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Endocrine > diabetes and endocrinology > Flashcards

diabetes and endocrinology Flashcards

1
Q

what chemical marker is picked up on pregnancy test?

A

HCG

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2
Q

what produces HCG?

A

-implanted fertilised ovum

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3
Q

what hormones does the corpus luteum produce?

A

progesterone

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4
Q

what hormone does the ovum produce?

A

-oestradiol

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5
Q

what hormones does the placenta produce?

A
  • human placental lactose (hPL)
  • placental progesterone
  • placental oestrogen
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6
Q

during pregnancy what does the pituitary produce?

A

-prolactin

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7
Q

what affect does placental progesterone have on blood glucose?

A

-it causes insulin resistance in mother which raises blood glucose and causes gestational diabetes

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8
Q

what types of diabetes may occur in pregnancy?

A
  • type 1
  • type 2
  • GDM (gestational diabetes mellitus)
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9
Q

how to tell the difference between gestational diabetes and type 2?

A
  • gestational will start during pregnancy and end once delivery where as type 2 continues after delivery
  • usually 6 week post natal fasting glucose or GTT is done
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10
Q

when does fetal organogenesis occur?

A

-at 5 weeks (sometimes earlier)

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11
Q

what are some complications associated with type 1 and type 2 diabetes in pregnancy?

A
  • congenital malformation
  • prematurity
  • intra uterine growth retardation (IUGR)
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12
Q

what are some complications associated with gestational diabetes in pregnancy?

A
  • macrosomia (>90 centile for size which can cause problems with delivery)
  • polyhydramnios
  • intrauterine death
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13
Q

what are some complications for the neonates if the mother had diabetes during pregnancy?

A
  • respiratory distress (due to immature lungs)
  • hypoglycaemia (Can cause fits)
  • hypocalcaemia (can cause fits)
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14
Q

why can GDM cause macrosomia?

A

-maternal hyperglycaemia causes foetal hyperglycaemia which causes foetal hyperinsulinemia (insulin is a major growth factor causing macrosomia)

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15
Q

why can the mother have diabetes cause neonatal hypoglycaemia?

A
  • the mother has always had high blood glucose and once that gets cut off it takes a while for the baby to adjust to regulating their own blood glucose levels
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16
Q

what is the managent of type 1 and type 2 diabetes in pregnancy?

A
  • pre-pregnancy counselling (good sugar control preconception)
  • folic acid 5mg (recommended 3 months prior to pregnancy)
  • if T2DM consider changing tablets to insulin
  • regular eye checks every 10 weeks (pregnancy accelerated retinopathy)
  • avoid ACEI and statin (use Labetalol, Nifedipine and methyldopa for controlling BP)
  • start aspiring 150mg at 12 weeks
17
Q

what is the blood glucose goal for pre and 2h post meal aim in pregnant diabetics?

A

pre meal < 4- 5.5 mmol/l

2hr post meal <6-6.5 mmol/l

18
Q

what drugs are given to T1DM during pregnancy?

A

-insulin

19
Q

what drugs are given to T2DM during pregnancy?

A
  • metformin

- usually require insulin later on

20
Q

what drugs are given to GDM during pregnancy?

A
  • lifestyle changes

- metformin but if not well controlled may need insulin later on

21
Q

what affect does hypo and hyper thyroidism have on fertility?

A

-reduced fertility

22
Q

what occurs to thyroid during pregnancy?

A
  • increased demand on thyroid
  • thyroid increases in size
  • more T4 produced to maintain normal concentration
23
Q

what should be done for patients on thyroxine once they know they’re pregnant?

A

-increase it

24
Q

what is the management of hypothyroidism in pregnancy?

A
  • increased thyroxine dose by 25mg as soon as pregnancy expected
  • check TFTs monthly for first 20 weeks then 2 months until tern
  • aim for TSH <3 mU/l
25
Q

what are the risks of untreat hypothyroidism in pregnancy?

A
  • increased abortion
  • pre eclampsia
  • abruption
  • postpartum haemorrhage
  • preterm labour
  • foetal neuropsychological development
26
Q

what is the IQ like for children whos mothers had hypothyroidism compared to those with normal mothers?

A

-children with mothers who have hypothyroidism on average have lower IQs

27
Q

what occurs to TSH levels in pregnant women and why?

A

-hCG levels increase which increases thyroxine and causes TSH to be suppressed

28
Q

what affect does Grave’s have on TSH levels?

A

Grave’s increases thyroxine levels which causes a decrease in TSH

29
Q

what risks does hyperthyroidism have with pregnancy?

A
  • infertility/ ammenorheoa
  • spontaneous miscarriage
  • stillbirth
  • thyroid crisis in labour
  • transient neonatal thyrotoxicosis
30
Q

what causes thyrotoxicosis in pregnancy?

A
  • Graves’ disease
  • TMNG toxic adenoma
  • thyroiditis
31
Q

what is the management of hyperthyroidism in pregnancy?

A

Wait and see how it goes (Graves may improve during pregnancy)

  • BB if needed
  • low dose anti thyroid drugs
  • propylthiouracil 1st trimester
  • carbimazole 2/3rd trimester
32
Q

what medication would be given to a pregnant women with hyperthyroidism in her first trimester?

A

propylthiouracil

33
Q

what medication would be given to a pregnant women with hyperthyroidism in her 2nd/3rd trimester?

A

-carbimazole

34
Q

what can carbimazole cause if given in 1st trimester of pregnancy?

A

-emryopathy

35
Q

what risk does propylthiouracil have when given to a pregnant woman?

A

-risk of liver toxicity (best to avoid using this drug however must use in 1st trimester over carbimazole)

36
Q

what are some side effects of carbimazole in pregnant women?

A
  • can cause embryopathy in 1st trimester
  • scalp abnormalities
  • GI abnormalities
  • Choanal & oesophageal atresia
37
Q

what causes neonatal hyperthyroidism?

A

TRAb antibodies can cross the placenta and cause neonatal hyperthyroidism (so check TRAb antibodies ideally during third trimester)

Endocrine (53 decks)

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