Endo Flashcards
Flushing, diarrhoea, bronchospasm, tricuspid stenosis, hypotension, pellagra →
Ix?
Tx?
CARCinoid:
- Cutaneous flushing
- Asmathic wheezing
- RHF (tricuspid valve)
- Cramping & diarrhoea
carcinoid with liver mets
urinary 5-HIAA
somatostatin analogues e.g. octreotide
Acromegaly is associated with which heart condition
cardiomyopathy
In type 1 diabetics, recommend monitoring blood glucose __________ (frequency)______
at least 4 times a day, including before each meal and before bed
liraglutide, exenatide are
GLP-1
___(drug)______ reduces cerebral oedema
dexamethasone
elderly man admitted to hospital with pneumonia
TSH normal, T4 reduced
what do you do?
nothing, sick euthyroid is common in the elderly and unwell
Headaches, amenorrhoea, bitemporal superior quadrantanopia–>
polactinoma
Addisonian crisis- tx?
IV hydrocortisone
how often must T1 diabetics monitor their blood glucose?
at least 4 times a day, including before each meal and before bed
tx for bilateral adrenocortical hyperplasia?
aldosterone antagonist e.g. spironolactone (cant do surgery as cant completely remove pts ability to produce aldosterone and cortisol)
Endocrine parameters reduced in stress response:
Insulin
Testosterone
Oestrogen
triad of sweating, headaches, and palpitations in association with severe hypertension - Ix?
Phaeochromocytoma - plasma and urinary metanephrines
pioglitazone is C/I in
HF
The early stages of diabetic nephropathy are associated with________, in contrast to most other causes of CKD
enlarged kidneys
what BMI does someone have to be to qualify for GLP memetic tx?
35
what can you use to differentiate between the different types of diabetes?
- c-peptide levels
- diabetic specific antibody levels (ab to glutamic acid decarboxylase or anti-GAD)
Thyrotoxic storm is treated with ___________________________________
beta blockers, propylthiouracil and hydrocortisone
clues that it’s secondary HTN and not primary
- persistently high or malignant blood pressure
- labile blood pressure measurements
- young age and electrolyte abnormalities
what is tertiary hyperparathyoidism?
Tertiary hyperparathyroidism usually occurs after prolonged secondary hyperparathyroidism – the
glands become autonomous, and so produce excessive PTH even after the cause of hypocalcaemia (in this case, CKD 4) has been corrected; this then causes the hypercalcaemia that typifies tertiary hyperparathyroidism.
Hyperparathyroid: which disease presents with
- Raised PTH, raised Ca, low phosphate
- Raised PTH, low/normal Ca, raised Phosphate, low vitamin D
- Raised/normal Ca, raised PTH, low/normal phosphate, normal/low vit D, raised ALP
primary
secondary
tertiary
- complication of treating hyperNa
- complication of treating hypoNa
- cerebral oedeoma
- Central pontine myelinolysis
how to distinguish between unilateral adenoma and bilateral hyperplasia in Conn’s?
adrenal venous blood sampling
Boerhaave’s syndrome
transmural oesophageal perforation secondary to an episode of forceful emesis
This condition typically presents with a triad of vomiting/retching; severe retrosternal chest pain, typically radiating to the back and subcutaneous emphysema
what abx increases risk of cranial HTN?
doxycycline
All proximal scaphoid pole fractures require ________
surgical fixation
The PTH level in primary hyperparathyroidism may be ___________
normal
features of acromegaly
- coare facial apperance
- spade-like hands
- increase in shoe size
- large tongue, prognathism, interdental spaces
- excessive sweating and oily skin
- features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia
- galactorrhoea
complications of acromegaly
hypertension
diabetes
cardiomyopathy
colorectal cancer
Ix for acromegaly
- IGF-1 + OGTT
- OGTT should suppress GH but won’t
Tx options of acromegaly
1st line: acromegaly
2nd line: somatostatin analgoue (octreotide), GH receptor antagonist (pegivisomant)
causes of hyperprolactinoma
- pituitary adenoma
- hypothyroidism
- PCOS
- SE of haloperidol
SGLT2 inhibitors should be given in addition to metformin if:
- pt has high risk of developing CVD (QRISK>10%)/CHF
T2DM sick-day rules with medications
- don’t stop insulin
- stop metformin/sulfonylureas
Pathophysiology of DKA
uncontrolled lipolysis which results in an excess of free fatty acids that are ultimately converted to ketone bodies
Hashimoto’s thyroiditis is associated with ________
MALT lymphoma
endo syndromes that can cause hyperCa
acromegaly, thyrotoxicosis, Addison’s
following a change in thyroxine dose thyroid function tests should be checked after
8-12 weeks
what reduces the absorption of levothyroxine?
iron, calcium carbonate
give at least 4 hours apart
investigation of hypopituitarism
insulin stress test
IV insulin given, GH and cortisol levels measured
with normal pituitary function GH and cortisol should rise
what medications can reduce hypoglycaemic awareness?
beta-blockers
3 types of MEN + inheritence pattern
AD
MEN1: 3Ps - hyperparathyroid, pituitary (prolactinoma), pancreas (insulinoma, gastrinoma –> peptic ulcer)
MEN2: parathyroid, phaeochromocytoma
MEN3: phaeochromocytoma
myxoedema coma - Px and Tx?
Px: confusion, hypothermia
Tx: IV fluids, levothyroixine, corticosteroids [to cover for ?Addisons]
alpha-blocker example
phenoxybenzamine
Ix if you suspect a pituitary adenomna
- MRI head with contrast
- formal visual field testing
- pituitary blood profile (incl GH, prolactin, ACTH, FSH, LH, TFTs)
Most common cause of primary hyperaldosteronism
bilateral adrenal hyperplasia
Tx for primary Conn’s?
spironolactone
how does sick euthyroid syndrome present
TSH inappropriately normal, thyroxine and T3 low
No tx, recover when recover from systemic illness
sublinical hyperthyroidism: Ix findings and Px? Why is it bad?
Ix: LOW TSH, normal free thyroxine
Px: multiondular goitre in elderly females
Bad bc AF, osteoporosis
sublinical hypothyroidism: Ix findings and Px? Why is it bad?
Ix: TSH raised, T3 and T4 normal
risk of progressing to over hypothyroidism
thyroid cancers - P-FMAL
Papillary (most common, young females)
Follicular
Medullary (secrete calcitonin, part of MEN2)
Anaplastic
Lymphoma (associated with Hashimoto’s thyroiditis)
what do you replace first in secondary hypothyroidism?
steroids before the thyroxine
thyrotoxic storm: in addition to beta-blockers and anti-thyroid drugs, what do you give?
dexamethasone
toxic multinodular goitre - Ix and Tx
Ix: nuclear scintigraphy reveals patchy uptake
Tx: radioodine therapy
________ is the key parameter to monitor in patients with hyperosmolar hyperglycaemic state
Serum osmolality
causes of prolactin - all ‘Ps’
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone
Patients with type I diabetes and a BMI > 25 should be considered for ______ in addition to insulin
metformin
Over-replacement with thyroxine increases the risk for _________
osteoporosis
Asymptomatic patients with an abnormal HbA1c or fasting glucose
must be confirmed with a second abnormal reading before a diagnosis of type 2 diabetes is confirmed
_______________ is a cause of cranial diabetes insipidus
Hereditary haemochromatosis
The diagnosis of type 2 diabetes mellitus (T2DM) can only be made if
there is one elevated glucose measurement and the presence of symptoms, or if two glucose measurements at separate time points show elevated glucose.
Glitazones - associated with what SE
fractures
_______ (diabetic drug) ____ should be stopped following a myocardial infarction
Metformin (risk of lactic acidosis)
IGT itself can be defined by OGTT 2h glucose of
between 7.8 and 11.1mmol/L alone.
A fasting glucose greater than or equal to_____________ implies impaired fasting glucose (IFG)
6.1 but less than 7.0mmol/l
