Endocrinology
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Endocrinology

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Endocrinology Endocrinology Document Transcript

  • AM2 Endocrinology I. Thyroid Gland Disorders 1. Identify iodine as necessary for the synthesis of thyroid hormones. 2. Identify TRH and TSH and describe their role in regulating thyroid hormone levels. 3. Identify thyroxine (T4) and triiodothyronine (T3) as the two major thyroid hormones. 4. Describe the difference between free vs. protein-bound thyroid hormone (TBG). 5. Identify and describe the role of each of the following diagnostic tests in evaluating thyroid disease. T4 RAI Free T4 T3 resin uptake T3 RAI (total serum T3) free thyroid index (FTI) TSH antithyroid antibodies thyroglobulin thyroid radioiodine uptake (RAI uptake) thyroid scanning thyroid ultrasound fine needle aspiration and cytology 6. Identify autoimmune processess and treatment for hyperthyroidism as the most common causes of hypothyroidism in the USA; identify iodine deficiency as the most common cause worldwide. 7. Identify Hashimoto's thyroiditis as an autoimmune disease that often results in hypothyroidism with goiter. 8. Define "cretinism." Identify the relationship between thyroid hormone deficiency at birth and mental retardation. 9. Describe the typical signs and symptoms of hypothyroidism. 10. Describe the clinical picture of severe hypothyroidism with myxedema.
  • 11. Describe basic principles of thyroid replacement therapy for hypothyroidism (choice of drug, schedule for increasing dosages, cautions in elderly or cardiac patients). 12. Identify Graves' disease as the most common cause of hyperthyroidism; distinguish between Graves' disease and other forms of hyperthyroidism. 13. Identify or describe the classic signs and symptoms of hyperthyroidism; identify infiltrative ophthalmopathy as specific for Graves' disease. 14. Briefly describe the pros and cons of treating hyperthyroidism with: antithyroid drugs (e.g., propylthiouracil and methimazole), radioactive iodine, surgery. 15. Describe the syndrome of toxic multinodular goiter. 16. Describe the syndrome of subacute thyroiditis. 17. Describe the syndrome of thyroid storm. 18. Describe the workup for a patient with a solitary thyroid nodule. 19. Describe the difference between, and clinical significance of, "hot" nodules versus "cold" nodules on radioisotope scanning. II. Diabetes Mellitus 1. Know the laboratory criteria for the diagnosis of diabetes mellitus in adults. 2. Describe the differences between type 1 and type 2 diabetes mellitus. 3. Recognize the typical symptoms of hyperglycemia which may cause the patient to present to the primary care practitioner. 4. Briefly describe the role that each of the following plays in the causation of diabetes mellitus: autoimmune processes, genetic inheritance, insulin resistance.
  • 5. Identify diabetic ketoacidosis (DKA) and nonketotic hyperglycemic- hyperosmolar coma as the two major consequences of uncontrolled diabetes. 6. Recognize the signs and symptoms of DKA. 7. Recognize the signs and symptoms of nonketotic hyperglycemic- hyperosmolar coma. 8. Describe the symptoms of hypoglycemia that may be caused by insulin or sulfonylureas. 9. List or recognize the major chronic complications of diabetes mellitus, especially increased atherosclerosis (CAD, CVA, PVD), diabetic retinopathy, nephropathy, neuropathy, and foot ulcers. 10. Describe the characteristic clinical findings of diabetic retinopathy. 11. Describe the role that each of the following plays in management of diabetes. diet weight reduction for obesity exercise insulin* oral agents* self-monitoring of blood glucose glycosylated hemoglobin assay (Hb A1c) *Note: we will leave details of the insulins and oral agents to the Patient Management course. You should at least have an idea of which insulins are short-, intermediate-, or long-acting for this course. 12. Describe the management issues for each of the following special cases in diabetes mellitus. adolescents elderly pregnant patients III. Endocrine Roundup: A. Parathyroid Disorders 1. Describe the role of each of the following in calcium homeostasis. parathyroid hormone (PTH)
  • vitamin D calcitonin 2. Identify the problems caused in the body by hypercalcemia. 3. Identify hyperparathyroidism and malignancy as the two major causes of hypercalcemia. 4. Identify common causes of hypocalcemia. 5. Identify the problems caused in the body by hypocalcemia. 6. Describe the following signs associated with hypocalcemia. Chvostek's sign Trousseau's sign tetany B. Pituitary Gland Disorders 1. Describe the relationship between the hypothalamus and the anterior pituitary gland. 2. Recognize each of the following as anterior pituitary hormones, and state briefly what each of them does in the body. adrenocorticotropic hormone (ACTH) growth hormone (GH) prolactin thyroid stimulating hormone (TSH) follicle stimulating hormone (FSH) ltteinizing hormone (LH) 3. Recognize bilateral temporal field loss (homonymous hemianopsia) as a classic presenting sign in pituitary tumors. 4. Identify arginine vasopressin (AVP), also known as antidiuretic hormone (ADH), as a hormone produced by the posterior pituitary gland. 5. Define "diabetes insipidus" and identify how it would be recognized. 6. Identify dwarfism, gigantism, and acromegaly as consequences of either under- or over-secretion of growth hormone. 7. Recognize the association of galactorrhea and amenorrhea in women with excessive prolactin secretion (hyperprolactinemia).
  • C. Adrenal Gland Disorders 1. Identify cortisol, aldosterone, and androgens as adrenal hormones. 2. Describe the negative feedback relationship of ACTH secretion and cortisol levels. 3. Describe the clinical presentation of primary adrenal insufficiency (Addison's disease). 4. Describe the clinical presentation of adrenocortical hyperfunction (Cushing's syndrome). Distinguish between Cushing's syndrome and Cushing's disease. 5. Identify primary hyperaldosteronism as a cause of secondary hypertension; recognize the association with spontaneous hypokalemia. 6. Describe the clinical features of pheochromocytoma. D. Osteoporosis 1. Identify risk factors for development of osteoporosis. 2. Describe the clinical findings of osteoporosis. 3. Describe prevention and treatment measures* for osteoporosis. *Note: details of the pharmacologic treatment options will be tested in the Patient Management course.