Endo Flashcards
What are the HLA associations for T1DM?
HLA-D3 and -D4
Which antibodies are found in T1DM?
Anti-islet, anti-GAD
What are the criteria for diagnosing diabetes/IFG/IGT?
- Diabetes
- Fasting 7, or 11.1 2 hrs after OGTT
- HbA1c 48 or 6.5%
- IFG: 5.6-7.0
- IGT: 7.8-11
What are the secondary causes of DM?
- Drugs: steroids, anti-HIV, atypical neuroleptics, thiazides
- Pancreatic: CF, chronic pancreatitis, HH, pancreatic Ca
- Endo: phaeo, cushings, acromegaly, T4
- Glycogen storage diseases
- Klinefelter’s, Turner’s, Down’s, Wolfram
What are the aims for capillar blood glucose in DM?
Fasting: 4.5-6.5
2h post prandial: 4.5-9
What is the goal for HbA1c in DM?
<45-50 (7.5-8%)
What are the stages of diabetic retinopathy?
- Background
- Dots: microaneurysms
- Blot haemorrhages
- Hard exudates: yellow lipid patches
- Pre-proliferative
- Cotton wool spots (retinal infarcts)
- Venous beading
- Haemorrhage
- Proliferative
- New vessels
- Pre retinal or vitreous haemorrhage
- Maculopathy
- Decreased acuity may be the only sign
- Hard exudates within one disc width of macula
What is Whipple’s triad?
Hypoglycaemia if:
- Low plasma glucose (3mM or less)
- Symptoms consistent with hypoglycaemia
- Relief of symptoms with glucose administration
What are the causes of fasting hypoglycaemia?
- EXPLAIN
- Exogenous drugs
- Pituitary insufficiency
- Liver failure
- Addison’s
- Islet cell tumours (insulinomas)
- Immune (insulin receptor antibodies e.g. Hodgkin’s)
- Non pancreatic neoplasms e.g. fibrosarcomas
Which MEN has insulinomas?
MEN1
What are the features of MEN1?
- Pituitary adenoma: prolactin or GH
- Parathyroid adenoma/hyperplasia
- Pancreatic tumours: gastrinoma or insulinoma
What are the features of MEN2?
- Thyroid medullary carcinoma
- Adrenal phaeochromocytoma
- Hyperthyroidism
- Marfanoid habitus
What are the adverse effects of Thiazolidinediones e.g. pioglitazone?
- weight gain
- liver impairment: monitor LFTs
- fluid retention - therefore contraindicated in heart failure. The risk of fluid retention is increased if the patient also takes insulin
- recent studies have indicated an increased risk of fractures
- bladder cancer: recent studies have shown an increased risk of bladder cancer in patients taking pioglitazone
Most common cause of thyrotoxicosis?
Grave’s
Which glucose/HbA1c level defines pre diabetes?
Fasting plasma glucose of 6.1-6.9 mmol/l
HbA1c 42-47 mmol/mol (6.0-6.4%)
What is the T2DM blood pressure target?
no organ damage: < 140 / 80
end-organ damage: < 130 / 80
What are the drug causes of raised prolactin?
metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids
What do Thiazolidinediones do?
agonists to the PPAR-gamma receptor - reduce peripheral insulin resistance
What are the indications for treatment of subclinical hypothyroidism?
TSH > 10
thyroid autoantibodies positive
other autoimmune disorder
previous treatment of Graves’ disease
What should you do to the steroid doses in Addison’s with an intercurrent illness?
Double the hydrocortisone only
Which diabetic drugs can cause DKA?
Serious and potentially life-threatening cases of diabetic ketoacidosis (DKA) have been reported in patients taking SGLT2 inhibitors canagliflozin, dapagliflozin or empagliflozin for type 2 diabetes.
Which has a tender goitre, Hashimoto’s or De Quervain’s?
De Quervain’s
Which drug interacts with levothyroxine?
Ferrous sulphate - decreases absorption
What are the contraindications to SGLT2 inhibitors?
Recurrent thrush - because it increases glucose in the urine
Which ECG changes are seen in hypocalcaemia?
Common: Corrected QT interval prolongation
Rare: Atrial fibrillation or torsade de pointes
What electrolyte/pH abnormality is seen in Cushings?
hypokalaemic metabolic alkalosis
At what HbA1c threshold should you add a second drug for a patient on metformin?
only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)
