Endo and Diabetes Flashcards
What is HHS characterized by?
Hypovolaemia
Hyperglycaemia (> 30 mmol/L)
Mild or absent ketonaemia (blood ketones < 3 mmol/L)
High osmolality (> 320 mOsm/kg)
How do you manage HHS?
fluid replacement
fluid losses in HHS are estimated to be between 100 - 220 ml/kg
IV 0.9% sodium chloride solution
typically given at 0.5 - 1 L/hour depending on clinical assessment
potassium levels should be monitored and added to fluids depending on the level
insulin
should not be given unless blood glucose stops falling while giving IV fluids
venous thromboembolism prophylaxis
patients are at risk of thrombosis due to hyperviscosity
What are the complications of HHS?
Myocardial infarction
Thrombotic complications
Cerebral oedema
How do you treat hypercalcaemia?
- Rehydration 4-6L in 24 hours
- Bisphosphonates- single dose of Pamidronate after adequate hydration will lower calcium in over 2-3 days- maximum at 1 week, by inhibiting osteoclast acvitiy.
What are some complications of hypernatrmia?
Death
Stroke
Thrombotic episode
Loss of consciousness
Seizures
Explain how hypothyroidism can cause hypertension
Increased Peripheral Vascular Resistance: Reduced thyroid hormone levels can cause blood vessels to become less elastic and narrower, increasing resistance to blood flow and raising blood pressure.
Reduced Heart Rate and Cardiac Output: Hypothyroidism can lead to a slower heart rate and reduced efficiency of the heart, which can trigger the body to raise blood pressure to ensure adequate blood flow to tissues.
Salt and Water Retention: Hypothyroidism can affect kidney function, leading to retention of salt and water, which increases blood volume and blood pressure.
What is the treatment for phaechromocytoma?
Alpha blockade using phenoxybenzamine is used in treatment of secondary hypertension in pheochromocytoma. Patients should always be well alpha blocked before commencing any beta blockade.
What are the symptoms/signs of growth hormone deficiency syndrome?
Children:
Poor growth or short stature
Increased fat around the waist
Delayed puberty
Younger-looking facial appearance
Low energy levels
Adults:
Reduced muscle mass and strength
Increased fat, especially around the waist
Decreased bone density, increased risk of fractures
Fatigue and low energy levels
Reduced exercise capacity
Depression and anxiety
Poor memory and concentration
What blood test if low would indicate growth hormone deficiency?
IGF-1
What is the most common cause of hypopituitarism?
The most common cause of hypopituitarism is non-secretory pituitary macroadenomas, which usually go unnoticed for a long time since they do not cause specific symptoms. The diagnosis can be confirmed with imaging and managed surgically
What is Sheehan’s syndrome?
Sheehan’s syndrome is defined as postpartum pituitary necrosis secondary to a postpartum haemorrhage.
What should you do if you find a pituitary incidentaloma?
If a pituitary incidentaloma is found within the sellar, laboratory investigation must be done to determine if it is functional or non-functional
What is a rare side effect of Carbimazole?
Agranulocytosis
Extremely low level of granulocytes (white blood cells)
Patients can present with mouth ulcers and a sore throat
What is a feature that is specific to Grave’s disease compared to other causes of hyperthyroidism?
Exopthalmus
What is the risk of correcting hyponatremia too quickly?
Central pontine myelinolysis
