ACNP Endocrine- Questions and Answers
Thyroid Crisis Correct Ans-USE OUTPATIENT MEDS IN IV FORM
Propylthiouracil (PTU) 150-250 mg Q6H OR Tapazole 15-25 mg Q6H with the following in 1
hr:
- Lugols 10 gtts TID OR
-Sodium iodide 1 gm slow IV with
- Propanolol 0.5-2 gm IV Q4H or 20-120 mg PO Q6H with
-Hydrocortisone 50 mg Q6H with rapid reduction as situation improves
AVOID ASA--exacerbates thyroid storm by interfering with binding of T3 and T4
Management of Hypothyroidism Correct Ans-Syntrhoid 50-100 mcg Qday, increasing
doseage by 25 mcg every 1-2 weeks until symptoms stabilize.
>60 years of age, decrease dosage
Myxedema Coma Correct Ans-Protect airway
Fluid replacement
Synthroid 400 mcg IV x 1, then 100 mcg daily
Support HOTN
Slow rewarming with blankets (not bear hugger or hyperthermia blankets): to avoid circulatory
collapse
Symptomatic care
,Cushing's Correct Ans-ACTH hypersecretion by the pituitary
Adrenal tumors
Chronic adminsitration of glucocorticoids
Signs and symptoms of Cushings Correct Ans-1. Central obesity--fat mobilizes from
extremities
2. Moon face with buffalo hump
3. Acne
4. Poor wound healing--increased androgens which suppress immune system
5. Purple striae
6. Hirsutism
7. HTN--steroids cause vasoconstriction
8. Weakness
9. Amenorrhea
10. Impotence
11. HA
12. Polyuria and thirst
13. Labile mood
14. Frequent infections
Labs and diagnostics in Cushing's Correct Ans-Hyperglycemia
Hypernatremia
Hypokalemia
, Glycosuria
Leukocytosis
Elevated plasma cortisol in AM >24
Dexamaethasone suppresion test to differentiate cause
Increased serum ACTCH--> cosyntropin
Management of Cushing's Correct Ans-D/C meds inducing symptoms
Transphenoidal resection of a pitutiary adenoma
Surgical removal of adrenal tumors
Resection of ACTH secreting tumors
Manage electrolytes
Normal AM Cortisol Correct Ans-6-24
Addison's Disease Correct Ans-Deficient cortisol, androgens and aldosterone
Autoimmune destruction of the adrenal gland
Metastatic cancer
Bilateral adrenal hemorrhage (e.g. with anticoagulant therapy)
Pituitary failure resulting in decreased ACTH
Signs and symptoms of Addison's Correct Ans-1. Hyperpigmenation in buccal mucosa and
skin creases (especially knuckles, nail beds, nipples, palmar creases, and posterior neck)
Thyroid Crisis Correct Ans-USE OUTPATIENT MEDS IN IV FORM
Propylthiouracil (PTU) 150-250 mg Q6H OR Tapazole 15-25 mg Q6H with the following in 1
hr:
- Lugols 10 gtts TID OR
-Sodium iodide 1 gm slow IV with
- Propanolol 0.5-2 gm IV Q4H or 20-120 mg PO Q6H with
-Hydrocortisone 50 mg Q6H with rapid reduction as situation improves
AVOID ASA--exacerbates thyroid storm by interfering with binding of T3 and T4
Management of Hypothyroidism Correct Ans-Syntrhoid 50-100 mcg Qday, increasing
doseage by 25 mcg every 1-2 weeks until symptoms stabilize.
>60 years of age, decrease dosage
Myxedema Coma Correct Ans-Protect airway
Fluid replacement
Synthroid 400 mcg IV x 1, then 100 mcg daily
Support HOTN
Slow rewarming with blankets (not bear hugger or hyperthermia blankets): to avoid circulatory
collapse
Symptomatic care
,Cushing's Correct Ans-ACTH hypersecretion by the pituitary
Adrenal tumors
Chronic adminsitration of glucocorticoids
Signs and symptoms of Cushings Correct Ans-1. Central obesity--fat mobilizes from
extremities
2. Moon face with buffalo hump
3. Acne
4. Poor wound healing--increased androgens which suppress immune system
5. Purple striae
6. Hirsutism
7. HTN--steroids cause vasoconstriction
8. Weakness
9. Amenorrhea
10. Impotence
11. HA
12. Polyuria and thirst
13. Labile mood
14. Frequent infections
Labs and diagnostics in Cushing's Correct Ans-Hyperglycemia
Hypernatremia
Hypokalemia
, Glycosuria
Leukocytosis
Elevated plasma cortisol in AM >24
Dexamaethasone suppresion test to differentiate cause
Increased serum ACTCH--> cosyntropin
Management of Cushing's Correct Ans-D/C meds inducing symptoms
Transphenoidal resection of a pitutiary adenoma
Surgical removal of adrenal tumors
Resection of ACTH secreting tumors
Manage electrolytes
Normal AM Cortisol Correct Ans-6-24
Addison's Disease Correct Ans-Deficient cortisol, androgens and aldosterone
Autoimmune destruction of the adrenal gland
Metastatic cancer
Bilateral adrenal hemorrhage (e.g. with anticoagulant therapy)
Pituitary failure resulting in decreased ACTH
Signs and symptoms of Addison's Correct Ans-1. Hyperpigmenation in buccal mucosa and
skin creases (especially knuckles, nail beds, nipples, palmar creases, and posterior neck)
