Endocrine
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1
Panhypopituitarism is complete loss of.....
- Tropic hormone production
2
ADH confirmed indirectly by _________. This is when...
Water Deprivation Testing
3
GH Physiologic dosing= ______ & is divided into ___ or ____ doses per week
- 0.3mg/kg/wk
- 6 or 7
- 6 or 7
4
Hydrocortisone for ACTH replacement: __ to __ times/day until ____. Typical dose is _____ mg/m2/day. Stress dosing: ____ ; IM solucortef for emergencies
- 3-4
- until growth completed
- 8-12
- 2-3x
- until growth completed
- 8-12
- 2-3x
5
Fludrocortisone for ACTH treatment/dosing= ______
Typical dose is 0.1mg PO daily
6
Levothyroxine for TSH replacement: Typically ~ _______. Titrated based on _____
- 1-2 mcg/kg/day
- labwork
- labwork
7
Type 1 Diabetes is an ______ process of _______ destruction located in the _______, leading to the loss of ______ production
- autoimmune
- pancreatic islet cell (beta cell)
- islets of Langerhans
- endogenous insulin
- pancreatic islet cell (beta cell)
- islets of Langerhans
- endogenous insulin
8
Insulin total daily dose calculation....
0.7 x weight in kg (0.5-1.2 units/kg/day)
9
Insulin Basal rate dosing calculation....
0.5 x weight in kg (or 1/2 of TDD) divided by 24
10
Insulin Bolus dose calculation....
Insulin to carbohydrate ratios: 500/TDD
11
Insulin sensitivity factor calculation....
Current BG - Tatrget BG / ISF 1800/TDD
12
Long Acting Insulin action times:
- Detemir: ____ hour action time (Levemir)
- Glargine: _____ hour action time (Lantus, Basaglar, Semglee, Rezvoglar)
- Detemir: ____ hour action time (Levemir)
- Glargine: _____ hour action time (Lantus, Basaglar, Semglee, Rezvoglar)
- 12-24
- 18-24
- 18-24
13
Ultra Long Acting insulin actions times:
- Toujeo (Glargine): _____ hour action
- Tresiba (Degludec): U100 & U200: ____ hour action
- Toujeo (Glargine): _____ hour action
- Tresiba (Degludec): U100 & U200: ____ hour action
- 24-36
- 30-42
- 30-42
14
Rapid or “short” acting insulins include _____, _____, & _____
Novolog (Aspart), Humalog (Lispro), Apidra (Glulisine)
15
Ultra Rapid Acting Insulins include ______ & ______
Fiasp (Insulin Aspart), Lyumjev (Insulin Lispro-aabc)
16
Hypoglycemia= BG < ____. s/s include.....
impaired vision, anxious, irritable, weakness, dizziness, shaking, hunger, rapid heart beat, sweating
17
Hypoglycemia treatment: _____ of carbohydrate, IV dextrose- _____ of D5, _____ of D25, _____ of D50, _____, & _____
- 15 g
- 10 cc/kg
- 2cc/kg
- 1 cc/kg
- Baqsimi (Intranasal), Gvoke (subQ)
- 10 cc/kg
- 2cc/kg
- 1 cc/kg
- Baqsimi (Intranasal), Gvoke (subQ)
18
Glucagon stimulates glucose release from ______, aka _______. Dosing= _____
- Liver
- glycogenolysis
- IM 0.03 mg/kg, max 1 mg
- glycogenolysis
- IM 0.03 mg/kg, max 1 mg
19
Aldosterone (mineralocorticoid) Function= ___ reabsorption and ____ excretion; so when insufficient--> kidney loses _____ and holds on to __
- NA reabsorption and K excretion
- excessive water/na
- K
- excessive water/na
- K
20
Congenital Adrenal Hyperplasia (CAH) is a _______ that occurs at ______ or _____
- Primary AI
- birth or 1-4wks of life
- birth or 1-4wks of life
21
Congenital Adrenal Hyperplasia (CAH) presentation....
Ambiguous genitalia in females, lethargy, vomiting, diarrhea, FTT, dehydration, hyponatremia and hyperkalemia.
22
Congenital Adrenal Hyperplasia (CAH) diagnostics...
- ACTH Stimulation Testing
23
ACTH Stimulation Testing is done if cortisol level < ____. the process includes....
- 15
- Baseline cortisol level between 4-8AM
- Cortisol < 3 = adrenal insufficiency- Give injection
- Repeat labs in 30 min.
-If ACTH is high Primary AI
- if low then secondary/tertiary AI
- Baseline cortisol level between 4-8AM
- Cortisol < 3 = adrenal insufficiency- Give injection
- Repeat labs in 30 min.
-If ACTH is high Primary AI
- if low then secondary/tertiary AI
24
Adequate Adrenal Function= Cortisol level > _____. Insufficiency = cortisol level < ____
- 15
- 3
- 3
25
Addison Disease diagnostics....
- ACTH Stimulation Testing
- often requires CT of adrenal glands
- often requires CT of adrenal glands
26
Congenital Adrenal Hyperplasia (CAH) treatment...
If not making aldosterone: replacement of salt and fludrocortisone 0.1-0.2 mg and hydrocortisone as needed.
27
Salt-wasting Congenital Adrenal Hyperplasia (CAH) occurs mostly in ____ and is ____
- Males
- most severe
- most severe
28
Salt-wasting Congenital Adrenal Hyperplasia (CAH) treatment
fludro, NaCl supp during infancy, cortisol replacement w/ hydrocort.
29
Addison disease treatment
- Mineralocorticoids: fludrocort
-Glucocorticoid: hydrocort q6
-Glucocorticoid: hydrocort q6
30
Primary adrenal insufficiency patients will need SDS if .... Dosing=
sick, febrile >101, mild to mod trauma, seizure, injured, and pre-op.
-Stress Dose: 25-50mg/m2/day
-Stress Dose: 25-50mg/m2/day
31
Central DI= _______ and is caused by....
-Insufficient production or failure of pituitary
gland to secrete ADH
- Genetic (Wolfram Syndrome), Congenital (midline defects), Acquired (tumor, trauma, surgery, infection)
gland to secrete ADH
- Genetic (Wolfram Syndrome), Congenital (midline defects), Acquired (tumor, trauma, surgery, infection)
32
Nephrogenic DI= _______ and is caused by....
- Resistance of renal collecting ducts to ADH
- Renal disease, Metabolic disturbances, Medications (AmphoB, Lithium)
- Renal disease, Metabolic disturbances, Medications (AmphoB, Lithium)
33
Differentiation of central vs. nephrogenic= Water deprivation test (nephron), Vasopressin (central)
....
34
Diabetes insipidus is excretion of ____ d/t ADH deficiency
large volumes of dilute urine
35
Syndrome of Inappropriate ADH is _____ secretion despite _____ & _____. Excessive H20 absorption in renal tubules→ ________ and _______ without ______
- excessive ADH
- normal osmolarity and euvolemia
- dilutional hyponatremia and weight gain without s/s edema
- normal osmolarity and euvolemia
- dilutional hyponatremia and weight gain without s/s edema
36
Cerebral salt wasting is...
Renal loss of sodium leading to hyponatremia and volume depletion
37
Three main hormones of the adrenal cortex are _______, _____, & _____
- Mineralocorticoids = Aldosterone
- Glucocorticoids = Cortisol
- Adrenal Androgen = Dehydroepiandrosterone
(DHEA)
- Glucocorticoids = Cortisol
- Adrenal Androgen = Dehydroepiandrosterone
(DHEA)
38
Signs and Symptoms of Mineralocorticoid (aldosterone) Deficiency
Weight Loss
Fatigue
Nausea, Vomiting, Anorexia
Salt-Craving
Hypotension
Hyperkalemia, Hyponatremia
Metabolic Acidosis with Normal Anion Gap
Fatigue
Nausea, Vomiting, Anorexia
Salt-Craving
Hypotension
Hyperkalemia, Hyponatremia
Metabolic Acidosis with Normal Anion Gap
39
Signs and Symptoms of Mineralocorticoid (Aldosterone) Excess
Hypertension
Elevated Sodium
Low Potassium
High Calcium
Fatigue
Headache
Muscle Weakness
Elevated Sodium
Low Potassium
High Calcium
Fatigue
Headache
Muscle Weakness
40
Cortisol release is controlled by the secretion of _____ by the _____ gland, which is controlled by _______ hormone secreted by the ______
- ACTH
- anterior pituitary
- corticotropin-releasing hormone (CRH)
- hypothalamus
- anterior pituitary
- corticotropin-releasing hormone (CRH)
- hypothalamus
41
Cortisol fxn: Stimulates the liver to ________
& tells the body to ______. Inhibits _____ & stimulates catabolism of _____; has _____ effects; and decreases _____ & _____
& tells the body to ______. Inhibits _____ & stimulates catabolism of _____; has _____ effects; and decreases _____ & _____
- make glucose (gluconeogenesis)
- hold onto glucose
- muscle protein
- Anti-inflammatory
- eosinophils and lymphocytes
- hold onto glucose
- muscle protein
- Anti-inflammatory
- eosinophils and lymphocytes
42
Signs and Symptoms of Glucocorticoid (Cortisol) Deficiency
Hypoglycemia
Nausea, Vomiting
Fatigue
Muscle Weakness
Nausea, Vomiting
Fatigue
Muscle Weakness
43
DI diagnostics
- inc. Serum NA+ (> 150)
- serum osmolality > 295
- low urine na: < 30
- Urine osmolality < 200
- urine SG < 1.005
- Inc. UOP
- Dehydrated
- serum osmolality > 295
- low urine na: < 30
- Urine osmolality < 200
- urine SG < 1.005
- Inc. UOP
- Dehydrated
44
DI management: calc free water deficit, Decrease Na+ levels by ___ to ___ mEq/L every ___ to ___ hours with a max of ___ to ____ mEq/L/24h
- 1-2
- 2-4
- 10-12
- 2-4
- 10-12
45
DI vasopressin dosing
Start @ 0.5 mu/kg/h and increase by 0.5 mu/kg/h until UOP <2 mL/kg/h
46
SIADH diagnostics
- dec Serum NA+ (< 135)
- serum osmolality < 280
- High urine na: > 30
- Urine osmolality > 200
- urine SG >1.020
- low UOP < 0.5 ml/kg/hr
- Hydration: normal or mild edema
- serum osmolality < 280
- High urine na: > 30
- Urine osmolality > 200
- urine SG >1.020
- low UOP < 0.5 ml/kg/hr
- Hydration: normal or mild edema
47
Cerebral Salt Wasting presentation
HA, NV, dehydration, hypotension, Depressed mental state, agitation, lethargy, seizures, coma
48
Cerebral Salt Wasting diagnostics
- dec Serum NA+ (< 135)
- serum osmolality < 280
- High urine na: > 80
- Urine osmolality > 200
- urine SG >1.010
- High UOP > 2-3 ml/kg/hr
- Dehydration
- serum osmolality < 280
- High urine na: > 80
- Urine osmolality > 200
- urine SG >1.010
- High UOP > 2-3 ml/kg/hr
- Dehydration
49
Cerebral salt wasting management: Correct Na+ slowly to prevent _______. Increase Na+ levels by _____ mEq/h and no greater than ____ mEq/L/24h
- central pontine demyelination
- 0.5-1
- 10-12
- 0.5-1
- 10-12
50
Hyperglycemic Hyperosmolar State (HHS) complication of diabetes, usually type ____ due
to an ______ and an increase in ________
to an ______ and an increase in ________
- 2
- insulin deficiency
- counter regulatory hormones
- insulin deficiency
- counter regulatory hormones
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