Endo Flashcards
What are the low and high dose Dex suppression test findings for Cushing’s disease
Does not suppress with low dose
Suppresses with high dose
Patient with Zollinger-Ellinson syndrome and Whipple’s presents with polyuria and constipation?
Parathyroid adenoma causing hyperPTH and hypercalcaemia
Acarbose MoA and common side effect
inhibits alpha glucosidases in SI, delaying digestion of starch
SEs: diarrhoea/flatulence, (hepatoxicity)
Antihypertensive that can increase insulin requirement
Bendroflumethiazide
Grave’s ophthalmopathy treatment
High dose steroids
Surgical orbital decompression if refractory or vision threatened
SEs/important contraindication of sulphonylureas
Give examples
Hypo
Weight gain ie. not recommended in obese
Glibenclamide, Glimepiride
Prolactin level 9000, macro or micro adenoma?
If Prolactin >2000, likely macroadenoma
Nelson’s syndrome
hormone secreting pituitary macroadenoma following adrenalectomy for Cushing disease
Most commonly occurring thyroid cancer
Papillary thyroid cancer (70%)
Octreotide indications and important SE
Indications: VIPomes Carcinoid tumours Acromegaly Glucagonomas
SE: gallstones (in long term use)
Karyotype of Turners
45 X0
Kallman’s syndrome
hypothalamic gonadotrophin deficiency and hypo/anosmia
Other features: craniofacial feature eg. cleft palate, nerve deafness, colourblindness
If fasting glucose shows IFG
AND
OGTT shows IGT
what is the diagnosis?
Impaired glucose tolerance
Which features are more specific for Grave’s disease than other causes of hyperthyroidism?
Exopthalmos
Ophthalmoplegia
Thyroid acropachy
Pretibial myxoedema
NB. NOT lid lag
Indications for islet translplant
T1DM + >2 severe hypos in last 2 years + impaired awareness/warning of hypo
Precocious puberty causes and treatment (early onset puberty)
Idiopathic
Harmartomas of posterior hypothalamus
Treat idiopathic with long term GnRH analogues
Troisier’s sign
Palpable left supraclavicular node
~GI malignancy
Not to be confused with Trousseau’s sign (hypocalcaemia): carpopedal spasm if brachial artery occluded with BP cuff
Pseudohypoparathyroidism presentation
Same blood panel as secondary hyperparathyroidism (low Ca, high PTH) but with high PO4
BUT also round face and short 4th and 5th fingers
ie. PTH Resistance
Dumping syndrome
Nerve supply to stomach damage ie. fast transit into SI -> pancreas over produces insulin = hypo symptoms post-meals
Usually a complication to GI surgery. eg. fundoplication
Karyotype and features of Klinefelters
47 XXY
Hypogonadism ie. little body hair, slight, gynaecomastia
Most common hormonally active pituitary tumours
Eosinophilic GH secreting adenoma
Basophilic ACTH secreting adenoma
Prolactin secreting adenoma
Persistent hyperprolactinaemia despite no symptoms, dx?
Macroprolactinaemia
Macroprolactin = auto-antibody complex with no biological activity
Endo cause of hyperglycaemia + hepatosplenomegaly
Acromegaly (not hypoglycaemia!)
Wolfram syndrome triad
T1DM (Dx <16yo) + optic atrophy + deafness
Most likely diabetes meds to cause hypoglycaemia
Gliclazide
CAH pathology and Rx
Excess production of androgens - little cortisol
Increased ACTH causes hyperplasia
Rx: Hydrocortisone
Most common cause of secondary hypertension
Conns
Suspect if <40yo hypertensive
Probable second most common cause of secondary hypertension
Renal disease
eg. GN, RAS (asymmetrical kidneys on scan), PKD
Chronic fatigue syndrome definition, features, Rx
at least 4mo disabling fatigue affecting mental and physical functionmore than 50% of the time
Female>male Exertion (physical or mental) makes symptoms WORSE Palpitations PAINFUL LNs, no enlargement Muscle/joint pain Sore throat Sleep disturbance Nausea Dizziness
Rx: CBT Graded exercise therapy "pacing" Pain team referral if dominant Low dose amitryptilline for sleep
DM Dx
Random glucose or 2h OGTT >11.1
Fasting glucose >7
HbA1c >48 (but does not exclude if less)
Asymptomatic: need above criteria twice
Symptomatic: once
(IFG: 6.1-7
IGT: 7.8-11.1)
How does treatment differ for osteoporosis if on long term steroids
Treat if t-score <1.5 as opposed to <2.5
Example of GLP-1 mimetic
Indication
Exenatide
Latter Rx for T2DM
Skin manifestation of DM
Necrobiosis lipoidica
Shiny painless yellow/red/brown skin on shins
~telangiectasia (unlike EN)
Which DM med should you monitor LFT
Pioglitazone
When to start primary prevention statin in T1DM
Nephropathy
had T1DM for 10 years
>40yo
Other CVD RFs
When to start primary prevention statin in T2DM
As per QRISK
Commonest cause of male hypogonadism
Rx
Klinefelter’s 47XXY
(Low testosterone + gynaecomastiae)
Rx: testosterone
Pituitary tumour causing thyrotoxicosis, TFTs?
NORMAL TSH (inappropriately) High fT4
