Difference between revisions of "Endocrinology"
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*'''Prolactin-secreting''' pituitary adenomas, including large ones, are first treated with '''oral dopamine antagonists''', whereas other pituitary adenomas are treated with surgery if large enough. | *'''Prolactin-secreting''' pituitary adenomas, including large ones, are first treated with '''oral dopamine antagonists''', whereas other pituitary adenomas are treated with surgery if large enough. | ||
*Congenital Adrenal Hyperplasia is most commonly '''21-hydroxylase deficiency''' (hypotension, low Na, high K, hypoglycemia, ambiguous genitalia in girls), but can also be '''11β-hydroxylase deficiency''' (hypertension, low K, hypoglycemia, ambiguous genitalia in girls) or '''17α-hydroxylase deficiency''' (hypertension, low K, euglycemia, ambiguous genitalia in boys). | *Congenital Adrenal Hyperplasia is most commonly '''21-hydroxylase deficiency''' (hypotension, low Na, high K, hypoglycemia, ambiguous genitalia in girls), but can also be '''11β-hydroxylase deficiency''' (hypertension, low K, hypoglycemia, ambiguous genitalia in girls) or '''17α-hydroxylase deficiency''' (hypertension, low K, euglycemia, ambiguous genitalia in boys). | ||
| + | *Amiodarone decreases peripheral conversion of T4 to T3, but generally this self resolves in 6-9 months after treatment initiation. Amiodarone has a half-life of 100 days. | ||
=Electrolyte Imbalanaces= | =Electrolyte Imbalanaces= | ||
Revision as of 19:52, 14 January 2023
Missed Concepts
- Workup of thyroid nodule almost always ends with FNA, the one exception is a patient without suspicious US findings or cancer risk factors, a low TSH, and a hot nodule on 123-Iodine scan (toxic adenoma). For these patients go straight to treatment (Methimazole pretreatment to achieve euthyroid > RF ablation vs. surgery)
- Hashimoto thyroiditis can be associated with other autoimmune conditions such as atrophic gastritis (pernicious anemia).
- During vitamin B12 repletion, you should monitor serum potassium, which can drop as new RBCs are formed.
- Young, normal weight patient, without family history of diabetes presents with symptomatic DKA? T1DM
- Total T3 and T4 in pregnancy can be 1.5x normal range and still be physiologic. TSH is suppressed. There is no role for measuring free T4 in pregnancy
- Hyperglycemia and catabolic symptoms (weight loss, urinary frequency) are indications for insulin.
- One complication of SGLT2 inhibitors is euglycemic DKA with BG < 250, but still with an elevated AG and low pH.
- Prolactin-secreting pituitary adenomas, including large ones, are first treated with oral dopamine antagonists, whereas other pituitary adenomas are treated with surgery if large enough.
- Congenital Adrenal Hyperplasia is most commonly 21-hydroxylase deficiency (hypotension, low Na, high K, hypoglycemia, ambiguous genitalia in girls), but can also be 11β-hydroxylase deficiency (hypertension, low K, hypoglycemia, ambiguous genitalia in girls) or 17α-hydroxylase deficiency (hypertension, low K, euglycemia, ambiguous genitalia in boys).
- Amiodarone decreases peripheral conversion of T4 to T3, but generally this self resolves in 6-9 months after treatment initiation. Amiodarone has a half-life of 100 days.
Electrolyte Imbalanaces
| Electrolyte | High | Low |
|---|---|---|
| Sodium | Example | Example |
| Potassium | Nausea, vomiting, ECG changes, asystole | Example |
| Calcium | Example | Usually asymptomatic, but can cause increased DTRs, muscle cramps, convulsions |
| Magnesium | Low-absent DTRs, flaccid paralysis, apnea | Example |
| Phosphorus | Example | Example |
Hyponatremia
- Moderate to severe hypothyroidism can cause cause mild euvolemic hyponatremia.
Hypercalcemia
- H&P:
- Dx: Best initial test is PTH
- Tx: