, atherosclerosis
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| Type I immune-mediated diabetes | ketosis, present of islet cell Abs, HLA positive; eucaloric healthy diet & preprandial rapid-acting insulin + basal insulin replacement w/intermediate or long-acting insulin
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| Type I idiopathic diabetes | ketosis, no antibodies, no HLA association; eucaloric healthy diet & preprandial rapid-acting insulin + basal insulin replacement w/intermediate or long-acting insulin
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| Type II nonobese diabetes | no ketosis, no antibodies, no HLA; Tx w/eucaloric diet alone OR Diet plus insulin or oral agents
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| Type II obese diabetes | no ketosis, no antibodies, no HLA; Tx w/weight reduction OR hypocaloric diet + oral agents or insulin
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