Endocrine
NCLEX Clinical Study Booklet · 12 cards
Diabetes Mellitus.
GlucoseWhat is Diabetes Mellitus?
- Chronic hyperglycemia from insulin deficiency or resistance.
- Type 1: no insulin (autoimmune). Type 2: insulin resistance.
What are the Causes / Risk Factors?
- Type 1: autoimmune beta-cell destruction
- Type 2: obesity, inactivity, genetics
- Metabolic syndrome
What are the Symptoms?
- 3 P's: polyuria, polydipsia, polyphagia
- Fatigue, blurred vision
- Weight loss (T1), slow healing
- Recurrent infections
How is it Diagnosed?
- Fasting glucose ≥126
- A1C ≥6.5%
- Random glucose ≥200 with symptoms
- OGTT
What is the Treatment?
- Type 1: insulin (required)
- Type 2: diet, exercise, metformin, ± insulin
- Blood glucose monitoring
- Foot care; A1C goal <7%
NCLEX TipThe 3 P's (polyuria, polydipsia, polyphagia) are classic. Type 1 always requires insulin.
Diabetic Ketoacidosis.
EmergencyWhat is Diabetic Ketoacidosis?
- Severe insulin deficiency → hyperglycemia + ketosis + acidosis.
- Usually Type 1. A medical emergency.
What are the Causes / Risk Factors?
- Missed insulin
- Infection / illness (stress)
- New-onset Type 1
- Undiagnosed diabetes
What are the Symptoms?
- Glucose >250 with ketones
- Kussmaul respirations (deep, rapid)
- Fruity (acetone) breath
- Dehydration, polyuria
- N/V, abdominal pain
- Altered LOC
How is it Diagnosed?
- Glucose >250
- Metabolic acidosis (pH <7.3, ↓HCO₃)
- Ketones (blood/urine)
- ↑anion gap; check K⁺
What is the Treatment?
- IV fluids (0.9% NS) FIRST
- IV regular insulin (only insulin given IV)
- Replace potassium (insulin drives K⁺ into cells)
- Monitor glucose, K⁺, pH
NCLEX TipDKA order: fluids → insulin → potassium. Watch potassium closely as insulin shifts K⁺ into cells.
Hyperosmolar Hyperglycemic State.
EmergencyWhat is Hyperosmolar Hyperglycemic State?
- Extreme hyperglycemia WITHOUT significant ketosis.
- Usually Type 2. Very high mortality.
What are the Causes / Risk Factors?
- Infection / illness
- Poor fluid intake (elderly)
- Undiagnosed/undertreated Type 2
- Certain medications
What are the Symptoms?
- Glucose often >600
- Severe dehydration
- Altered LOC, seizures
- NO significant ketones/acidosis
- Neurologic deficits
How is it Diagnosed?
- Glucose >600
- ↑serum osmolality
- Minimal ketones, pH >7.3
- Electrolytes
What is the Treatment?
- Aggressive IV fluids (priority)
- IV insulin
- Electrolyte replacement
- Treat underlying cause
NCLEX TipHHS = very high glucose + severe dehydration but NO ketoacidosis. The priority is aggressive fluids.
Hypoglycemia.
EmergencyWhat is Hypoglycemia?
- Blood glucose <70 mg/dL.
- The brain lacks glucose — rapid onset and dangerous.
What are the Causes / Risk Factors?
- Too much insulin / oral agents
- Missed meals
- Excess exercise
- Alcohol
What are the Symptoms?
- Shaky, diaphoretic
- Tachycardia, palpitations
- Confusion, irritability
- Hunger, dizziness
- Seizures, coma (severe)
How is it Diagnosed?
- Blood glucose <70
- Symptom resolution with glucose
What is the Treatment?
- Conscious: 15 g fast carbs (juice, glucose tabs), recheck in 15 min
- Unconscious: IV D50 or IM glucagon
- Follow with complex carb + protein
- Identify the cause
NCLEX TipRule of 15: give 15 g fast carbs, recheck in 15 min. If unconscious → IV dextrose or IM glucagon.
Hyperthyroidism / Graves'.
ThyroidWhat is Hyperthyroidism / Graves'?
- Excess thyroid hormone → hypermetabolism.
- Graves' disease is the most common cause.
What are the Causes / Risk Factors?
- Graves' (autoimmune)
- Toxic nodular goiter
- Thyroiditis
- Excess thyroid hormone intake
What are the Symptoms?
- Weight loss, heat intolerance
- Tachycardia, palpitations, HTN
- Nervousness, tremor
- Exophthalmos (Graves')
- Diarrhea, insomnia
- Goiter
How is it Diagnosed?
- ↓TSH, ↑T3/T4
- Thyroid scan
- Thyroid antibodies (Graves')
What is the Treatment?
- Antithyroid drugs (methimazole, PTU)
- Beta blockers (symptom control)
- Radioactive iodine, thyroidectomy
- Watch for thyroid storm (emergency)
NCLEX TipHyperthyroid = everything speeds up. Thyroid storm (high fever, tachycardia, agitation) is life-threatening.
Hypothyroidism / Myxedema.
ThyroidWhat is Hypothyroidism / Myxedema?
- Insufficient thyroid hormone → hypometabolism.
- Severe form: myxedema coma.
What are the Causes / Risk Factors?
- Hashimoto's thyroiditis (autoimmune)
- Thyroidectomy / radioactive iodine
- Iodine deficiency
- Certain medications
What are the Symptoms?
- Weight gain, cold intolerance
- Fatigue, bradycardia
- Constipation
- Dry skin, hair loss
- Depression, slowed cognition
- Nonpitting edema (myxedema)
How is it Diagnosed?
- ↑TSH, ↓T3/T4
- Thyroid antibodies
- Lipid panel (↑cholesterol)
What is the Treatment?
- Levothyroxine (lifelong) — morning, empty stomach
- Start low in elderly/cardiac patients
- Monitor TSH
- Watch for myxedema coma (hypothermia, ↓LOC)
NCLEX TipLevothyroxine is lifelong — take in the morning on an empty stomach, same time daily. Don't stop abruptly.
Cushing's Syndrome.
AdrenalWhat is Cushing's Syndrome?
- Excess cortisol.
- Cushing = Cortisol excess.
What are the Causes / Risk Factors?
- Long-term corticosteroid use (common)
- Pituitary adenoma (Cushing disease)
- Adrenal tumor
- Ectopic ACTH
What are the Symptoms?
- Moon face, buffalo hump
- Central obesity, thin extremities
- Purple striae, easy bruising
- Hyperglycemia, HTN
- Muscle weakness, osteoporosis
- Immunosuppression
How is it Diagnosed?
- ↑cortisol (24h urine, salivary)
- Dexamethasone suppression test
- ACTH level, imaging
What is the Treatment?
- Taper exogenous steroids (never stop abruptly)
- Surgery (tumor)
- Monitor glucose, BP, infection
- Fall/fracture precautions
NCLEX TipCushing's = too much cortisol (moon face, buffalo hump, striae, hyperglycemia). Never stop steroids abruptly.
Addison's Disease.
AdrenalWhat is Addison's Disease?
- Adrenal insufficiency — too little cortisol and aldosterone.
- Addison = Absent adrenal hormones.
What are the Causes / Risk Factors?
- Autoimmune adrenal destruction
- Abrupt steroid withdrawal
- Infection, hemorrhage
- Tuberculosis
What are the Symptoms?
- Fatigue, weakness
- Weight loss, anorexia
- Hyperpigmentation (bronze skin)
- Hypotension, salt craving
- Hyponatremia, hyperkalemia
- Hypoglycemia
How is it Diagnosed?
- ↓cortisol
- ACTH stimulation test
- Electrolytes (↓Na, ↑K)
What is the Treatment?
- Lifelong cortico-/mineralocorticoid replacement
- Increase dose during stress/illness
- Addisonian crisis: IV hydrocortisone + fluids (emergency)
- Teach: never skip steroids
NCLEX TipAddisonian crisis = severe hypotension/shock → emergency IV hydrocortisone and fluids. Increase steroids during stress.
SIADH.
PituitaryWhat is SIADH?
- Too much ADH → water retention and dilutional hyponatremia.
- SIADH = Soaked inside (fluid overload).
What are the Causes / Risk Factors?
- Small cell lung cancer
- CNS disorders, head injury
- Certain medications
- Pulmonary disorders
What are the Symptoms?
- Hyponatremia (confusion, seizures)
- Concentrated urine, low output
- Weight gain WITHOUT edema
- Headache, nausea
- Muscle cramps
How is it Diagnosed?
- ↓serum sodium & osmolality
- ↑urine osmolality/sodium
- Fluid overload signs
What is the Treatment?
- Fluid restriction
- Hypertonic saline (severe, slowly)
- Treat the cause
- Monitor Na⁺, neuro status, daily weight
NCLEX TipSIADH = fluid retention and LOW sodium. Restrict fluids and correct sodium slowly.
Diabetes Insipidus.
PituitaryWhat is Diabetes Insipidus?
- Too little ADH → excessive water loss.
- DI = Dry inside (dehydration). The opposite of SIADH.
What are the Causes / Risk Factors?
- Pituitary/hypothalamic damage (central)
- Kidneys unresponsive to ADH (nephrogenic)
- Head injury, surgery, tumors
What are the Symptoms?
- Polyuria (large volumes of dilute urine)
- Extreme thirst (polydipsia)
- Dehydration
- Hypernatremia
- Weight loss
How is it Diagnosed?
- ↑serum sodium & osmolality
- ↓urine specific gravity & osmolality
- Water deprivation test
What is the Treatment?
- Desmopressin (DDAVP) for central DI
- Replace fluids
- Monitor I&O, daily weight, Na⁺
- Ensure access to water
NCLEX TipDI = dilute urine, high output, high sodium (dry). Treat central DI with desmopressin (DDAVP).
Hyperparathyroidism.
ParathyroidWhat is Hyperparathyroidism?
- Excess PTH → ↑calcium, ↓phosphorus.
- Pulls calcium out of the bones.
What are the Causes / Risk Factors?
- Parathyroid adenoma
- Chronic kidney disease (secondary)
- Hyperplasia
What are the Symptoms?
- Hypercalcemia: 'bones, stones, groans, moans'
- Bone pain, fractures
- Kidney stones
- Constipation, fatigue
- Muscle weakness
How is it Diagnosed?
- ↑PTH, ↑calcium, ↓phosphorus
- Bone density scan
- Parathyroid imaging
What is the Treatment?
- Parathyroidectomy
- Hydration; ↓calcium intake
- Bisphosphonates
- Monitor cardiac & renal function
NCLEX TipHyperparathyroid = high calcium. Watch for kidney stones, fractures, and cardiac changes.
Pheochromocytoma.
AdrenalWhat is Pheochromocytoma?
- Catecholamine-secreting adrenal (medulla) tumor.
- Episodic massive catecholamine release.
What are the Causes / Risk Factors?
- Adrenal medulla tumor (usually benign)
- Genetic syndromes (MEN)
What are the Symptoms?
- Severe episodic HYPERTENSION
- Pounding headache
- Palpitations, tachycardia
- Diaphoresis
- Anxiety, tremor
How is it Diagnosed?
- 24h urine catecholamines/metanephrines
- Plasma metanephrines
- CT/MRI of adrenals
What is the Treatment?
- Surgical removal (adrenalectomy)
- Alpha blockers first, then beta blockers
- AVOID palpating the abdomen (triggers release)
- BP monitoring
NCLEX TipPheochromocytoma = episodic severe HTN, headache, palpitations, sweating. Avoid palpating the abdomen.
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