Endo Flashcards
How do SGLT-2 inhibitors work?
Reversibly inhibit sodium glucose co transporter in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion
Where donSGLT-2 inhibitors work?
Proximal convoluted tubule
Examples of SGLT-2 drugs
Canagliflozin, dapagliflozin, empagliflozin
Adverse effects of SGLT-2 inhibitors
Urinary and genital infections (glycosuria)
Fournier’s gangrene
Normoglycaemic ketoacidosis
Increased risk of lower limb amputation
Causes of Gynaecomastia
Physiological - normal in puberty
Syndromes with androgen deficiency - Kallman’s, Klinefelter’s
Testicular failure - mumps
Liver disease
Testicular cancer
Ectopic tumour secretion
Hyperthyroidism
Haemodialysis
Drugs
Drug causes of Gynaecomastia
Spironolactone - most common
Cimetidine
Digoxin
Cannabis
Finasteride
GnRH agonists - goserelin, buserelin
Oestrogens
Anabolic steroids
Which familial syndrome are linked to phaeochromocytosis
MEN2
Neurofibromatosis
Von-Hippel-Lindau
Symptoms of phaeochromocytoma
Classic triad of headache, sweating and palpitations
Anxiety
Nausea
Tremor
Signs of phaeochromocytoma
HTN
Postural hypotension
Tremor
Pallor
Reflex Bradycardia
Tests for phaeochromocytoma
24hr urinary metenephrines
24hr urinary catecholamines
Blood for plasma free metenephrines
CT imaging
Genetic testing for familial syndromes
Treatment for phaeochromocytoma
Surgery is definitive
Alpha blocker for HTN - phenoxybenzamine
Then beta blocker - propranolol or bisop
What is Kallmann’s syndrome
Delayed puberty secondary to hypogonadotrophic hypogonadism
X linked recessive
Features of Kallmann’s
Delayed puberty
Anosmia
Hypogonadism
Sex hormone levels low
LH/FSH levels low
Normal or above average height
Management of Kallmann’s
Testosterone supplement
Gonadotropin supplement layer if fertility desired
What are the different incontinence types
Overactive bladder/urge - detrusor overactivity, urge is quickly followed by uncontrollable leakage
Stress - from coughing/laughing
Mixed - both urge and stress
Overflow - bladder outlet obstruction (enlarged prostate)
Functional - comorbid physical inability to get there in time - dementia, sedation etc
Investigations for urinary incontinence
Bladder diaries - min 3 days
Vaginal exam
Urine dipstick & culture
Urodynamic studies
Management of urge incontinence
Bladder retraining
Bladder stabilising drugs - antimuscarinics first - oxybutynin, tolterodine, darifenacin
- avoid oxybutynin in old ladies
Mirabegron if anticholinergic side effects
Management of stress incontinence
Pelvic floor muscle training
Surgical procedures
Duloxetine if not for surgery
(Duloxetine - increased synaptic contraction within pudendal nerve = increased stimulation of urethral striated muscles)
Causes of cranial diabetes insipidus
Idiopathic
Post head injury
Pituitary surgery
Craniopharyngiomas
Infiltrative - histiocytosis X, sarcoidosis
DIDMOAD - wolframs
Haemochromatosis
What is diabetes insipidus
Decreased secretion of ADH or insensitivity to ADH
Causes of nephrogenic diabetes insipidus
Genetic - vasopressin receptor most commonly then aquaporin2
Electrolytes - hypercalcaemia & hypokalaemia
Lithium - desensitises kidneys ability to respond to ADH in collecting ducts
Demeclocycline
Tubulo-interstitial disease - obstruction, sickle cell, pyelonephritis
Features of diabetes insipidus
Polyuria
Polydipsia
Investigations of diabetes insipidus
High plasma osmolality
Low urine osmolality
Water deprivation test
Management of diabetes insipidus
Nephrogenic - thiazides and low salt diet
Central - desmopressin
Inheritance pattern of familial hypercholesterolaemia
Autosomal dominant
Simon Broome criteria for diagnosing familial hypercholesterolaemia
Total cholesterol >7.5mmol and LDL >4.9
For definite FH - tendon xanthoma in patients or 1/2 degree relatives or dna evidence
Management of familial hypercholesterolaemia
Specialist referral
High dose statins
Screen relatives
Stop statins 3 months before conception in women
What do statins do
HMG-CoA reductase inhibitors
