Endo Flashcards
How often is HbA1c checked?
Every 3-6 months until stable
Then 6 monthly
What are the target HbA1cs?
Lifestyle: <48mmol
Lifestyle + metformin: <48mmol
Otherwise: <53mmol
What is the metformin pathway of T2DM management?
- Metformin
- Metformin + gliptin/sulfonylurea/pioglitazone/SGLT2 inhibitor
- 3 of the above OR insulin
- Metformin + sulphonylurea + GLP-1 mimetic
What is the HbA1c threshold for adding another hypoglycaemic agent?
58mmol
What is the level of HbA1c dependent on?
Red blood cell lifespan
Average blood glucose concentration
Which conditions mean HbA1c is lower than expected?
Sickle cell
G6PD deficiency
Hereditary sphreocytosis
Which conditions mean HbA1c is higher than expected?
Vit B12/folic acid def
IDA
Splenectomy
(increased RBC lifespan)
How do you calculate the average plasma glucose from HbA1c?
2x HbA1c - 4.5
What is T2DM is a symptomatic patient?
Fasting glucose >7mmol
Random or post OGTT >11.1
What is T2DM in an asymptomatic patient?
FG>7 or random/post OGTT>11.1
On 2 separate occasions
What is impaired fasting glucose?
Fasting glucose 6.1-7mmol
What is impaired glucose tolerance?
Fasting glucose <7mmol AND
OGTT 2 hour value 7.8-11.1mmol
What can be added in T1DM patients with BMI over 25?
Metformin
Which is the first hormone secreted in response to hypoglycaemia?
Glucagon
What are the characteristics of MODY?
Patients younger than 25 years
Autosomal dominant
Lack of ketosis
Good response to sulfonylurea
What is the most common type of MODY?
MODY 3 - defect in HNF-1 alpha gene
What is MODY 3 associated with?
Increased risk of HCC
What is the pathophysiology of DKA?
Uncontrolled lipolysis which results in an excess of free fatty acids which are converted to ketone bodies
What is the diagnostic criteria of DKA?
Glucose >11mmol or known DM
pH<7.3
Bicarb<15
Ketones>3 or urine ketones +++
What is the management of DKA?
Fluid resuscitation +/- K
IV insulin 0.1IU/kg/hr
Once BM<15 - start 5% dextrose
What should happen with a patient’s normal insulins when in DKA?
Continue long acting insulin
Omit short acting insulin
When should a patient be switched to normal insulins post DKA?
Eating and drinking
After first meal
Name 5 complications of DKA.
Hypokalaemia Cerebral oedema Arrhythmias ARDS AKI
What is the pathophysiology of HHS?
Hyperglycaemia –> osmotic diuresis
Volume depletion –> raised serum osmolality –> hyperviscosity
electrolyte disturbances
What is the diagnostic criteria of HHS?
Hypovolaemia
Hyperglycaemia >30mmol without ketonaemia or acidosis
Raised serum osmolality >320mosmol/kg
What is the treatment of HHS?
IV 0.9% saline
Fixed rate insulin 0.05IU/kg/hr
What are the features of thyroid MALT lymphoma?
Painless goitre
Non-functional thyroid tumour
90% Hashimoto’s thyroiditis patients have which antibody?
anti-TPO
How does subacute De Quervain’s thyroiditis present?
Occurs following a viral infection
Typically presents with hyperthyroidism, painful goitre, raised ESR
How is De Quervain’s thyroiditis diagnosed?
Thyroid scintigraphy - globally reduced uptake of iodine-131
What is the treatment of De Quervain’s thyroiditis?
Self limiting
NSAIDs for pain
What are the biochemical abnormalities in non thyroidal illness?
Low TSH, low thyroxine, low T3
What is the most common type of thyroid cancer?
Papillary
What cell does medullary thyroid cancer originate from?
C cells (parafollicular) which produce calcitonin
Which syndrome is medullary thyroid cancer associated with?
MEN 2a and 2b
What is the treatment of papillary and follicular thyroid cancer?
Total thyroidectomy
Followed by radio-iodine I-131
Yearly thyroglobulin levels
Which antibodies are diagnostic of Graves’ disease?
TSH receptor stimulating antibodies (present in 90%)
What percentage of Graves’ patients have eye problems?
30%
What are other signs of Graves’ disease?
Pretibial myxoedema
Thyroid acropachy, which is a triad of: digital clubbing, soft tissue swelling of hands and feet, periosteal new bone formation
What percentage of Graves’ patients have positive anti-TPO and anti-thyroglobulin antibodies?
Anti-TPO: 75%
Anti-thyroglobulin: 30%
What is the cause of subclinical hyperthyroidism?
Excessive thyroxine
Multinodular goitre
What are risk factors for thyroid eye disease?
Smoking
Radio-iodine
What is the treatment of thyroid eye disease?
Steroids
Topical lubricants
Radiotherapy
What is the treatment of myxoedemic coma?
Hydrocortisone and levothyroxine
Treated as presumed adrenal insufficiency until ruled out
What are the features of MEN type 1?
Pancreatic endocrine tumours
Pituitary tumours
Primary hyperparathyroidism
What are the features of MEN type 2a?
Primary hyperparathyroidism
Phaeochromocytoma
Medullary thyroid cancer
RET oncogene
What are the features of MEN type 2b?
Marfinoid body habitus Neuromas Phaeochromocytoma Medullary thyroid cancer RET oncogene
What is the most common cause of primary hyperaldosteronism?
Bilateral idiopathic adrenal hyperplasia
What are the other causes of primary hyperaldosteronism?
Adrenal adenoma (Conn's) Adrenal carcinoma