Diabetes and Endo

Question 1

How to counsel a patient to take insulin for T1DM?

Answer 1

https://www.uptodate.com/contents/type-1-diabetes-insulin-treatment-beyond-the-basics

Question 2

What are the causes of galactorrhoea

Answer 2

prolactinoma
breast surgery
brain tumours
pregnancy
medication induced - morphine, SSRIs, risperidone

Question 3

What drugs do you start someone with T2DM on?

Answer 3

metformin etc
aspirin
statin
BP

Question 4

Diff between HHS and DKA?

Answer 4

HHS comes on over days
hypovolaemia + hyperglycaemia + high osmolality (normal ketones and pH)
aggressive fluids, insulin only if ketonuria or acidosis

Question 5

Pituitary adenoma?

Answer 5

Pituitary adenomas typically cause symptoms by:
excess of a hormone (e.g. Cushing’s disease due to excess ACTH, acromegaly due to excess GH or amenorrhea and galactorrhea due to excess prolactin)
hypopituitarism - no functioning adenoma

a pituitary blood profile (including GH, prolactin, ACTH, FSH, LSH and TFTs)
formal visual field testing
MRI brain with contrast

surgery first line for non-functioning but bromocriptine/cabergoline first line for prolactinoma

Question 6

Acromegaly

hypogonadism

PCOS

hypopituitarism

SIADH

Carcinoid syndrome

Hypoparathyroidism

hypocalcaemia signs

phaeo

addison’s vs conn’s

Answer 6

transsphenoidal surgery -> octreotide
carpal tunnel, diabetes, hypertension, cardiomyopathy, colorectal cancer

ED (men), amenorrhoea (females)
mumps
PCOS, POI
COCP
hyperprolactinaemia
turner’s

rotterdam criteria is the triad (need 2/3)

congenital, tumour e.g. non functioning adenoma, sheehan’s, TB

treat cause, fluid restriction, to 1L per day, otherwise give oral demeclocycline

high 5-HIAA
Mx: octreotide, mets treatment

post surgical, post radiation, magnesium problems

chvostek’s, troussaeu,, - facial twitch and carpal tetany due to tight BP cuff, cramps, paraesthesia
give calcichew, calcium gluconate

alpha blockers -> beta blockers -> surgery

addisons: plasma ACTH and synACTHen test, hydro and fludro
conn’s: CT abdo, adrenal vein sampling, adrenelectomy/spironolactone

Question 7

What are the causes of gynaecomastia?

Answer 7

• physiological: normal in puberty
• syndromes with androgen deficiency: Kallman’s, Klinefelter’s
• testicular failure: e.g. mumps
• liver disease
• testicular cancer e.g. seminoma secreting hCG
• ectopic tumour secretion
• hyperthyroidism
• haemodialysis
  drugs: spironolactone, cimetidine, digoxin, GnRh agonists (goserelin)

Question 8

What are the causes of raised prolactin?

Answer 8

• metoclopramide, domperidone
  
  • phenothiazines
  • haloperidol
    very rare: SSRIs, opioids