Tiêu đề 5 Endocrine LMV 4.6.pdf ✅

1 | P a g e [ E n d o c r i n o l o g y ] © Copyright www.plab1keys.com (Constantly updated for online subscribers) Copyrights @ Plab1Keys.com Endocrinology Version 4.6 Corrected, Updated, Lighter With the Most Recent Recalls and the UK Guidelines ATTENTION: This file will be updated online on our website frequently! (example: Version 2.5 is more recent than Version 2.4, and so on) Key 1 Thyrotoxicosis (Hyperthyroidism) in pregnancy: * Propylthiouracil is preferred preconception (before pregnancy if a woman is planning to get pregnant) and in the first trimester and postpartum. * Carbimazole is preferred in 2nd and 3rd trimesters + in general (non- pregnant) * Carbimazole: risk of aplasia cutis and omphalocele in the fetus. * Propylthiouracil: risk for hepatotoxicity in the mother. Plab1keys.com Strict Copyrights! No Sharing or Copying Allowed by any means Compensations and Penalties Worldwide System is Active
2 | P a g e [ E n d o c r i n o l o g y ] © Copyright www.plab1keys.com (Constantly updated for online subscribers) Copyrights @ Plab1Keys.com * Both drugs can cross the placenta; so, use the lowest possible dose. * Radioiodine therapy is contraindicated during pregnancy. * If hyperthyroidism cannot be controlled by drugs → partial thyroidectomy can be done in the 2nd trimester. However, the safest Rx modality for pregnant women with hyperparathyroidism is by giving antithyroid medications (e.g., PTU). Key 2 2ry adrenal insufficiency (mostly iatrogenic). • After a long period of steroids intake, a sudden cessation of steroid intake will lead to 2ry adrenal insufficiency (iatrogenic). • Look for unexplained abdominal pain + nausea, vomiting ± postural hypotension ‘’Dizziness, Falls’’. Note that (1ry adrenal insufficiency = Addison’s disease, will be discussed in the coming keys). Key 3 Diabetic ketoacidosis: - Occurs mostly in DM type 1 - Presentation:
3 | P a g e [ E n d o c r i n o l o g y ] © Copyright www.plab1keys.com (Constantly updated for online subscribers) Copyrights @ Plab1Keys.com Abdominal pain, vomiting, Kussmaul breathing (deep hyperventilation), dehydration, glucose>11. - Management: √ Initially → IV fluids √ followed by IV infusion of insulin + measure arterial blood gases (ABG). “sometimes, ABG is not given, instead, VBG is given -venous blood gases-” N.B. Sometimes, these options are not given, pick (measure capillary blood glucose) Obviously! - Dx: (pH < 7.3), ketonemia > 3 or ketonuria ++, Glucose > 11, Bicarb < 15 Key 4 Ca = Calcium, ALP = Alkaline Phosphatase
4 | P a g e [ E n d o c r i n o l o g y ] © Copyright www.plab1keys.com (Constantly updated for online subscribers) Copyrights @ Plab1Keys.com Key 5 Hyperkalemia with ECG changes: - Tall Tented T wave, Prolonged QRS → - Firstly, protect the cardiac membrane by giving IV Calcium Gluconate (OR: Calcium Chloride). - Then, reduce the serum Potassium by giving insulin with dextrose OR sometimes salbutamol inhalation. Tall Tented T wave, Prolonged QRS → Hyperkalemia Once these ECG changes occur → give IV calcium gluconate or calcium chloride Key 6 Acromegaly: ◙ In acromegaly, there is excess growth hormone (GH) secondary to a pituitary adenoma in over 95% of cases. ◙ Some important features: - Bitemporal hemianopia, “due to compression on optic chiasm”. - spade like hands,
5 | P a g e [ E n d o c r i n o l o g y ] © Copyright www.plab1keys.com (Constantly updated for online subscribers) Copyrights @ Plab1Keys.com - enlarged nose and jaw. - large tongue, - prognathism “an extension or bulging out (protrusion) of the lower jaw (mandible)” - interdental spaces - Headaches, Hypertension, Sweating. ◙ Initial (screening) test and F/U test → IGF-1 (insulin like growth factors). ◙ The most definitive (confirmatory test) → OGTT with serial Growth Hormone measurements. OGTT = Oral Glucose Tolerance Test N.B In normal people, Growth hormone is suppressed by Glucose. In acromegaly, Growth hormone is not suppressed by Glucose.