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(No page numbers: we didn’t get this note package until the next class)
THYROID:
Women outstrip men in benign conditions of the thyroid, but men outstrip women in malignant conditions.
Specific conditions of the thyroid that affect elderly (>50): Toxic multinodular goiter.
20-30 years old, tends to be more autoimmune conditions.
Graves is associated with pernicious anemia, rheumatoid arthritis.
Find a cold nodule? Red flag for cancer.
ADRENAL:
Patient may present with diffuse pigmentation on flexor surfaces, around scars, areola, mucus membranes.
DDX: systemic sclerosis due to thickening of the skin.
Buccal fat pad enlargement: cushings
Cushings: thinning of skin, bruises easily.
Lab tests? Serum ACTH and Serum cortisol are most useful.
Serum ACTH:
Decreased: steroids suppress adrenals. Estrogen, alcohol, insulin: may elevate ACTH.
Serum cortisol:
Lowest at 12pm.
First sign of loss of diurnal variation: assess via salivary cortisol.
Addison’s
Hyperpigmentation (primary) ex. JFK
Electrolyte tests are off in primary. In secondary Addison’s they are normal.