09/02/2026
1. Hypothyroidism
• Low T3/T4, high TSH
• Slow and low: weight gain, cold intolerance, bradycardia, constipation.
• Risk: Myxedema coma → airway, IV levothyroxine, warming blanket.
• Drug: Levothyroxine – take in AM, empty stomach, lifelong therapy.
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2. Hyperthyroidism (Graves’ Disease)
• High T3/T4, low TSH
• Fast and high: weight loss, heat intolerance, tachycardia, diarrhea, exophthalmos.
• Thyroid storm: fever, HTN crisis, tachy >150.
• Tx: PTU, methimazole, radioactive iodine (avoid pregnancy, limit contact).
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3. Diabetes Insipidus (DI)
• Low ADH
• Polyuria, polydipsia, dilute urine, hypernatremia.
• Urine SG < 1.005
• Tx: Desmopressin (DDAVP), fluid replacement.
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4. SIADH
• Too much ADH
• Oliguria, concentrated urine, hyponatremia, headache, confusion.
• Tx: fluid restriction, hypertonic saline (3%), loop diuretics.
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5. Diabetes Mellitus Type 1
• No insulin → DKA risk
• Sudden onset, weight loss, fruity breath, Kussmaul breathing.
• Tx DKA: IV fluids → regular insulin IV → potassium check.
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6. Diabetes Mellitus Type 2
• Insulin resistance, slow onset.
• HHNS risk: severe dehydration, very high glucose (>600), no ketones.
• Lifestyle: diet + exercise + oral hypoglycemics (metformin – hold 48h before contrast).
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7. Metabolic Syndrome
Remember “We Better Think High”:
• W: Waist circumference ↑
• B: BP ↑
• T: Triglycerides ↑
• H: HDL ↓
• • Fasting glucose >100
Risk for: DM2 + Heart disease
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8. Addison’s Disease
• Low cortisol & aldosterone
• Weight loss, bronze skin, hypotension, hyponatremia, hyperkalemia.
• Addisonian crisis: shock, severe hypotension → IV steroids + fluids.
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9. Cushing’s Syndrome
• High cortisol
• Moon face, buffalo hump, truncal obesity
• Purple striae, thin skin, hyperglycemia, infection risk.
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10. Insulin Therapy
• Rapid: Lispro, Aspart → onset 15 min → give with meal tray.
• Regular insulin: IV in DKA.
• NPH: cloudy, roll, never IV.
• Long-acting: Glargine, Detemir → no peak, don’t mix.
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11. Pheochromocytoma
• Tumor of adrenal medulla → excess catecholamines
• Triad: headache + diaphoresis + palpitations.
• Severe HTN
• Avoid abdominal palpation (can trigger hypertensive crisis)
• Tx: adrenalectomy, alpha blockers (phenoxybenzamine)
