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Endocrine Disorders, Syndrome is caused by exogenous use of…

- - - - Ketones in urine
    - - Polyuria
      - Polydipsia
      - Polyphagia
    - - Insulin
  - - - Diet and exercise
      - Oral Medication
    - - Overwight
      - No ketones
  - - - Symptoms
        
        3 P's
        
        Polyuria
        
        Polydipsia
        
        Polyphagia
      - Treatment
        
        Insulin: Short Acting
    - - T: Tachycardia
      - I: Irritability
      - R: Restlessness
      - E: Excessive Hunger
      - D: Diaphoresis
      - Treatment
        
        Rule of 15
  - - - liver starts gluconeogenesis (fats and amino acids make glucose)
        
        Ketones = acidosis
        
        cells sense high blood sugar and pull water out of cells and into bloodstream
- - - - Hashimotos
        
        Immune system attacks thyroid cells
    - - Fatigue
      - Weight Gain
      - Constipation
      - Dry skin and hair
    - - Increased TSH
      - Decreased T3 and T4
    - - Short stature
      - Mental retardation
      - Protruding tongue
      - Coarse facial features
    - - Medication
        
        Levothyroxine (take without food in AM)
    - - Myxedema Coma
        
        Symptoms
        
        Myxedema of skin
        
        Bradycardia
        
        Mental status change
        
        Enlarged thyroid
        
        Treatment
        
        IV levothyroxine
  - - - Graves Disease
        
        Swelling of neck and protrusion of eyes
    - - TSH Decrease
      - T4 and T3 increased
      - Thyroid stimulating immunoglobulins elevated
      - Thyrotropin receptor antibodies
    - - Radioactive iodine uptake
    - - Medications
        
        Methimazole and propylthiouracil (PTU)
        
        Thionamides -> Decreases hormones before surgery
      - Thyroidectomy
        
        Subtotal
        
        Total
      - Radioactive Iodine Therapy
        
        Waste is hazardous
      - Monitor temp and provide eye protection
    - - Thyroid storm/Acute thyrotoxicosis
        
        Symptoms
        
        Hypertension
        
        Delirium
        
        Vomiting
        
        Hyperthermia
        
        Dysrhythmias
        
        Fever
        
        Treatment
        
        Thionamides
        
        Surgery
  - - - Hypocalcemia
    - - Hypercalcemia
- - - - Hyperpigmentation
      - Low BP
      - Vitiligo
      - Weight Loss
      - Nausea, Vomit, Diarrhea
    - - ACTH
        
        Primary: Cortisol does not rise (adrenal problem)
        
        Secondary: Cortisol rises (pituitary problem)
    - - Decreased cortisol and aldosterone
    - - Low sodium
      - High potassium
      - Hypoglycemia
    - - Cause
        
        Acute drop in adrenal corticoids
      - Treatment
        
        IV Steroids
        
        Hyperkalemia
        
        Insulin + Dextrose
        
        Thiazide Diuretics
        
        Heart Monitoring
        
        Acidosis
        
        Sodium Bicarbonate
      - Symptoms
        
        Fever
        
        Severe vomit and diarrhea
        
        Hyponatremia
        
        Convulsions
  - - - Midnight/Late night salivary cortisol
      - Low dose dexamethasone suppression test
      - 24 hr urine cortisol
    - - Moon Face
      - Purple Striae
      - High BP
      - High BG
      - Moon face
      - Muscle weakness
    - - High cortisol
    - - Medication
        
        Ketoconazole: Corticosteroid inhibitor
        
        Mitotane: Selective destruction of adrenocortical cells
      - Chemotherapy or radiation of adrenal glands
      - Surgery
        
        Primary -> Remove adrenal gland
        
        Secondary-> Remove pituitary gland