Endocrine
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| HTN not responsive to meds | Renal artery stenosis (Infrarenal artery)
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| HTN w/ hypernatremia, hypokalemia | Primary Aldosteronism
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| Tetany, carpopedal spasm, hypocalcemia, cataracts; Chvostek & Trousseau sxs | Hypoparathyroidism
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| Exogenous corticosteroid use | Cushing syndrome
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| Dexamethasone suppression test | Cushing syndrome
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| Central obesity, abdominal stria, hyperglycemia, moon facies, buffalo hump, easy bruising | Cushing syndrome
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| Acute steroid withdrawal | Addison dz, crisis
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| Hyperpigmentation, hypoglycemia, orthostatic hypotension, hypotension not responsive to fluids, hypotension following an illness, trauma, or surgery | Addison dz, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
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| Worsening fatigue, wt loss, weakness, recurrent abdominal pain, hair loss, hyperpigmentation. Hyponatremia, hyperkalemia | Addison dz, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
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| Hyponatremia, hyperkalemia | Acute adrenal insufficiency (Addison crisis)
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| Polyuria (to 12 L/day), polydipsia. Dilute urine, Hypernatremia | Diabetes insipidus
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| Concentrated urine. Hyponatremia | SIADH
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| 45, X – low hairline, low set ears, webbed neck, short stature; shield chest, wide set nipples, infertility, lack of Secondary sex characteristics | Turner (gonadal dysgenesis
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| XXY male - short stature, low intelligence; small firm testes, gynecomastia, abn arm-body length | Klinefelter (hypogonadism)
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| Adrenal Insufficiency (AI) is: | Cortisol Deficiency
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| Primary Adrenal Insuff = | Addison Dz; adrenal gland does not respond to ACTH & not make adrenal hormones; 80% 2/2 autoimmune destn of adrenal cortex
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| Secondary Adrenal Insuff = | Pit does not make ACTH; adrenal is not stimulated to make cortisol
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| Tertiary Adrenal Insuff = | Suppression of CRH & ACTH by exogenous cortisol use
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| Primary Adrenal Insuff: Sx | Fatigue, hyponatremia, Hyperkalemia; ortho hypotension; delayed DTRs; Hyperpigmentation (from ACTH, only in primary AI);
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| Secondary adrenal insuff & RAAS | b/c secondary & tertiary adrenal insuff only involve low ACTH levels, the RAAS is still intact; Only cortisol is deficient.
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| Secondary adrenal insuff: Sx | Hyperkalemia & Hypotension are rarely seen; hyperpigmentation is not seen
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| Hypogonadotropic Hypogonadism = | F: Amenorrhea/Infertility; M: Erectile Dysfunction/ Infertility; Inappropriately Low FSH/LH for low estrogen or testosterone
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| Hypogonadotropic Hypogonadism: Eval | MRI Pituitary to assess for cause; Labs [prolactin; Iron/TIBC (Hemachromotosis); if estrogen level low, do Provera challenge]
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| Diabetes Insipidus = | No ADH; unable to conc urine; Polyuria; Polydipsia (esp night); UOP: 5-20 L / d; U spec grav < 1.0006; Hypernatremia; Normal Glucose
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| Diabetes Insipidus: Water Deprivation Test | Follow every 1-2 hrs: Na; UOP, Urine Osmo; Wt; BP & HR (Lying / Standing); Once serum osm >300 & urine osm has not increased, give 10 ug of vasopressin and follow urine osm
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| Water Deprivation Test: purpose | distinguish btw central and nephrogenic DI
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| Water Deprivation Test: Nephrogenic: | give AVP, kidney won’t respond, urine remains dilute
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| Causes of Diabetes Insipidus | Panhypopituitarism; Sarcoidosis/ Infiltrative Dz; Tumor; Trauma
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| Sx of Hypopituitarism | Secondary Hypothyroidism; Hypocortisolism (secondary adrenal insuff); Amenorrhea, Menopause, Erectile Dysfunction, Infertility; Polyuria/Polydipsia
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| Hyperprolactinemia: Sx (Women) | Galactorrhea; Amenorrhea; Infertility
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| Hyperprolactinemia: Sx (Men) | ED; Infertility; HA; Mass Effect (eg, from tumor in head); Galactorrhea (Pathognomonic)
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| Prolactinoma: tx w/ Dopaminergic Drugs if: | Macroadenoma; Mass Effect; Visual Field Deficit; Fertilty Desired
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| Prolactinoma: tx w/ Hormone Replacement if: | No Fertility Desired; Microadenoma; Visual Field Full; No Mass Effect; Estrogen or Testosterone is low
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| Acromegaly vs Gigantism | Acromeg: pit tumor secreting GH in adulthood; Gigantism: pit tumor secreting GH during PUBERTY before epiphyseal plate fusion; rapid linear growth, heights up to 8ft 11 in
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| Risks of LT exposure to GH include: | Arthropathy, neuropathy, CVD; HTN; resp dz; malig; CHO intol/DM
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| When to Suspect Acromegaly | MEN-1/other FH; Prominent brow; enlarged soft tissue of hands/ft, doughy handshake; splayed teeth, macroglossia; DM; HTN/ LVH;
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| Cushing syndrome | XS cortisol prodn; Exogenous (Use of synthetic Glucocorticoids); Endogenous = Cushing Dz; poss 2/2 adrenocortical tumor or nonpit ACTH-producing tumor (eg, SCLC)
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| Cushing syndrome: Sx | DM; HTN; Osteoporosis; Psychosis; Easy Bruising; central Obesity; Hyponatremia; Moon Facies; Buffalo Hump; prox Mx Wasting/weakness; Hirsutism; Purple Striae; Supraclavicular Fat; Infections; amenorrhea
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| Cushing Dz may be due to: | Pit ACTH overprodn; Ectopic ACTH Prodn; or Pit/Adrenal Adenoma producing cortisol
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| Cushing Dz: endogenous cortisol excess: | 75-80 % of cases; elevated cortisol levels do not suppress hypothalamic & ant pit secretion of CRH & ACTH
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| Ectopic ACTH production = | Nonpituitary Tumors secrete ACTH and do not respond to negative inhibition of high cortisol levels
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| Ectopic ACTH production poss d/t: | Small Cell Lung Ca; Carcinoid Tumors; Pheochromocytoma; Thymoma; Pancreatic Cell tumors; Medullary Ca of the Thyroid
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| Adrenal Hypercortisolism | ACTH & CRH are suppressed; Caused by: Adrenal Adenomas; Adrenal Ca; Micronodular or Macronodular Hyperplasia
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| Lack of stimulating hormone: causes | Pituitary (PanHypopituitarism); Hypothalamus (Stress, Tumor)
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| Hyperfunctioning of Endocrine Gland | Autonomous Fn of Primary Gland (Thyroid Toxic Adenoma); Autonomous Fn of Gland making Stim Hormone (Cushing Dz: ACTH); Ab’s that Stim Hor Receptor (Graves / TSI); Ectopic Prod Stim Hormone (Ectopic ACTH)
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| Hypercalcemia S/S | serum Ca >10.5 mg/dL; altered mentation, N/V; polyuria, polydipsia, stones
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