Endocrine
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Abarnard
Popular Medical sets