endo Flashcards
inheritance pattern congential adrenal hyperplasia
pathology
which deficiency?
recessive
in response to low cortisol levels, the anterior pituitary secretes high levels of ACTH
- 21-hydroxylase deficiency (90%)
- 11-beta hydroxylase deficiency (5%)
- 17-hydroxylase deficiency (very rare)
X-ray changes in hyperparathyroidism
- osteopenia (low bone density)
- erosion of the terminal phalyngeal tufts
pepperpot skull
primary / secondary / teritary hyperPTH
primary (oversecretion of parathyroid):
high PTH, high calcium, low phos
secondary (vit D def, CKD):
high PTH, low calcium, high phos
teritary (CKD, hyperplasia):
v high PTH, high calcium, high phos
where does PTH act to increase Ca levels
bowel
kidneys
bone
chief cels secrete PTH
electroylte imbalance seen in cushing
hypokalaemic metabolic acidosis
with impaired glucose tolerance
Ectopic AC
features of cushings
hyperglycaemia (central obesity) osteoporosis muscle wasting / weakness skin thinning / brusing / striae ulcers immunosuppression / infection (neutropenia)
moon face
buffalo hump
diagnostic tests for cushings
- 24 urinary cortisol sample
- dexamethasone suppression test
low (1mg) / (8mg)
serum cortisol
serum ACTH
c-peptide significance?
low in T1DM
- pancreas is not making enough insulin precursor –> which breaks down to form C-peptide + insulin)
high/normal levels in T2DM
how do you diagnose insulinoma?
whipple’s triad
- hypoglycaemia in mornings (before eating)
- reversal of symptoms with glucose/food
- recorded low BMs at time of symptoms
high c peptide
conn’s blood results
hypernatraemia
hypokalaemia
metabolic alkalosis
aldosterone Na/K
H ions pumped out
1st line conn’s investigation
aldosterone:renin ratio
conn’s:
high aldosterone
low renin
CT abdo/adrenal after
Maturity-onset diabetes of the young inheritance pattern
autosomal dominant
define fasting glucose
fasting glucose 6.1 to 7mmol/l
define impaired glucose tolerance
fasting glucose < 7
OGTT 2 hr 7.8 - 11mmol/L
mx for acute addisonian crisis
iv hydrocortisone
addision’s pt - what do you do with their steroids?
double hydrocortisone
same dose fludrocortisone
gliptins / DPP-4
increases incretin levels
–> inhibit glucagon secretion
best for obese pt - doesn’t cause weight gain
pioglitazone
reducing peripheral insulin resistance
don’t use in HF
LFT monitor
weight gain
metformin
increases insulin sensitivity
GI upset
lactic acidosis
weight loss
sulfonylurea
stimulate beta cells to secrete insulin
hypoglycaemia
weight gian
hyponatraemia
SLGT
inhibits reabsorption of glucose in the kidney
UTI risk
thrush risk
pt in thyrotoxic storm Mx
beta blocker
proplythiouracil
hydrocortisone
features of a thyrotoxic storm
tachycardic
confused
hypotension
spike temp
what is sick euthyroid syndrome?
norma/lowl TSH
low t3/t4
in the presence of acute illness
no treatment needed
why is dexamethasone used for space occuping lesion in brain/raised intracranial pressure?
strong glucocorticoid properties - anti-inflammatory
minimal mineralcorticoid properties - fluid retaining
which diabetic drugs are related to bladder CA?
thiazolidinediones
- pioglitazone
reducing peripheral insulin resistance
weight gain
liver impairment
fluid retention risk - don’t use in heart failure
what is the fixed rate of insulin for DKA?
0.1 units / kg / hr
what is the fastest you can correct potassium?
10mmol / hr
potassium is normally given in 40mmol
so 40mmol in 4L saline
hyper / hypothyroidism
which gives mennorhagia / oligomenorrhagia / amenorhagia?
hyper - oligo / amen
hypo - menn
Order strength of glucocorticoids (6)
anti-inflammatory
dexamethasone (40) betmethasone (40) methlyprednisolone (20) fludrocortisone (15) prednisolone (4) hydrocortisone (1) cortisone (1)
Order strength of minercorticoids
fluid retention
aldosterone (400)
fludrocoritsone (150)
hydrocortisone (1)
prednisolone (0.8)
what is Hastimoto’s?
what is the Mx & the monitoring TSH?
- autoimmune hypothyroid
- anti-thyroid perioxidase antibodies
- painless goitre
give lveothyroxine –> monitor TSH to stablise
what is toxic multinodular goitre?
thyroid gland containg number of autonomously functioning thyroid nodules –> hyperthyroidism
Mx - iodine therapy
HbA1c
what causes a increased / decrease in value?
increase RBC life span:
- splenectomy
- b12 / folate deficiency
- iron def
Decrease RBC life span:
- G6PD
- hereditary spherocytosis
- sickle cell
