ENDOCRINOLOGY

CUSHING SYNDROME:

ADRENAL INSUFFICIENCY

HYPERALDOSTERONISM

NEUROBLASTOMA

PHEOCHORMOCYTOMA

HYPOTHYROID

HASHIMOTO THYROIDITIS

SUBACUTE GRANULOMATOUS THYROIDITIS (DE QUERVAIN)

RIEDEL THYROIDITIS

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HYPERTHYROID

GRAVES DISEASE – Case: [35yoF palpitations, wt loss, increased appetite, diarrhea in last 2 months. PE:
exophthalmos, lid lag, lid retraction, enlarged & nontender thyroid gland. Low TSH, increased free T4
and T3. Pt diagnosed with Graves’ disease. Various treatment options discussed, she opts for long-term
treatment with METHIMAZOLE.]
Which of following conditions is pt at RISK FOR DEVELOPING FROM THE MEDICATION?
= Agranulocytosis

The 3 major treatment options for Graves' disease are:

1. Radioactive iodine ablation (preferred in the United States) = permanently treats hyperthyroid
2. Antithyroid drugs (ATD): PTU Propylthiouracil & Mthimazole [PTU NOT preferred – Liver
injury/failure]
 PTU for 1st trimester Pregnancy dt Fetal Teratogenicity with Methimazole
 SE: AGRANULOCYTOSIS [inform pt about it]
3. Thyroidectomy (surgery = permanently treats hyperthyroid)
 ED:
 Graves' disease can be treated with anti-thyroid drugs, radioactive iodine therapy, or
thyroidectomy.
 Most serious side effect of anti-thyroid drugs is AGRANULOCYTOSIS (0 3% of pts).
o Patients developing SORE THROAT and fever should stop the drug and see a
physician to check their white count WBC

Why WRONG:
Permanent PTU & Methimazole do Radioactive Iodine
Hypothyroidism: not cause renal damage therapy → can worsen
*Results after or risk to kidneys Ophthalmopathy in
radioiodine tx or Graves pts.
thyroidectomy….→
HYPOTHYROID

THYROID STORM

TOXIC MULTINODULAR GOITER

THYROID ADENOMA

THYROID CANCER

PAPILLARY CARCINOMA

FOLLICULAR CARCINOMA

MEDULLARY CARCINOMA
ANAPLASTIC CARCINOMA

LYMPHOMA

HYOPARATHYROIDISM

HYPERPARATHYROIDISM

PITUITARY ADENOMA

NELSON SYNDROME

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ACROMEGALY

ACROMEGALY –Case [“hands getting thick and swollen” “difficulty wearing shoes” BP 150/90. “coarse
facial features, prominent frontal bones and jaws”]
What’s the most common CAUSE OF DEATH in patients with this condition?
= Congestive cardiac failure

ED:
 MCCOD in acromegaly = HEART 38-62%deaths [Coronary heart disease, cardiomyopathy,
arrhythmias, LV hypertrophy, diastolic dysfunction) [HTN occurs in 30%pts, but itself is NOT
solely responsible for increase in CVS mortality]

The following are some non-cardiac causes of death in patients with acromegaly
1. Strokes the incidence of strokes is higher in patients with acromegaly
2. Colon cancer this condition is thought to occur with increased frequency
3. Renal failure this can result from hypertension and hyperglycemia
4. Adrenal failure this can occur due to hypothalamo-pituitary problems due to a pituitary
tumor, although surgical resection and radiotherapy of the pituitary tumor can also cause
secondary adrenal failure

LARON SYNDROME

DIABETES INSIPIDUS

SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE

HYPOPITUITARY
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DIABETES MELLITUS

DIABETIC NEPHROPATHY – Case: [ 60yoM, has EDEMA of face and ankles for 2 weeks. LONG h/o DM,
is managed with exercise, dietary modification, and glyburide. Glycosylated hemoglobin level a month
ago was 6.9%. BP 146/87 mm Hg, pulse is 75/min, and respirations are 15/min. Bilateral pitting edema
around the ankles and periorbital edema.
Laboratory results are as follows: BUN 37mg, Creatinine 2.4mg. Urine protein show 3700mg/24hr.]
What is most appropriate NEXT STEP MANAGEMENT to alter the course of this patient’s diabetic
nephropathy?
= Intensive Blood Pressure control

ED:
 [INITIAL STEP:] Strict/intensive Blood Pressure Control → most beneficial therapy to reduce
the progression of diabetic nephropathy. Target BP: 130/80mmHg
o [Primary intervention to SLOW decline of GFR]
o Diabetes Mellitus pt: goal : BP 140/90
o Diabetes Nephropathy pt: [has kidney issues] goal: BP 130/80
 ACE-I & ARBs = preferred anti-HTN meds for DM patients. … can reduce intraglomerular
pressure…renoprotective. [CAUTION when use in Diabetic Nephropathy-bc can induce
Acute decline in GFR & Hyperkalemia]

 [Diabetic Nephropathy: Hyperfiltration (increased GFR & Microalbuminuria)…if not treated,

microalbumin can progress to macroproteinuria Urine protein >300mg/24hs, then decline
GFR]

Why WRONG:
Intensive glycemic control:
(HbA1c <7.0%....reduces
progression o
microalbuminuria….BUT, more
aggressive reduction of
glycemic control beyond this
target is related to MORE RISK
FOR HYPOGLYCEMIA & heart
problems

HYPEROSMOLAR-HYPERGLYCERMIA NONKETOTIC SYNDROME

OSTEOMALACIA – Case: [Generalized bone pain 4 months after undergoing small-bowel resection.
His pain is more severe at the lower spine, pelvis, and lower extremities; examination shows tenderness
at these sites. Proximal muscle weakness is noted. X-rays of the lumbar spine show decreased bone
density with blurring of the spine X-rays of the femoral neck show pseudofractures bilaterally]
Which of the following laboratory abnormalities is consistent with this patient's diagnosis?
=
Serum Calcium: Serum Phosphate: Serum Parathyroid Hormone:
LOW LOW INCREASED

ED:
 Osteomalacia due to vitamin D deficiency have low or low-normal serum calcium, low serum
phosphate, increased serum parathyroid hormone, low plasma 25-0H vitamin D levels, and
elevated alkaline phosphatase. Unlike in osteoporosis, most patients complain of bone
pain and muscle weakness. X-ray findings include decreased bone density with thinning of
cortex and pseudofractures (Looser zones)
GLUCAGONOMA

INULINOMA

SOMATOSTATINOMA

CARCINOID SYNDROME

ZOLLINGER-ELLISON SYNDROME

MEN: MULTIPLE ENDOCRINE NEOPLASIA