Chapter 6 - Endocrine

Question 1

What are the signs and symptoms of hypothyroidism?

Answer 1

• Tiredness
• Weight gain
• Constipation
• Aches
• Feeling cold
• Dry skin
• Lifeless hair
• Fluid retention
• Mental slowing
• Depression

Question 2

Do diabetics have to inform the DVLA if they drive?

Answer 2

Only if they are taking insulin, due to risk of hypoglycaemia

Question 3

What advice to DVLA give to diabetic drivers needing insulin?

Answer 3

1) if hypoglycaemia episode occurs, drivers must wait till they recover completely before continuing their journey
2) if hypoglycaemia occurs drivers must stop the vehicle in a safe place and stop the engine
3) Drivers treated with insulin should ensure that a safe supply of sugar is always available in the vehicle
4) Drivers should avoid driving if their meal has been delayed
5) Blood glucose should be checked within 2 hours of getting behind the wheel, and every 2 hours whilst driving
6) if BMs are <5mmol/L - drivers advised to take carbohydrates before driving
- if BMs <4mmol/L drivers are advised NOT to drive

Question 4

What is the difference between glucocorticoids and mineralocorticocoids?

Answer 4

Glucocorticoids - mimic cortisol (which supports a variety of important cardiovascular, metabolic, immunologic, and homeostatic functions)

Mineralocorticoids - mimic aldosterone ( Mineralocorticoids are corticosteroids that influence salt and water balances (electrolyte balance and fluid balance)

Both play a role in anti-inflammatory and immunosupressive therapy

Question 5

What are the main side-effects of mineralocorticoids?

Answer 5

Hypertension
Hypernatraemia
Water retention 
Hypokalaemia 
Hypocalcaemia

Question 6

What are the main side-effects of glucocorticoids?

Answer 6

Diabetes
osteoperosis
muscle wasting
psychiatric reactions

Question 7

Why are corticosteroids usually given in the morning as a single dose?

Answer 7

Suppresive action of a corticosteroid on cortisol is LEAST when it is given as a single dose in the morning

Question 8

Why should patients on long term steroids not stop abruptly?

Answer 8

Risk of adrenal suppression - lead to acute adrenal insufficiency, hypotension or death

Therefore it’s important to have a reducing regimen to allow the body to produce normal levels of steroid hormones

Question 9

What are the general side effects of steroids?

Answer 9

Abdominal distention, acute pancreatitis, Cushing’s syndrome, weight gain, water retention, menstrual irregularities, dyspepsia, increased appetite, muscle weakness, glaucoma, aggravation of epilepsy, aggravation of schizophrenia, bruising, impaired healing, nausea

Longer term side effects:

hyperglycaemia, hyperlipidaemia, hypernatraemia, hypokalaemia, psychiatric reactions, osteoperosis, muscle weakness

Question 10

Should steroids be omitted on the day of surgery?

Answer 10

No, normal oral dose should be commenced on the morning of surgery and recommenced after surger

moderate - major surgery: IV hydrocortisone usually used for 24-72 hours after before oral dose is recommenced

Question 11

Patients on long term steroids should be given what?

Answer 11

A steroid card which gives guidance on minimising risk and provides details of prescriber, drug dosage and duration of treatment

Question 12

True or False: Long term steroids may individual more susceptible to infections

Answer 12

True

Question 13

In which types of patients should steroids be withdrawn gradually?

Answer 13

• those who have had 40mg prednisolone (or equivalent) daily for more than 1 week
• those who have been given repeat doses in the evening
• those who have received more than 3 weeks treatment
• those who have recently received repeated courses
• those who have taken a short course within 1 year of stopping long term therapy
• those who have potentially other causes of adrenal insufficiency

Question 14

When does the greatest rate of bone loss occur with daily steroid use?

Answer 14

First 6-12 months, early steps to reduce the risk of osteoperosis should be taken, particularly in elderly patients and post-menopausal women to reduce the risk of osteoperosis

Question 15

What is first line treatment in the prophylaxis and treatment of osteoperosis?

Answer 15

Bispohosphonates - alendronic aicd and risidronate sodium are the drugs of choice

Question 16

Why should strontium ranelate be used with caution?

Answer 16

risk of serious cardiovascular events

Question 17

What has CSM advised regarding the use of HRT for prophylaxis of osteoperosis?

Answer 17

Not recommended as first line therapy for long term prevention of osteoperosis in women over 50.

HRT - is of most benefit if started early in menopause and continued for 5 years, but bone loss resumes on stopping HRT

Question 18

What side-effects are common with bisphosphonates?

Answer 18

Osteonecrosis of the jaw - patients should be advised to maintain good oral hygiene and receive routine dental check ups. Patients advised to report any ear pain, discharge from the ear or an ear infection during treatment with bisphosphonate

severe oseophogeal reactions, patients should be advised to stop taking the tablets if dysphagia, new or worsening heartburn and pain on swallowing occurs

Question 19

How should bisphosphonates be taken?

Answer 19

Tablets should be swallowed whole with plenty of water while sitting or standing upright. Doses should be taken on an empty stomach at least 30minutes before breakfast and patients should remain sitting or standing upright for at least 30minutes after administration

Question 20

Metformin should be used in caution or avoided in patients with renal impairment why?

Answer 20

Increased risk of lactic acidosis

Tx reviewed if eGFR < 45ml/min
Avoid if eGFR <30ml/min