Endo Flashcards
4 Cardinal symptoms of diabetes
Polyuria
Polydipsia
(Lethargy
Weight loss) less common in type 2
What are the primary causes of Diabetes
1 - autoimmune desturction of beta islet cells - check anti islet and anti GAD
2 - Low exercise with obesity and high calorie and alcohol excess
What are the secondary causes of diabetes
Drugs: Steroids, Tacrolimus, HAART, atypical neuroleptics, thiazides
Pancreatic: CF, Chronic Pancreatitis, HH, Ca
Endo: Cushings, phaeo, acromegaly
How do you remember the management for diabetes
CCCC Control - glucose Complications Macro and micro Competency - can they do it right, education re injection sites Coping - psychologivcally, work etc.
What are the macrovascular complications of diabetes
Look at monitoring pulses in limbs, blood pressure and listening to the heart.
IHD, PVD, stroke
(recurrent UTI)
What are the MICROvascular complications of diabetes
Retinopathy, neuropathy, nephropathy
What do you give when a diabetic is 50
aspirin or before if they have other risk factors and been diabetic 10 years
What are the contraindications for metformin?
GFR less than 30
Tissue hypoxia - sepsis or MI
pre GA and iodinated contrast
side effects of metformin
GI sx - Nause and vomiting, diarrhoea and abdo pain
Which diabetic drugs increase insulin production
sulphonylureas - gliclazide/ glibenclamide
meglitinides - nateglinide
DPP-4 inhibitors - sitagliptine/linagliptine
GLP-1 Agonists - exenatide/ liraglutideboth via increases in GLP-1 effects
They also reduce glucagon secretion and delay gastric emptying
Which diabetic drugs increase the bodies sensitivity to insulin?
Biguanides - metformin
thiazolodinediones - piolitazone
liraglutide
GLP1 RA
Sitagliptine
DPP-4 inhibitor
Exenatide
GLP1RA
pioglitazone
thiazolidinedione
gliclazide
sulphonylurea
gibenclamide
sulphonylurea
Name 2 types of insulin regime
Biphasic and Basal Blous
Biphasic - Twice daily (before breakfast and dinner) mixture of long and short acting insulin often used for children and those with regular daily routine.
Basal bolus - one long acting before bed plus short acting before each meal with dose adjustment depending on the meal and associated with better outcomes
Causes of hypoglycaemia
EXPLAIN Overuse of insulin/ sensitisers with exercise Drugs Pituitary insufficiency Liver Failure Insulinoma Addisons imune non pancreatic
Measure glucose, insulin, Ketones, Cpeptide
What are the common symptoms in acromegaly
headache, amenhorrhoea arthralgia carpal tunnel bitemporal hemianopia face change, shoes and rings dont fit snoring parasthesias
May have accompanying hyperprolactinaemia - loss of libido, galactorrhoea, amehorrhoea, erectile dysfunction
What are the causes of acromegaly
99% pituitary adenoma
GnRH secretion from carcinoid tumour
signs of acromegaly
large soft tissues - wide nose big ears prognathia macroglossia wide teeth goitre with a raised JVP myopathy - standing up ABDO - organomegaly, acanthosis nigricans
How do you diagnose acromegaly
IGF-1 raised screenign test
OGTT with GH (fails to suppress)
Complications of acromegaly
Endocrine - impaired glucose tolerance or DM
Cardiovascular - high BP, LVH, cardiomyopaty, IHD, Stroke
Neoplasia - Colorectal cacer
treatment for acromegaly
Trans sphenoidal excision
somatostatin analogues - actreotide
GH antagonists - pegvisomant
What are the causes of diabetees insipidus
Cranial Idiopathic 50% Congenital Tumours Trauma
Nephrogenic
Drugs: lithium, vaptans
psychological
Name 6 causes of acanthosis nigricans
Endocrine: Obesity and metabolic syndrome Acromegaly Cushings Diabetes mellitus
Malignancy:
pancreatic
gastric
Name 4 causes of macroglossia
downs syndrome
acromegaly
hypothyroidism
amyloidosis
How would you complete the examination of someone with acromegaly
Look at previous photos ECG - LVH+ischemia Urine dip glucose Colonoscopy if older epworth sleepiness score OSA
what are the complications of trans phenoidal excision of an adenoma
meningitis
panhypopituitarism
diabetes insipidus
Which hormones are released from the anterior pituitaru
ACTH/MSH TSH LH/FSH GH Prolactin
posterior pituitary hormones
ADH(vasopressin)
Oxytocin
What are the causes of a bitemporal hemianopia
Pituitary adenoma(compresses from below therefore loss is from the top down) Craniopharyngeoma(compresses from top therefore loss is from the bottom up)
Causes of a high prolactin
Dopamine antagonists - anti emetics and antipsychotics
Name 3 signs of diabetes mellitus seen in the hands
BM pricks on fingers
Granuloma annulare - also associated with autoimmune thyroiditis and hyperlipidaemia. seen on the hands
Cheiroarthropathy - prayer sign, cannot fully extend the wrists due to thivkened skin - tight and waxy
Name the causes of a Marcus Gunn pupil (RAPD)
CAC VISION - MS and Glaucoma most common Congenital Alcohol - other drugs Compresssion - Glaucoma, optic glioma, pituitary adenoma Vascular: DM/GCA/embolic event inflamatory - optic neuritis MS Sarcoid Infection - TB, herpes zoster, syphilis Odema - papillodema Neoplastic infiltration - lymphoma/leukaemia
Most common causes of marcuss gunn
glaucoma and MS
What type of goitre does graves disease give you?
diffusely enlarged with increased radioiodine uptage
what percentage of thyrotoxicosis does graves make up?
60%
What is graves associated with?
Type 1 diabetes
vitiligo
addisons disease
What would you see on the technecium uptake scan in thyroiditis
reduced uptake
What would you see on the uptake scan of a toxic multinodular goitre?
hot areas or nodules. almost always benign, however the goitre may contain other non functioning nodules which are malignant. also known as plummers disease. autonomously functioning nodules
How do you treat thyrotoxicosis?
Medical - beta blockers for symptomatic reduciton
Carbimazole - inhibits TPO can titrate or block and replace
Radioactive iodine - non pregnant or lactating however they often become hypothyroid rather than euthyroid
Surgical thyroidectomy - damage to recurrent laryngeal nerve(2% risk)
Which conditions have a thyrotoxic phase?
hashimotos thyroiditis
de quervains thyroiditis
subacute lymphocytic thyroiditis
What is the most common cause of hypothyroidism in the UK?
atrophic thyroiditis
What antibodies are present in atrophic thyroiditis?
Anti TPO and Anti TSH
What are the primary causes of hypothyrodisism?
Iodine deficiency (world comonest) Atrophic thyroiditis (UK) Hashimotos thyroiditis (TPO +ve) subacute thyroiditis de quervains drugs: carbimazole, amiodarone, lithium thyroid agenesis
secondary causes include: post surgery or radiotherapy/radioiodine
What kind of goitre do you get in atrophic thyroiditis
no goitre - you get a lymphocytic infiltrate
Do you get a goitre in hashimotos thyroiditis?
Yes due to the regeneration after atrophy
How long does it take to see an improvement with levothyroxine treatment?
2 weeks
How do you manage myxodemic coma
Bloods correct hypoglycaemia Slowly replace t3/t4 IV hydrocortisone manage hypothermia and heart failure
what diseases is atrophic thyroiditis assocaited with?
Other autoimmune diseases namely addisons, pernicious anaemia and vitiligo.
What kind of goitre is seen in de quervains
diffuse PAINFUL
often witha preceeding viral infection such as coxsackie - giant cells on histology
What is the management for subacute lymphocytic thyroiditis?
self limiting
-typicaly seen post partum
What is the most common type of thyroid carcinoma
Papillary 80 (young patients 20 - 40)
folliular 10
Medullary 5
anaplastic
What are the characteristics of a malignant nodule?
cold solitary men young age solid radiation exposure
What is the best treatment for MODY?
Sulphonylureas - gliclazide
very responsive
What is the gene linked with MODY
HNF1A
type 2 mody is glucokinase mutation
What is the treatment for pagets?
bisphosphonates
What are the complications of pagets?
1% bdevelop osteosarcoma
bone thinckening
fractures
cranial nerve involvement - deafness
What is the management in hypothyroid?
TFT
TPO/TSH antibodies
screen for other autoimmunity
What are the causes of hyperparathyroidsism?
80% single adenoma
15% hyperplasia
4% multiple adenoma
1%carcinoma
What is the treatment of hypercalcaemia?
intravenous saline - 3-4 litres per day
bisphosphonates
Diabetic neuropathy definition?
occlusion of the vasa nervorum causes ischemia of myelinated and unmyelinated nerve fibres
What is sorbitol and how does it cause a peripheral neuropathy?
highly hydrophilic substance which is unable to pass throught he cell membrane so becomes trapped in neuronal scwann cells, causing swelling and cell death.
Name 5 symtpoms of an autonomic neuropathy?
Postural hypotension - fludrocortisone
ED - sildenafil
urinary retention
gastroparesis - early satiety/gord/bloating
How to remember causes of a polyneuropathy?
MDTVIII Metabolic Drugs Toxins Vasculitic Inflammatory Infectious Inherited
froments sign?
ulnar nerve palsy - require help of the median nerve to hold a piece of paper
What should type 1 diabetics do when they are ill?
check blood glucose more regularly, check urinary ketones
drink lots of water?
dont stop insulin even if not eating much
keep up caloric intake where possible with sugary drinks
if they have a raised ketone at the same time as a raised sugar - they should take some insulin - daily dose /6
which diabetic agents cause weight gain?
thiazoledinediones
sulphonylureas
What are th e precipitants of an addisonian crisis?
stopping long term steroids
surgery
trauma
infection
drugs that cause hypercalcaemia?
thiazides
what reduces the intestinal absorption of thyroxine?
iron tabs
tender vs non tender hyPER thyroid
tender - de quervains
non tender graves
contraindications to metformin
ESRF
