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  • Note - Endocrania

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    Mohamed Hussien
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    This document provides information on diabetes mellitus (DM), thyroid disorders, and adrenal hormones. It discusses the types and treatment of DM, including medications for glycemic control. It also summarizes the diagnosis and treatment of hypothyroidism, hyperthyroidism, Cushing syndrome, Addison's disease, and Conn's syndrome. Key points are outlined for each condition in less than 3 sentences.

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    This document provides information on diabetes mellitus (DM), thyroid disorders, and adrenal hormones. It discusses the types and treatment of DM, including medications for glycemic control. It also summarizes the diagnosis and treatment of hypothyroidism, hyperthyroidism, Cushing syndrome, Addison's disease, and Conn's syndrome. Key points are outlined for each condition in less than 3 sentences.

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    61 views3 pages

    Note - Endocrania

    Uploaded by

    Mohamed Hussien
    This document provides information on diabetes mellitus (DM), thyroid disorders, and adrenal hormones. It discusses the types and treatment of DM, including medications for glycemic control. It also summarizes the diagnosis and treatment of hypothyroidism, hyperthyroidism, Cushing syndrome, Addison's disease, and Conn's syndrome. Key points are outlined for each condition in less than 3 sentences.

    Copyright:

    © All Rights Reserved
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    of 3

    Endocrania:

    DM:

    Type 1:
    Destruction of B-cell in pancreases that produce insulin
    # C-peptide test to determine if there still insulin production or not
    # if there is no sufficient amount of insulin to take glucose inside the cell to produce energy à the body will break the fat to
    produce ketone body as an alternative source of energy
    Type 2:
    Insulin resistant and deficiency, decrease insulin sensitivity in body cells

    Diagnosed of DM:
    • A1C > 6.5
    • FBG > 126

    Medication:
    A. Oral:
    1. Biguanide (metformin):
    # SE: lactic acidosis, Metallic taste, decrease Vit B2, GI upset (take it with food)
    # Avoid: with Iodinated contrast 48 hours. # Drug interaction: topiramate
    # off label use: gestational DM, decrease weight, Poly cystic ovarian syndrome (PCOS)
    # CI: lactic acidosis, renal failure. > 80 y: metformin consider CI, bc. Kidney function will decrease
    2. Meglitinides: (repaglinide, Nateglinide). # CI: T1DM, DKA, cause hypoglycemia
    3. Sulfonylurea: (Glipizide, Glimepiride, Glyburide) # CI: T1DM, DKA, Sulfa allergy, cause hypoglycemia
    4. Thiazolidinediones: (pioglitazone, Rosiglitazone) # CI: HF, Hepatic failure, edema
    5. SGLT-2I: (canagliflozin, Dapagliflozin, Empagliflozin) # Monitor: renal
    6. DPP-4I: (Sitagliptin, Sexagliptin, Linagliptin) # Cause: Pancreatitis

    B. Injection:
    1. GLP-1: (Exenatide, Liraglutide) # Have adverse effect on thyroid
    # Liraglutide it an FDA approved to decrease weight
    2. Insulin # High risk medication
    - Rapid (lispro, Aspart)
    - Short (regular) # use IV in DKA
    - Intermediate (NPH) # cloudy and can be mix with other insulin
    - Long (detemir, Glargine)

    Insulin dose:
    T1DM: 0.3-0.6 U/kg/day
    T2DM: 0.1-0.2 U/kg/day
    Vaccination with Diabetic patient:
    Vaccine in diabetic foot: TD ONLY
    Vaccine in DM: Pneumonia, HBV, influenza

    Diabetic insipidus:
    • Vasopressin
    • Desmopressin
    # desmopressin also used in nocturnal enuresis and urine incontinence (UI)

    DM in pregnant:
    1st: insulin # NOT cross placenta
    2nd: metformin
    3rd: Glyburide # NOT cross placenta

    DM & weight:
    Approved medication: liraglutide
    Off-label use: Metformin
    Obesity: Orlistat

    NOTE on DM:

    # Medication can exaggerate blood glucose and cause hyperglycemia: Thiazide diuretic & statin
    # Medication can exaggerate insulin effect and cause hypoglycemia: linezolid
    # Medication masking the symptoms of hypoglycemic: Beta-Blockers

    Oral hypoglycemic agent used in T1DM: empagliflozin


    Oral hypoglycemic agent CI in HF: Sulfonylurea, glitazone (ex: pioglitazone)
    Diabetes medication need renal adjustment: Sitagliptin
    Oral hypoglycemic cause acute pancreatitis: DPP-4 (sitagliptin)
    Metformin and sitagliptin: monitoring kidney
    Pioglitazone and glipalamide: monitor liver

    Meta needed for insulin production: Zinc, Copper, Chromium


    # Chromium help to regulate glucose

    Hypoglycemia: glucose or dextrose


    Dextrose: NOT in DM and ICP

    -----------------
    Thyroid:

    Hypothyroidism:

    Diagnosis:
    Primary Hypothyroidism: low T4, High TSH
    Secondary Hypothyroidism: low T4, Low TSH
    Subclinical Hypothyroidism: Normal T4, High TSH

    S/sx: Cold intolerance, fatigue, decrease weight


    Causes: Hashimotos’s disease, drugs (lithium), conditions

    Treatment: Levothyroxine
    # t1/2: 7 days
    # take on empty stomach (morning)
    # Safe for pregnant but we should increase dose by 30%-50% in pregnancy
    # you will see the effect on patient energy & lab

    Crisis case of hypothyroidism: Myxedema # Life-threating condition


    # Treatment: levothyroxine

    Hyperthyroidism:

    Diagnosis: High T4, Low TSH

    S/sx: Heat intolerance, decrease weight, Goiter, Exophthalmos


    Causes: Grave’s disease, Thyroiditis, drugs

    Treatment:
    A. Antithyroid agents: Methimazole, Propylthiouracil (PTU)
    # in pregnancy {1st trimester PTU, 2nd & 3rd trimesters use methimazole}
    # SE: Agranulocytosis, PTU à Hepatotoxic
    B. Iodides: Potassium iodide (KI), Saturated Solution of Potassium iodide (SSKI)

    Crisis case of hyperthyroidism: Thyroid storm # Life-threating condition


    # Treatment: PTU + SSKI + Dexamethasone + Propranlol (for symptoms) + Acetaminophen (for fever)

    Adrenal hormones:

    Hyper Cortisone secretion: Cushing syndrome


    Hypo Cortisone secretion: Addison’s disease
    Hyper Aldosterone secretion: Conn’s syndrome

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