Endo 2 Flashcards
DM
c-peptide and specific antibodies
in type 1 low / no c peptide due to absolute insulin deficiency
diagnosing t2DM
asymptomatic but abnormal HBA1c?
repeat then can be confirmed T2dm
monitoring in t1dm?
before each meal and before bed
in pts with t2dm when would you immediately add empagliflozin?
SGLT-2 should be introduced at any point they develop CVD
/ have high risk of CVD
if there is active eye disease in hyperthyroid what tx should be avoided?
radioiodine therapy should be avoided as it can worsen eye disease
contraindications for metformin?
lactic acidosis and eGFR <30
HF, renal impairment, acute MI, resp failure, severe infection
first line tx for peripheral neuropathy?
amitriptyline
duloxetine
gabapentin
pregabalin
when should you treat subclinical hypothyroidism?
> 10 TSH on 2 separate occasions
3 months apart
when starting antidiabetic medication for someone with CVD RF
start metformin titrate dose
then add SGLT2 inhibitor
lagophthalmos?
incomplete eyelid closure
proptosis
bulging eyes
most common cause of primary hyperaldosteronism
bilateral adrenal hyperplasia
Cushing syndrome
biochemical abnormality
hypokalaemia
metabolic alkalosis
> increased renal mineralocorticoid action from excess cortisol
impaired glucose tolerance
gliclazide is a?
sulfonyurea
what is an example of SGLT-2 inhibitor?
dapagliflozin
empagliflozin
features of primary hyperaldosteronism?
1st line ix?
HTN
hypokalaemia
plasma aldosterone/renin ratio
> high aldosterone and low renin
> High resolution CT abdo
adrenal vein sampling
Where does a phaeo arise from?
adrenal medulla
releases metanephrine : adrenaline
Investigating adrenal insufficiency?
9am cortisol
100-500
then short synacthen test
cortisol measured
ACTH adminstered
cortisol measured again
cortisol should rise
short Synacthen test
plasma cortisol am measured
Synacthen 250ug IM
check cortisol again (normally should rise in response (>500)
exogenous insulin overdose
serum insulin is high
c-peptide is low
insulinoma findings?
high insulin
high c peptide
neuroglycopenic symptoms occur at?
<2.8 mmol/l
what is acropachy?
autoimmune reactions in nails > soft tissue swelling under the nail bed
symptomatic of GRaves
nail pitting is associated with?
psoriasis
addisonian crisis
Mx?
IV hydrocortisone 100mg
or IM
1 litre normal saline over 30-60 minutes
continue hydrocortisone 6 hourly
causes of addisonian crisis?
sepsis
surgeryg
adrenal haemorrhage
steroid withdrawal
pregnancy and addisons?
immune reg changes during pregnacy
what is ketonaemia?
> 3mmol/l
ketonuria on urine dip
Graves disease is managed?
secondary care - carbimazole
but in primary care
beta blocker can be started to manage adrenergic symptoms
if rly bad whilst awaiting referal can start carbimazole
in DKA mx when giving fluid
how to replace?
systolic BP <90
>90
<90
500ml of0.9% nacl over 5 mins
> 90
1L 0.9% NaCl / hour
unrecordable blood glucose means?
too high blood sigar
diabetic neuropathy how to manage?
refer to diabetic foot centre
complication of hypothyroidism?
mx?
myxoedema coma
thyroid hormone replacement and hydrocortisone given
