Endo Flashcards
Which type of meds does MODY typically respond well to?
Sulfonylureas
MEN-1 features?
parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
pituitary (70%)
pancreas (50%, e.g. Insulinoma, gastrinoma)
also: adrenal and thyroid
How to screen for medullary thyroid cancer recurrence?
Serum calcitonin
Define impaired fasting glucose?
6.1 - 7mmol/L
Define impaired glucose tolerance at 2 hours?
Fasting plasma glucose <7mmol/L
At 2 hours 7.8 - 11.1
Which type of anti diabetic med is contraindicated in HF?
Pioglitazone (thiazolidinedione)
Severity of Graves’ eye disease? NO SPECS
No signs / symptoms
Only signs (e.g: upper lid retraction)
Signs & symptoms (including soft-tissue involvement)
Proptosis
Extra-ocular muscle involvement
Corneal involvement
Sight loss due to optic nerve involvement
5Bs of thyroid storm tx?
B- B-Blockers
B- Block synthesis (thionamides - carbimazole)
B- block release (wolff-chiakoff)- iodine
B- Block T4-T3 conversion (PTU, steroids, and even amiodarone- again wolff chiakoff)
B- Block enterohepatic circulation (i.e. bile acid sequestrants)
What acid base disturbance does Cushing’s syndrome cause?
Hypokalaemic metabolic alkalosis
Sick euthyroid syndrome findings?
low T3/T4 and normal TSH with acute illness
De Quervain’s thyroiditis tx?
Simple analgesia
SEs of thiazolidinediones? e.g. piaglitazone?
Weight gain Liver impairment Fluid retention Increased risk of fractures Increased risk of bladder cancer
If a patient is admitted with DKA, what should happen to their long acting basal insulin?
It should be continued alongside IV insulin
How to stop IV insulin in a patient admitted with DKA?
Make sure they eat breakfast/lunch
Inject SC prandial insulin
Stop IV insulin 30 mins later
What does a high TSH but a normal fT4 suggest?
erratic compliance with thyroxine tx: patients who don’t take the medication regularly, but remember to take it immediately before a blood test is due
Features of acromegaly?
Diabetic retinopathy Prognathism Macroglossia Cardiomegaly Hepatosplenomegaly Colonic polyps
Causes of pseudo-Cushings syndrome?
Depression
Obesity
Alcohol excess
Liver enzyme inducers - phenytoin, phenobarbital and rifampicin
What should be used for alpha blockade in phaeo tx?
phenoxybenzamine
Test for carcinoid syndrome?
24hr urine 5HIAA
What scan for phaeo?
MIBG
DKA diagnostic criteria?
pH <7.3 and/or bicarbonate <15mmol/L.
Blood glucose >11mmol/L or known diabetes mellitus.
Ketonaemia >3mmol/L or significant ketonuria ++ on urine dipstick
How does Alcoholic ketoacidosis present?
low or normal glucose levels and usually occurs due to patients being able to tolerate oral nutrition resulting in a state of starvation with associated ketoacidosis
1st line mx for acromegaly? What is the alternative 1st line?
Trans-sphenoidal surgery
Octreotide (if surgery not suitable)
MEN 2A features?
Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma
Men 2B features?
Mucosal neuroma
Marfanoid appearance
Medullary thyroid carcinoma
Phaeochromocytoma
Thyroglobulin can be used as a tumour marker for which cancers?
Papillary
Follicular
Which thyroid cancer metastasises to lung and bone?
Follicular
Which thyroid cancer has orphan eyes appearance?
Papillary
most common cause of primary hyperaldosteronism?
Bilateral idiopathic adrenal hyperplasia
TD2M: What to do if a triple combination of drugs has failed to reduce HbA1c AND BMI >35?
metformin + sulfonylurea + GLP-1 mimetic is recommended, particularly if the BMI > 35
Causes of raised prolactin?
pregnancy prolactinoma physiological polycystic ovarian syndrome primary hypothyroidism phenothiazines
Other drugs: metoclopramide domperidone chlorpromazine haloperidol very rare: SSRIs, opioids
Most common cause of primary hyperparathyroidism?
Solitary parathyroid adenoma
Alcoholic ketoacidosis mx?
infusion of saline and thiamine
What cardiac abnormalities are associated with this carcinoid syndrome?
Pulmonary stenosis and tricuspid insufficiency
Thyrotoxic storm tx?
beta blockers, propylthiouracil and hydrocortisone
Causes of gynaecomastia?
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
Drug causes of gynaecomastia?
spironolactone (most common drug cause) cimetidine digoxin cannabis finasteride GnRH agonists e.g. goserelin, buserelin oestrogens, anabolic steroids
Tx for myxoedema coma?
IV corticosteroids + IV thyroid hormone replacement
MOA of gliptins?
dipeptidyl peptidase-4, DPP-4 inhibitors increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown
Incretins then increase insulin secretion by binding to beta cells on pancreas
What is likely to cause osteomalacia + hypokalaemia
type 2 renal tubular acidosis
Which type of renal tubular acidosis causes hyperkalaemia?
Type 4 renal tubular acidosis
How to tell the difference between MODY and LADA?
LADA –> decreased insulin –> increased glucagon –> increased ketones
MODY –> normal insulin –> normal glucagon –> normal ketones
MODY is essentially T2 in young whereas LADA is T1 in elderly
Risks of correcting sodium levels too quickly?
Hyponatraemia correction - osmotic demyelination syndrome
Hypernatreamia correction - cerebral oedema
Mx of peripheral neuropathy?
amitriptyline (don’t prescribe if BPH), duloxetine, gabapentin or pregabalin
How often must Insulin-dependent diabetics check their blood glucose when driving?
Every 2 hours
How many units of insulin in most standard preparations?
100U in 1ml
What can can reduce the absorption of levothyroxine and how can you prevent it?
Taking iron/calcium tablets
Take them 4 hours apart
Diagnostic criteria for HHS?
hypovolaemia
hyperglycaemia (blood sugar > 30mmol/L) without significant ketones/acidosis
serum osmolality > 320mosmol/kg
Which conditions predispose to pseudogout?
Acromegaly
Wilson’s
Tx for gynaecomastia?
Aromatase inhibitors
Reversible cause tx
Addison’s patient with intercurrent illness - what to do with their dose of steroids?
double the glucocorticoids
keep fludrocortisone dose the same
Congenital adrenal hyperplasia biochemical abnormalities?
Increased plasma 17-hydroxyprogesterone levels
Increased plasma 21-deoxycortisol levels
Increased urinary adrenocorticosteroid metabolites
Tx for hyperparathyroidism?
- Total parathyroidectomy
2. Cinacalcet
How does Cinacalcet work?
Mimics action of calcium in parathyroid gland - reducing PTH and therefore Calcium
Which form of Addison’s is associated with hyperpigmentation?
Primary Addison’s
Causes of Addison’s?
Primary causes: tuberculosis metastases (e.g. bronchial carcinoma) meningococcal septicaemia (Waterhouse-Friderichsen syndrome) HIV antiphospholipid syndrome
Secondary causes: pituitary disorders (e.g. tumours, irradiation, infiltration)
1st line Tx of prolactinoma?
Cabergoline
Trans-sphenoidal surgery if unsuccessful
What to do if TSH is between 4 - 10mU/L and the free thyroxine level is within the normal range?
<65 years + symptomatic: trial of levothyroxine - if no improvement in symptoms, stop levothyroxine
Older people (especially >80 years): ‘watch and wait’ strategy - generally avoid tx
Asymptomatic: observe and repeat TFTs in 6 months
What to do if TSH is > 10mU/L and the free thyroxine level is within the normal range?
<=70: start tx even if asymptomatic
Older (especially >80): ‘watch and wait’
Features of thyroid storm?
hyperthermia
tachycardia
jaundice
altered mental status
Indications for surgery in primary hyperparathyroidism?
Elevated serum corrected Calcium >0.25mmol/L above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations below peak bone mass (T score lower than -2.5)
Hypercalcaemia mx?
IV fluids
If Ca >3: + IV bisphosphonate
osteoporosis guidelines if a postmenopausal woman has a fragility fracture?
put on bisphosphonates (there is no need for a DEXA scan)
What to prescribe alongside bisphosphonates?
vitamin D and calcium supplementation should be offered to all women unless confident they have adequate calcium intake and are vitamin D replete
Investigation findings in Kallman syndrome?
hypogonadotropic hypogonadism
Low testosterone
Low/inappropriately normal FSH and LH
Investigation findings in Klinefelter’s syndrome?
hypergonadotropic hypogonadism
Low testosterone
High FSH and LH
How to determine cause of Cushing’s?
If low dose doesn’t suppress cortisol - CUSHING SYNDROME
High dose helps determine specific cause
Cortisol and ACTH suppressed = pituitary adenoma
Cortisol NOT SUPPRESSED, ACTH SUPPRESSED = adrenal adenoma
Neither suppressed = Ectopic
Breastfeeding women with hyperthyroidism. Tx?
PTU
What is Nelson’s syndrome?
enlargement of an adrenocorticotropic hormone-producing tumour in the pituitary gland due to loss of negative feedback, following surgical removal of both adrenal glands in a patient with Cushing’s disease
