ENDO

Question 1

Diagnosis addisons

Answer 1

Short synacthen test/ ACTH stimulation test

Question 2

management of primary hyperaldosteronism

Answer 2

adrenal adenoma: surgery (laparoscopic adrenalectomy)
bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

Question 3

HBA1C targets

Answer 3

48 if on metformin only
53 if on any drug on hypoglycemia or if hba1c has risen to 58 on one drug

Question 4

C peptide levels are typically low/ high in t1dm

Answer 4

Low

Question 5

What is sick euthyroid syndrome

Answer 5

low T3/T4 and normal TSH with acute illness

Question 6

Drugs causing gynaecomastia

Answer 6

spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

Question 7

Sulfonylurea work by

Answer 7

increasing pancreatic insulin secretion and hence are only effective if functional B-cells are present. On a molecular level they bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells

Question 8

Sulfonylurea side effects

Answer 8

hypoglycaemic episodes (more common with long-acting preparations such as chlorpropamide)
weight gain

Rarer adverse effects
hyponatraemia secondary to syndrome of inappropriate ADH secretion
bone marrow suppression
hepatotoxicity (typically cholestatic)
peripheral neuropathy

Sulfonylureas should be avoided in breastfeeding and pregnancy.

Question 9

Management of hypoglycemia

Answer 9

in the community (for example, diabetes mellitus patients who inject insulin):
Initially, oral glucose 10-20g should be given in liquid, gel or tablet form
Alternatively, a propriety quick-acting carbohydrate may be given: GlucoGel or Dextrogel.
A ‘HypoKit’ may be prescribed which contains a syringe and vial of glucagon for IM or SC injection at home
in a hospital setting:
If the patient is alert, a quick-acting carbohydrate may be given (as above)
If the patient is unconscious or unable to swallow, subcutaneous or intramuscular injection glucagon may be given.
Alternatively, intravenous 20% glucose solution may be given through a large vein

Question 10

Metformin mechanism

Answer 10

acts by activation of the AMP-activated protein kinase (AMPK)
increases insulin sensitivity
decreases hepatic gluconeogenesis
may also reduce gastrointestinal absorption of carbohydrates