Corrections - Endocrinology

Question 1

Give the suggested IV fluid regime in DKA

Answer 1

1st bag: 1L NaCl 0.9% over 1 hour

2nd bag: 1L NaCl 0.9% over 2 hours

3rd bag: 1L NaCl 0.9% over 2 hours

4th bag: 1L NaCl 0.9% over 4 hours

• Consider adding +40 mmol K+ (KCl) as needed
• When glucose <14 mmol/L, continue NaCl 0.9% (+ KCl) and ADD 10% glucose 125 mL/hour

Question 2

What is the max rate of potassium (KCl) infusion?

Answer 2

20 mmol/hr peripherally

Question 3

Rate of insulin infusion in DKA?

Answer 3

Fixed rate infusion - 0.1 units/kg/hour

Question 4

When should glucose be added to fluids in DKA?

Answer 4

When glucose <14 mmol/l

Question 5

Essential investigations in DKA?

Answer 5

1) FBC & CRP

2) U&Es

3) VBG: bicarb, potassium & pH

4) Urinalysis

5) ECG / CXR / MSU / blood cultures / pregnancy test –> depending on clinical suspicion

Question 6

What is multiple endocrine neoplasia (MEN) type 2?

Answer 6

A genetic condition characterised by neoplasia of the:

a) thyroid (medullary cell carcinoma)
b) parathyroid (parathyroid adenoma)
c) adrenal glands (phaeochromocytoma)

Question 7

MEN type 1 vs MEN type 2?

Answer 7

Type 1 –> 3 P’s
1) Parathyroid (hyperparathyroidism due to parathyroid hyperplasia)
2) Pituitary
3) Pancreas e.g. insulinoma, gastrinoma

Type 2 –> 2 P’s
1) Parathyroid (60%)
2) Phaeochromocytoma
3) Medullary thyroid cancer (70%)

Question 8

What is the most common presentation of MEN 1?

Answer 8

Hypercalcaemia

Question 9

What is the max daily dose of metformin?

Answer 9

2g daily

Question 10

What is acromegaly?

Answer 10

There is excess GH 2ary to a pituitary adenoma in over 95% of cases.

Question 11

Features of acromegaly?

Answer 11

• coarse facial appearance, spade-like hands, increase in shoe size
• large tongue, prognathism, interdental spaces
• excessive sweating and oily skin: caused by sweat gland hypertrophy
• features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia
• raised prolactin in 1/3 of cases → galactorrhoea

Question 12

What are some complications of acromegaly?

Answer 12

• hypertension
• diabetes (>10%)
• cardiomyopathy
• colorectal cancer

Question 13

What are 3 key complications of thyroid eye disease?

Answer 13

1) Exposure keratopathy (most common)

2) Optic neuropathy

3) Strabismus and diplopia

Question 14

What is exposure keratopathy?

Answer 14

Due to eyelid retraction and proptosis (exophthalmos) → cornea becomes excessively exposed, disrupting the normal tear film → dryness, irritation, and corneal ulceration.

Question 15

Features of exposure keratopathy?

Answer 15

• foreign body sensation
• pain
• photophobia
• in severe cases: can lead to corneal scarring and vision impairment

Question 16

What causes optic neuropathy in thyroid eye disease?

Answer 16

Occurs when enlarged extraocular muscles compress the optic nerve at the apex of the orbit.

Question 17

Symptoms of optic neuropathy caused by thyroid eye disease?

Answer 17

• a reduction in visual acuity
• colour vision deficits
• visual field defect

Question 18

Management of optic neuropathy caused by thyroid eye disease?

Answer 18

it requires urgent medical intervention to prevent permanent vision loss.

Question 19

What condition is thyroid eye disease seen in?

Answer 19

Grave’s disease

Question 20

What is the important modifiable risk factor for the development of thyroid eye disease?

Answer 20

Smoking

Question 21

Features of thyroid eye disease?

Answer 21

• exophthalmos
• conjunctival oedema
• optic disc swelling
• ophthalmoplegia
• inability to close the eyelids may lead to sore, dry eyes - if severe and untreated patients can be at risk of exposure keratopathy

Question 22

In management of DKA, what should be added to treatment plan once blood glucose is < 14 mmol/l?

Answer 22

10% dextrose at 125 mls/hr added to saline regime.

Insulin infusion should be continued.

Question 23

Who does 3ary hyperparathyroidism occur almost exclusively in?

Answer 23

Patients with CKD