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MedEd > Diabetes and Pituitary > Flashcards

Diabetes and Pituitary Flashcards

1
Q

Cause of T1DDM?

A

pancreatic islet beta-cells desstroyed by autoimmmune

ABSOLUTE insulin sinsufficiency -> lipolysis and ketogenesis

Associated with HLADR3/4

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2
Q

Cause of T2DM?

A

Obesity, HTN, inactivity, and disturbed lipids

Reduced peripheral sensitivty to insulin and reduced insulin production over time

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3
Q

T1DM presentation?

A

5-15YO
Polyuria and polydipsia (osmotic diuresis)
Weight loss from muscle and fat breakdown

DKA: abdo pain, N&V, tachypnoea (kussmaul), coma

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4
Q

T2DM presentation?

A

Asymptomatic
RFs present, obesity, Fhx, south asian, black, age,

Fatigue, poludipsia, polyria, infections e.g. fungal, cellulitis
Acanthosis nigricans

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5
Q

Which patients should HbA1c not be used in?

A

All children/young, high risk of acutely ill, medication that can rise glucose e.g. steroids, antipsychotis, acute pancreatic damage patients

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6
Q

T1DM management?

A

Basal bolus insulin

Long = glargine subcut OD)
Short = lispro/aspart subcut pre meal
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7
Q

T2DM glycaemic Mx?

A

1) Metformin if HbA1c >48
2) Add another drug (Dpp4i, pioglitazone, SU, SGLT-2i)
3) Add further drug

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8
Q

T2DM lipid Mx?

A

Atorvastatin 20mg OD if 10year CV>10%

80mg if IHD/CVD/peripheral arter disease

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9
Q

T2DM BP Mx?

A

1)ACEi or ARB
2) Add CCB or thiazide
3) Add ccb or thiazide
4) if K+>4,5, spironolactone
if less then alpha blocker/beta blocker

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10
Q

Example of each glycaemic medication?

A

DPP4i = sitagliptin
Pioglitazone
Sulfonylurea = glicazide
SGLT = dapaglifozin

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11
Q

Platelet Mx for T2DM?

A

Aspiring 75mg for patients with IHD/CVD/perpheral artery disease

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12
Q

what are the micro/macro complications of DM?

A

Micro = retinopathy, nephropathy, neuropathy

Macro = IHD, Cerebrovascular disease, peripheral artery disease

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13
Q

Causes of hypoglycaemia?

A

Missed meals, inadequate snacks, unaccustomed exercise, alcohol, some drugs e.g. SU, SGLT2, inappropriate insulin regime

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14
Q

Signs of hypoglycaemia?

A

Palpitations, tremor, seating, pallor, anxiety, drowsiness, confusion, altered behaviour, coma

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15
Q

Tx for hypoglycaemia?

A

Conscious = oral glucose and complex carborhydrates

Impaired = PArenteral 1mgglucagon IM
2nd line = IV dextrose (10% glucosie infusion)

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16
Q

DKA triad?

A

Hyperglyaemia, ketonaemia and metabolic acidosis

Also dehydration

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17
Q

S+S and Ix DKA?

A

Collapse and confusion, dehyrated, kussmaul breathing, abdo pain, N+V

Ketones >3mmol?l, pH <7.3 (high anion gap metabolic acidosis, plasma glucose >11

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18
Q

Mx of DKA?

A

Fluids started (normal saline unless K+ <5.5. then potassium chloride)
IV insulin after fluids
Include dextrose
Treat underlying cause

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19
Q

Breakdown of diabetic retinopathy?

A

Background = blot and dot haemorrhages/hard exudates

Pre-proliferative = background + cotton wool spots

Proliferative = pre-proliferative + new vessels on disk (neovascularization)

maculopathy = Previous + hard exudates near macula

20
Q

Mx of diabetic retinopathy?

A

background = improve glycaemic control

Pre and proliferative = pan-retinal photocagulation

Maculopathy = grid of photocoagulation

21
Q

What is neovascularization associated with?

A

Retinal detachment and vitreous haemorrhage -> visual loss

22
Q

Diabetic nephropathy features and Ix?

A

Albuminuria, reduction of eGFR, associated with retinopathy

1) urinarlysis and eGFR
Biopsy gold standard and show Kimmelstiel-wilson nodules (mesangiel expansion)

23
Q

Mx for diabetic nephropathy?

A

Improve glycaemic control and ACEi/ARB

24
Q

Breakdown of diabetic neuropathy?

A

Caused by blockage of vasa nervorum

Perpheral neuropathy = loss of sensation (feet) and may not sense injury. Monofilament exam and loss of anklejerk/vibration/fractures (charcots joint)

Mononeuropathy = sudden motor loss usually e.g. wrist drp, foot drop, 3rd nerve palsy (down and out)

Autonomic neuropathy = dysphagia, delayed gastric empyting, bladder dysfunction, postural hypotension and cardiac autonomic supply

25
Q

Mx of diabetic neuropathy?

A

Glycaemic control, if painful then neuropathic pain agent e.g. duloxetine, pregabalin or gabapentin

26
Q

Causes of cranial DI?

A

pituitary tumour/surgery, TBI, infection e.g. meningitis, sarcoidosis, SAH

27
Q

Causes of nephrogenic DI?

A

Lithium therapy, electrolyte imbalance e.g. Increase ca, decreased K, idiopahic, ureteric obstruction ,
Inherited AVPV2 gene

28
Q

DI presentation?

A

polyuria and nocturia, polydipsia, dehydration so tachycardia, reduced tissue turgor, dry mucous membranes
Cause e.g. bitemporal hemianopia

29
Q

IX for DI?

A

General = U&Es, Na but increased urea, glucose to exclude DM

Water deprivation test with desmopressin is diagnostic

30
Q

Mx for DI?

A

1) treat the cause
2) Crnial = intranasal desmopressin (less water)
3) nephrogenic = thiazide diurteic or NSAIDs (these inhibit prostaglandin and prostaglandin inhibits AHD)

31
Q

Causes of SIADH?

A 
CNS = SAH, stroke, tumour, TBI
Pulmonary = pneumonia, bronchietasis
Malignancy = Small cell lung cancer
Drugs = carbamazepine, SSRI
Idiopathic
32
Q

Features of SIADH?

A

expansion of ECF volume, decreased plasma osmolality and hyponatraemia, concentrated urine and increased Na excretion

33
Q

Mx for SIADH?

A

Treat the cause
Immediate fluid resus for hyponatraemia

oral demeclocyline or IV vaptans

34
Q

Features of volume statuses with hyponatraemia?

A

Hypovolaemic = tachy, reduced skin turgor, dry, low bp, postural hypotension and urine sodium low

Euvolaemic = normal or cause

Hypervolaemia = peripheral oedema, bibasal crackles and raised JVP

35
Q

Causes of each volume status with hyponatraemia?

A

Hypo = vomiting/diarrhoea + diuretics

Eu = Hypothrypid (TFTs)
Adrenal insufficiency (short synacthen)or SIADH (decreased plasma and increased urine osmolality

hyper = heart failure, cirrhosis of nephrotic syndrome

36
Q

Mx for volume statues>

A

Hypo = volume replacement with 0.9% saline

Other two si fluid restriction and treat underlying cause

37
Q

What do rapid Na+ changes cause?

A

if seizing/reduced GCS + hyponatraemic = give hypertonic 3% saline

Usually slow changes to prevent central pontine myelinlysis = quadriplegia, pseudobulbar palsy, seizures, coma and death

38
Q

Causes of hypernatraemia?

A

GI losses and sweat loss, rena losses such as osmotic diuresis (HHS) or DKI

Sodium Overload in Cushings, primary aldosteronism, iatrogenic

39
Q

Mx of hypernatraemia?

A

Correct water deficit - 5% dectrose
Correct ECF volume - 0.9% saline
Measure Na every 4-6 hours

40
Q

Examples of pituitary adenomas?

A

Acromegaly (GH secreting)
Prolactinoma
Cusings

41
Q

Causes of hyperprolactinaemia?

A

Pregnancy and breast feeding

Prolactinoma or other pituitary adenoma (stalk compression), oprimary hypothyroidism

High prolactin suppresses GnRH pulsatility

42
Q

S+S of hyperprolactinaemia?

A

Men = libido loss, erectile dysfunction, infertility, rare galactorrhoea

Women = galactorrhoea, secondary amenorrhoea/oligomenorrhoea, libido loss, infertilyi

Mass effect = heachache/visual field deficit

43
Q

Ix for hyperprolactinaemia>

A

Pregancy test
TFTs
Basal serum prolactin (if >60000mU/L) = prolactinma
MRI

44
Q

Prolactinoma Mx.

A

Dopamine agonists e.g. oral bromocriptine and cabergoline

45
Q

what is a hyperosmolar hyperglycaemic state (HHS)

A

hyperglycaemia but no ketonaemia so same presentation as DKA bar abdo pain as no ketonaemia

MedEd (32 decks)

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