USMLE 2 Endo Quick Notes
| Type I | o Pituitary tumors o Primary hyperPTH (90%) o Pancreatic/GI tumors (gastrinoma) |
| Type 2A (Sipple’s) | o Medullary thyroid cancer (MTC) o Pheochromocytoma o Parathyroid hyperplasia |
| Type 2B | o MTC o Pheochromocytoma o Mucosal neuromas o marfanoid habitus |
Multiple endocrine neoplasia classification
| ▪ MEN1 pancreatic tumors: gastrinoma, insulinoma, glucagonoma, VIPoma o gastrinoma causes recurrent peptic ulcers |
| ▪ Diabetes Mellitus ➢ DM screening: sustained BP > 135/80 mmHg ▪ OGTT is preferred to screen glucose intolerance & DM Type II ▪ Dx: Type II DM ➢ 2 hr OGTT ≥ 200 mg/dL o fasting blood glucose > 126 o HbA1c ≥ 6.5% o random plasma glucose ≥ 200 |
| ➢ weight loss = most effective lifestyle intervention to reduce BP • DASH diet is the next most effective approach in prevent & treat HTN especially non-obese; then exercise, dietary sodium, alcohol intake • smoking causes a transient rise in BP |
| ▪ early-onset HTN, progressive renal insufficiency, gross hematuria, flank pain, B/L abdominal masses Dx ▪ central obesity, facial plethora, proximal weakness, abdominal striae, ecchymosis: Cushing’s ▪ headaches, palpitations, diaphoresis a/w paroxysmal BP elevations: pheochromocytoma o urinary vanillylmandelic acid, & metanephrines |
| ▪ high serum & low urine osmolality due to inadequate ADH response is most likely due to lithium-induced nephrogenic DI ▪ Lithium induces ADH resistance, resulting in acute-onset nocturia, polyuria, & polydipsia ▪ hypovolemic hypernatremia ▪ Rx: discontinue lithium; salt restriction & diuretics (amiloride: K+ sparing diuretic) ▪ Rx: hemodialysis for lithium level ˃ 4 mEq/L or ˃ 2.5 mEq/L + signs of toxicity or renal disease |
