Endocrinology Pt. 2 Flashcards Preview

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Flashcards in Endocrinology Pt. 2 Deck (53)
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1

What (human leukocyte antigens)HLA haplotype is seen in 95% of patients with type 1 DM?

DR3 or DR4

2

What are some environmental triggers for DM type 1?

Viral infections (enteroviruses and rubella)

Early introduction of cow's milk (controversial)

3

What autoimmune factors contribute to DM type 1?

  • Islet cell antibodies (ICA) are present in 85% of patients
    • ICA may be detected in asymptomatic patients 10 years before onset of clinical symptoms
  • Other immunologic markers
    • Antibodies against insulin and against glutamic acid decarboxylase

4

The classic presentation of DM type 1 includes several weeks of...(3)

Polyuria

Polydipsia

Nocturia

polyphagia, wt loss, fatigue, weakness, dysfunction of peripheral nerves

5

In what percentage of patients is Diabetic ketoacidosis the initial presentation of DM type 1?

25%

6

Girls who have protracted cases of _____ _________ may have early type 1 DM

monilial vulvovaginitis

7

What is required to diagnose patients with type 1 DM?

diagnostic: fasting BG >/= 126 mg/dL on 2 occations

 

Need to confirm with a fasting ---- random blood sugar > 200 mg/dL with polyuria, polydipsia, weight loss, or nocturia

8

What is the honeymoon period of DM type 1?

Within a few weeks after initial diagnosis, 75% of patients exhibit a temporary progressive reduction in their daily insulin requirements; this is because of transient recovery of residual islet cell function resulting in endogenous release of insulin in response to carbohydrate exposure

9

What is the Somogyi phenomenon in DM type 1?

This occurs when the evening dose of insulin is too high causing hypoglycemia in early morning hours (3 am), resulting in the release of counter-regulatory hormones (epinephrine/glucagon) to counteract the insulin-induced hypoglycemia; patient then has high blood glucose and ketones in the morning

TX: reduce night time dose of insulin

10

What are some long term complications of DM type 1?

  • Microvascular complications: diabetic retinopathy, nephropathy, neuropathy
  • Macrovascular complications (usually seen in adults): atherosclerosis, HTN, heart disease, stroke
  • DKA: when ill or noncompliant

11

Which type of diabetes has the strongest hereditary component?

Type 2

12

What is likely the cause of DM type 2?

Combination of peripheral tissue resistance to insulin and progressive decline in insulin secretion

13

What is the clinical presentation of DM type 2?

  • Obesity
  • Acanthosis nigricans
  • Asymptomatic to mild DKA
  • recurrent vaginitis
  • peripheral neuropathies and blurred vision
  • chronic skin infections 

14

What is the management of DM type 2?

Oral hypoglycemic agents if blood sugar levels are not very high (metformin) - reduced gluconeogenesis, little or no hypoglycemia

Insulin therapy may be required

15

What is the definition of DKA?

Hyperglycemia uually greater than 300 mg/dL with ketonuria and a serum bicarbonate level < 15 mmol/L or a serum pH < 7.3

16

What are the roles of counter regulatory stress hormones in DM type 2?

Hyperglycemia resulting from insulin deficiency leads to an osmotic diuresis with polyuria and eventual dehydration; counter regulatory stress hormones (glucagon, epinephrine, cortisol, GH) are released and contribute to fat breakdown (lipolysis)

Glucagon stimulates conversion of FFA to ketones and eventually leads to DKA

 

17

What factors regulate the hypothalamic pituitary thyroid axis?

Thyroxine (T4), triiodothyronine (T3), TRH, TSH

18

What is bound to T4 and T3 in circulation

Thyroid binding proteins, including thyroid-binding globulin (TBG) and thyroid binding prealbumin (TBPA)

19

When are T4 and T3 in their biologically active forms?

When they are unbound

20

What is the clinical presentation of hypothyroidism?

  • Suboptimal growth velocity with delayed bone age
  • Goiter
  • Myxedema (puffy skin)
  • Amenorrhea or oligomenorrhea in adolescent girls

21

What maternal factors may lead to transient congenital hypothyroidism?

Use of PTU during pregnancy for maternal Graves' disease may result in transient hypothyroidism (PTU crosses placenta)

Maternal autoimmune thyroid disease - maternal thyroid blocking antibodies may cross the placenta and block TSH receptors on the newborn thyroid gland

22

How do most newborns with hypothyroidism present?

Asymptomatic and unremarkable physical examination (T4 is not essential for fetal growth)

23

What are classic physical examination findings of congenital hypothyroidism?

Large anterior and posterior fontanelles, protruding tongue, umbilical hernia, myxedema, mottled skin, hypothermia, delayed neurodevelopment, poor growth

24

What are the 2 classic symptoms of congenital hypothyroidism?

Lethargy and constipation

25

What is the management of congenital hypothyroidism?

Thyroid hormone replacement should begin immediately with L-thyroxine

26

What is measured to diagnose hypothyroidism?

  • TSH (neonatal screening tests)
  • Increased TSH
  • Low T4 level
  • Antithyroid antibodies (thyroid antiperoxidase antibodies)

27

What clinical features of hyperthyroidism are seen in the eye, the skin, and the CNS evaluations?

  • Eye: Lid lag and exophthalmos
  • Skin: Warm and flushed (presence of vitiligo or alopecia suggests the possible coexistance of other autoimmune polyendocrinopathies)
  • CNS: nervousness, fine tremors, history of fatigue and difficulty concentrating in school

28

What is Graves' disease?

Autoimmune disorder characerized by produciton of excessive thyroid hormone by the thyroid gland mediated by a TSH look-alike antibody

29

What antibody is associated with Graves' disease?

Thyroid-stimulating immunoglobulin (TSI), an IgG antibody that cross reacts with TSH and binds to and stimualtes the TSH receptors in the thyroid gland

30

What are the laboratory findings in Graves disease?

Increased T3 and T4 levels with suppressed TSH level in the presence of TSI