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53 terms

Diagnostics: Endocrine Tests

STUDY
PLAY
Ant Pituitary H's
TSH; FSH/LH; hGH; ACTH; LTH
Tx goals
Treat cause
Manage S/s
Monitor
Hyperthyroid AI syndrome
Grave's Dz
Grave's Mechanism
ABs that mimic TSH bind to TSH receptors, srtimulate T3/T4 release
Grave's Lab findings
TSH v LOW
T4/T3 v HIGH
Grave's S/s; gender split
Women 10X men
OI THE PAWN:
OLIGOMENORRHEA
Irritable
TREMOR, palpitations, TACHY
HEAT INTOLERANCE
Emotionally labile
Proximal muscle weakness
Anxiety
WEIGHT LOSS w/ hyperphagia
Nervous
Thyroid Storm
Off the chart T4; fever, tachy, ALOC
Hypothyroid AI syndrome
Hashimoto's Dz (Myxedema)
Hashimoto's mechanism & gender split
Women more freq
ABs bind to TSH receptors and BLOCK T4/T3 production
Thyroid panel values
T4: 0.8-2.4;
T3: 260-480;
TSH: 0.2-5.4
Mxyedema S/s
OI THE KING
In other words, opposite of the PAWN:
Fatigue, Hypermenorrhea, Cold sensitivity, Depression, Edema
Myxedema coma S/s
Prolonged hypothyroidism;
Brady --> CHF
Hypoventilation-->Acidosis
Paralytic Ileum
Myxedema Lab Findings
TSH HIGH
T3/T4 LOW
Hypothyroidism in neonates
Cretinism-> Retardation, hypotonic muscles, failure to thrive
hGH Over-production syndromes
Gigantism before epiphyseal plates close
Acromegaly after plates colse
Acromegaly causes & gender
Most common: Pituitary adenoma;
Males 40-45
Acromegaly S/s
Lantern jaw'
Kyphosis
Arthralgias/arthritis
INSULIN ANTAGONIST->DM S/s
hGH underproduction
pituitary dwarfism
FSH in females, males
Females: Stimulates development of follicle & Estrogen production
Males: Stimulates spermatogenesis
LH in females; males
Females: Stimulates Progesterone production by corpus luteum
Males: Stimulates production of Testosterone
Testosterone delivery & Lab Tests
Bound to Sex-Hormone Binding Globulin (SHBG);
Tests: Free & Total
Causes of hypertestosteronism
CHAD
Congenital Adrenal Hyperplasia
Hyperthecosis
ADrenal cortical tumors;
Causes of hypotestosteronism
KIST
Kleinfelters
Primary Hypogonadism
Secondary Hypogonadism
Testes D/o's
ACTH fx
Stimulates release of Adrenal Cortical Hormones, esp:
Cortisol
Aldosterone
ACTH deficiency
Secondary Addison's
Addison's S/s
SHAPE
Sodium excretion (hyponatremia)
Hyper-pigmentation, hTN
Autoimmune
Potassium & Hydrogen retention
End result: Hypotension/fatigue/Ix
ACTH excess & gender
Cushing's syndrome;
5X more in females
Ranked causes of Cushing's
Secondary (pituitary adenoma);
Ectopic secretions (Small cell CA/other tumors;
Iatrogenic (Esp steroids/prednisone)
Primary (adrenal tumors)
Cushing's S/s
MMM O HEAD
Moon face
Menstrual D/o
Metabolic Syndrome
Osteoporosis
Hypertension/hirsutism
Easy bruising
Acne
Depression
Cortisol Lab values
AM: 5-23 ug/dL
PM: 3-16 ug/dL
Cortisol suppression test
Dexamethasone ( DST, a cortisol analog) will SUPPRESS AM cortisol to <5 ug
Cortisol stimulation test
Cortrosyn. ELEVATE AM cortisol by @ least 10 ug/dL
Hyperaldosteronism S/s & Cause
CHAMPS:
Cut renin
HTN
Acidosis
Mg decreased
Potassium decreased
Sodium increased
Possible causes of decreased Cortisol
HA-HA-HA
Hypothyroidism; Adrenal Hyperplasia; Hepatitis/cirrhosis; Addison's; Hyposecretion at Ant pituitary
Possible causes of increased Cortisol
COAT:
Carcinoma/Cushing's;
Obesity
Adrenal adenoma
Tumor secreting ACTH
Phaeochromocytoma Description
Catecholamine secreting tumor of adrenal medulla (EPI, NOREPI, DOPAMINE)
Phaeo S/s & Dx
HA, Sweating, Tachy;
Dx: 24-hr urine catecholamine
Post Pit hormones
ADH (vasopressin / arginine vasopressin), Oxytocin
SIADH
Syndrome of Inappropriate ADH--
Excess ADH secretion leads to hypervolemia. Assoc'd w/ small cell, brain tumors
Diabetes insipidus
Deficient ADH--> High volume of dilute urine. Specific Gravity stays low at all levels of hydration, polyuria
Oxytocin
Uterine contractions & milk letdown
PTH
Main calcium regulator. Increased PTH-> Lincrased Ca by bone resorption & GI absorption
Calcium/Phosphat relationship
Inverse ( As Ca2+ increases, PO4 decreases)
PTH test normal & renal failure
Measure C-terminal in normal pts;
Measure N-terminal in Renal pts
Four uses of Testosterone test
PHIC
Pituitary fx, Hypogonadism, Impotence & Cryptorchidism
PSA
Prostate-Specific Antigen: SCREEN for prostate CA, monitor recurrence after surgery
PAP; when elevated?
Prostatic Acid Phosphatase: Dx of metastatic CA of the prostate. Elevated in CA beyond the capsule.
DM stats
No 4 cause of death;
90-95% DM2
Distinguishing DM1 & DM2
DM1: IMMUNE MEDIATED, Insulin DEFICIENT, Young, thin, recent wt loss, Kussmaul resp, Acetone breath;
DM2: Insulin RESISTANT, Obesity, FamHx, Non-Caucasian, HTN, HDL<35/TriG>250. Hx of gestational DM/Hx impaired glucose tolerance
DM2 Risk Factors
HARD BBioii
Habitual inactivity
Age >45;
Race
Dyslipidemia
BMI>25
Birth wt >9 lb
DM acute & chronic effects
Acute: Ketoacidosis (DM1), Hyperosmolar non-ketotic coma(DM2);
Chronic: Ulcer/neuropathy @ extremities, Renal failure (microalbumin check!), CHF
DM Dx
Fasting glu: >126, 2X;
3-hr glu tolerance: >200 TWO HOURS after glu load, 2X;
Fasting or 2-hr post-prandial >200 JUST 1X;
Must-do test every 3 mo for DM pts
HbA1c, monitors [GLU] and compliance, as Hb circulates for 120 days