Overnight low-dose dex suppression test for Dx High dose Dex suppression test for differentiating - fails to suppress in cushings syndro (ectopic ACTH sec or other abn), suceeds to suppress in Cushings disease - Cortisol up, ACTH up - Ectopic ACTH cushings syndro (SCLC) - Cortisol up, ACTH down - cushions syndro due to other causes (adrenal adenoma) - Cortisol down, ACTH down - cushings disease (pit adenoma)

- IVF - 5-8L isotonic saline - IV insulin inf at 0.1u/kg/hr - Start 10% destrose " 125ml/hr once BM < 14 Continue long acting insulin, stop short acting

Endo Flashcards by Senor Frogs

Acromegaly comp

Comp - HTN, DM, Cardiomyopathy, colorectal Ca

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Acromegaly Ix

Ix - GH fluctuate - not reliable
Raised Serum IGF-1 levels - also to monitor
GH not suppressed after OGTT
MRI - pit tumour

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Acromegal Tx

Trans-sphenoidal surgery = 1st line

If inoperable-
Somatostatin analogues (octreotide)
DA agonist (bromocriptine)

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lethargy, weakness, anorexia, nausea & vomiting, weight loss, pigmented palm creased

primary hypoaldosteronism (addisons)

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hypotension, hyponat, hyperkal, metabolic acidosis

Addisons bloods

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Ix for addisons

Short synACTHen test

Give 250ug ACTH IM - measure plasma cortisol 30 mins after
Normal response = increase of cortisol >500
If cortisol < 500 - adrenal insuff

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Tx for addisons

Hydrocortisone + fludro

(sick day rules, double H)

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Obesity, hypokalaemic metabolic alkalosis, imparied glucose tolerance

Cushings syndrome

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Causes of cushing syndro

ACTH dep: #
Cushings disease = ACTH sec pituitart adenoma
Ectopic ACTH (SCLC)

ACTH indep:
steroids
Adrenal adenoma

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Cushings Ix

Overnight low-dose dex suppression test for Dx

High dose Dex suppression test for differentiating - fails to suppress in cushings syndro (ectopic ACTH sec or other abn), suceeds to suppress in Cushings disease

Cortisol up, ACTH up - Ectopic ACTH cushings syndro (SCLC)
Cortisol up, ACTH down - cushions syndro due to other causes (adrenal adenoma)
Cortisol down, ACTH down - cushings disease (pit adenoma)

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Glucose tollerance interpretation

HbA1c >48 = DM,
41-47 = pre-D

Fasting BM
<6 = normal
6.1-7 = impaired fasting glucose
7+ = DM

Impaired glucose tolerance = OGTT > 7.8 but < 11.1

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Tx for DKA

IVF - 5-8L isotonic saline
IV insulin inf at 0.1u/kg/hr
Start 10% destrose “ 125ml/hr once BM < 14

Continue long acting insulin, stop short acting

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DKA diagnostic and resolution criteria

Dx - Glucose > 11 / known DM, pH < 7.3, Bicarb < 15, Ket > 3

Resolution - pH > 7.3, ketones < 0.6, bicarb > 15

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Tx for diabetic neuropathy

amitriptyline, duloxetine, gabapentin or pregabalin

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Causes fo lower or higher than expected HbA1c

Lower:
Sickle-cell anaemia, GP6D deficiency, Hereditary spherocytosis, Haemodialysis

Higher:
Vitamin B12/folic acid deficiency, Iron-deficiency anaemia, Splenectomy

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Tx for Graves disease

Propranolol helps with symptom control initially

CBZ = 1st line - start at 40 then gradually reduce

Radioiodine if resistant to anti-thyroid therapy

Causes of gynecomastia

Due to inc oestrogen:androgen ration

testicular failure, liver disease

Drugs;
Spironolactine, cimetidine, digoxin, finasteride, GnRH ago (gosrelin)

Causes of hypercalcaemia

Primary hyperparathy
Malig (myeloma, SQLC, bone mets)
Sarcoidosis
Vit D intox
Acromegaly
Thyrotoxicosis
Dehydration
Addisons
Thiazides

Dehydrated, altered consciousness + neurological deficits Raised serum osmo, Ketones <3,no sinificant acidosis

HHS
Hypergly >30

Tx - fluid rep, insulin
VTE prophylaxis (due to hyperviscosity)

Investigation and causes of hypogly

Check insulin and C peptide levels

High insulin, high C pep = exogenous insulin prod - insulinoma, excess sulphonylurea
High insulin, low C pep - excess insulin administration
Low insulin, low c pep - non insulin related cause - alcohol induced, sepsis, adrenal insuff, fasting

muscle twitching, perioral paraesthesia, long QT, depression

Hypocal

Trousseau’s sign: carpal spasm if inflated BP cuff on arm
Chvostek’s sign: tapping over parotid causes facial muscles to twitch

Causes of hypothyroidism

Hashimotos (AI) - most common cause in UK
Iodine def (most common cause worldwide)

DQT, post thyroidectomy
Lithium, CBZ, Amiodarone

Delayed puberty in boy, low sex hormones, low LH/FHS, cleft lip/palate, anosmia

Kallmans (hypogonadotropic hypogonadism)
X linked rec
Tx = testosterone supp

delayed puberty, lack of secondary sexual charachteristics, tall, small/firm testes, gynaecomastia

Kleinfelters (XXY)

Multiple endocrine neoplasia suppary

MEN type 1 (3Ps) Parathyroid (hyper), Pituitary tumour (prolactonoma), Pancreatic tumours (insulinoma) - most common Pc = hypercal Men 2a Parathyroid tumour, Phaeocromocytoma Men 2b - Phaeocromocytoma, marfanoid habitus

Confusion, hypothermia, thyroid issues

Myxoedema coma Tx - IV thyroid rep, IVF, Iv corticosteroids

Obesity classification by BMI

BMI < 18.5 = underweight Obese C1 = 30-35, 2 = 35-40, 3 = 40+

Orlistat criteria

= pancreatic lipase inhbitor BMI >28 with associated RFs OR BMI > 30

Linagliptin criteria

GLP-1 mimetic BMI >35 and DM/pre-D

sustained HTN, headaches, palpitations, sweating, anxiety

Phaeocromocytoma Ix - 24 hr urinary metanephrines Tx - alpha blocker (phenoxybenzamine) then BB (propranolol) then surgery

Treatment resistant hypertension, muscle weakness, metabolic alkalosis, hypokalaemia

Primary hyperaldosteronism (conns) Causes - bilat adrenal hyperplasia (most common) Adrenal adenoma Ix -raised aldosterone: renin ratio High-resolution CT abdo Tx - if adrenal adenoma - remove Bilat hyperplasia - aldosterone antagonist (spiro)

Ix and Tx Primary hyperparathy

Ix - raised Ca, low Phos, raised/inappropriately normal PTH Xray - pepper-pot skull Tx = total parathyroidectomy

Causes of excess prolactin

_> loss of libido/amenorrhoea, galactorrhoea Cause; prolactinoma, pregnancy, excess stress, acromegaly, PCOS, primary hypothy Drugs - metoclopramide, domperidone, haloperidol

SGLTi MAO and SEs

reduce glucose absorption and increases urinary glucose excretion Ses - urinary and genital inf, fournier gangrene, weight loss

Tx for subclinical hypothyroidism

If TSH > 10 and T4 normal on 2 separate occasion - offer levo If TSH 5.5-10 and T4 normal on 2 separate: - if <65 - offer 6 mo course if symptomatic - If > 65 watch and wait

MAO and SEs sulphonylureas (eg glimepiride)

MOA - inc panc insulin secretion Ses - weight gain, hypoglycaemia NB - avoid in preg and breastfeeding

MAO and SEs pioglitazone

Agonist of PPAR0gamma receptor SEs - weight gain, liver imp (monitor LFTs), fluid retention, bladder ca CI if Hf of heart failure

Fever > 38.5, tachycardia, N/V, confusion, HTN, agitation, jaundice, heart failure

Thyroid storm Tx - IV propranolol PTU

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Endo Flashcards

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