13 articles Endocrinology

Hemorrhagic Pituitary Macroadenoma

Hemorrhagic Pituitary Macroadenoma: Sx: Headache, diplopia (if affects optic chiasm) Consult Neurosurgery for recommendations Medications: Start Dexamethosone (Decadrone) 4mg IV q6hr Start Levothyroxine: Overt disease: 1.6mg/kg Subclinical disease: 1mg/kg If elderly, CAD: Start with lower dose and then titrate up. If hemorrhagic: Control BP to mitigate bleed and likely headache too. Caution: Patient may be…

Apathetic Hyperthyroidism – Hyperthyroidism in the elderly

Diagnose apathetic hyperthyroidism: In the elderly, hyperthyroidism (over activity of the thyroid gland – hypermetabolic state), may present with only depression, slow Afib, CHF, weakness, weight loss, and a small goiter. A high index of suspicion is needed to make the diagnosis. A masked hyperthyroidism, more common in depressed older patients – psychological withdrawal (depression,…

Thyroid nodule

Manage thyroid nodularity. 1st step: Determine whether a nodule is functional or nonfunctional. [Order TSH.] Functional thyroid nodule: either low/high Low TSH: Toxic multinodular goiter. Next: Order Thyroid scintigraphy. High TSH: Hashimoto thyroiditis. Next: Order serum anti-thyroperoxidase (TPO) antibodies. Nonfunctional thyroid nodule: Normal TSH 2nd step: Determine whether the nodule is malignant. Fine needle aspiration…

Prolactinoma

Manage a Prolactinoma: Best initial step – medications: Bromocriptine or Cabergoline Monitor response to therapy with periodic serum prolactin levels. If failure to respond to medical therapy – surgery: Transsphenoidal surgery. First-line therapy is medication > surgery (even if severe mass effect with vision loss) Treat with Dopamine Agonists (DA): Bromocriptine and Cabergoline. Decrease the…

Secondary Amenorrhea

Diagnose cause of Secondary Amenorrhea: (Dx structural: US & saline-infusion sonohysterogram) Most common causes of secondary amenorrhea: pregnancy, structural abnormalities, PCOS Steps to determine cause of secondary amenorrhea: Rule out pregnancy: Order beta-hCG. Order labs: Prolactin, TSH, FSH, LH, Estradiol Abnormal Prolactin or TSH levels: NONovarian cause! Elevation of FSH and LH with low Estradiol:…

Autoimmune Adrenalitis (Primary Adrenal Failure)

Autoimmune Adrenalitis: (most common cause of primary adrenal failure) 2/3 of patients have at least one other autoimmune endocrine disorder Most patients have adrenal autoantibodies: 21-hydroxylase antibodies 1st: The zona glomerulosa is affect first: increase in the plasma renin activity 2nd: Zona fasciculate affected next: Diminished cortisol response to response to ACTH Increase in basal…

Insulinoma

Diagnose an Insulinoma: Diagnosis of insulinoma is established by demonstrating inappropriately high serum insulin concentrations during a spontaneous or induced episode of hypoglycemia Ex: 72-hour fast for a patient with fasting hypoglycemia or in the case of the patient with solely postprandial symptoms, the mixed meal test. Fasting hypoglycemia – Postprandial hypoglycemia may be a…

Myxedema coma

Myxedema Coma: Complication of severe hypothyroidism Signs/symptoms: Change/altered mental status Edema, “puffy face” Hypotension, bradycardia, hypothermia Tachypnea Treatment: Goal is to restore the euthyroid state. Admit to the ICU. ****IV levothyroxine**** Initially: IV bolus 200-500 micrograms Daily: 50 – 100 micrograms IV Transition to oral levothyroxine. Supportive care: mechanical ventilation, vasopressors, glucocorticoids Warmed IV fluids…

Thyroid (hypo/hyperthyroidism)

Thyroid: Order a “Thyroid Cascade.” (should start with measuring TSH and will test more if abnormal TSH) Hypothyroid (Sx: Fatigue, Increased sensitivity to cold, Constipation, Dry skin, Unexplained weight gain, Puffy face, Hoarseness, Muscle weakness, Elevated blood cholesterol level, Muscle aches, tenderness, and stiffness, Pain, stiffness or swelling in your joints, Heavier than normal or…