Endo Conditions Flashcards
T1DM
Ix: Fasting glucose(>7)/OGTT(>11.1 after 2h), FBC, U+E, LFT (exclude other causes of symptoms e.g. tiredness, polyuria, polydipsa)
Mx: Education re. insulin regimens, monitoring carb intake + blood sugar levels on waking, at meals and before bed, managing complications.
Medical - long acting SC insulin OD and a short acting SC insulin 30 mins before meals. Alternate injection sites to avoid lipodystrophy
T2DM
Ix: HbA1c(>48, 42-47mmol/mol = prediabetes), Fasting glucose(>7)/OGTT(>11.1 after 2h)
FBC, U+E, LFT (exclude other causes of symptoms e.g. tiredness, polyuria, polydipsa),
Mx: conservative - diet (low glycaemic high fibre) and lifestyle (exercise, wt loss, stop smoking), refer to DPP, optimise RFs and monitor for complications (retinopathy, nephropathy, neuropathy). Medical - Metformin titrated to highest dose, add Sulfonylurea/pioglitazone/DPP-4 inhibitor/SGLT-2 inhibitor depending on SE/RFs e.g. SGLT-2 inhibitors preferred in CVD, triple therapy if this fails. Aim: (HbA1c <48, or <53 for metformin + other drugs)
Metformin SE: Diarrhoea, abdominal pain, lactic acidosis, Does NOT cause hypoglycaemia.
Sulphonylurea SE: Wt gain, hypoglycaemia,
Proglitazone - wt gain, fluid retention, HF, increased bladder cancer risk, no hypos,
DPP4 inhibitors SE - GI tract upset, pancreatitis
SGLT2 inhibitor SE: reduce CVD risk but wt loss, increased chance of UTI due to glycosuria
DI (Cranial vs nephrogenic vs primary polydipsia)
Ix: Dx: Low urine osmolality, high serum osmolality, Hypernatraemia, Water deprivation test + DDAVP.
Mx: treat underlying cause, DDAVP
SIADH
Ix: Dx of exclusion for reduced Na e.g -ve short synacthen test, no diarrhoea/vomiting.diuretic use), CXR for Sclc, review meds
Mx: Treat cause, correct hyponatremia but slowly to avoid central pontine myelinolysis, tolvaptan (ADH blocker), demeclocycline
Hyper/hypothyroidism
Ix: TFTs, FBC, U+E, LFT (look for other causes of symptoms e.g. tiredness), ECG: tachy/bradycardia, antibodies: anti-TPO, anti TG, anti-TSH
Mx: Graves - propranolol thyroid storm, carbimazole (titration block/block and replace), propylthiouracil, hashimoto’s - levothyroxine
Acromegaly
Ix: raised IGF-1, OGTT, Imaging: MRI pit, opthal referral for visual fields
Mx: definitive - transsphenoidal removal of pit tumour, medical: pegvisomant (GH antagnoist), bromocriptine/cabergoline, octreotide
Addisions
Ix: reduced Na (sometimes only feature), increased K, reduced BP, Short synacthen test - cortisol does not rise, Adrenal autoantibodies: adrenal cortex antibodies and 21-hydroxylase antibodies, Imaging: CT/MRI pit/adrenals
Mx: replacement with hydrocortisone (GR) and fludrocortisone (MR), steroid card, emergency ID tag, double GR dose when sick
Cushings, Conns, Phaeo
Ix: raised cortisol, raised aldosterone/low or high renin, plasma free metanephrines (as 24h catecholamines unreliable), BP increase, hypokalemia
Dexa suppression test - no suppression of cortisol in cushings, high dose to distinguish pit adenoma (cortisol will be suppressed) from adrenal adenoma/ectopic ACTH secretion.
Imaging: cushings - MRI for pit adenoma, CXR SCLC, CT/MRI for adrenal tumour, conns - CT / MRI for adrenal tumour, Renal doppler USS, CT angiogram or MRA for RAS. Phaeo - ECG for tachy
Mx: Cushings - transphenoidal resection for pit adenoma, remove adrenal/lung tumour, bilateral adrenalectomy and steroid hormone replacement for life
Conns - aldosterone antagonists (Eplerenone, Spironolactone), treat the underlying cause: surgical removal of adenoma, percutaneous renal artery angioplasty for RAS
Phaeo: a and b blockers, adrenalectomy to remove tumour
Addisonian Crisis (AKA Adrenal Crisis)
Presentation: Reduced GCS, Hypotension, Hypoglycaemia, hyponatraemia, hyperkalemia
Mx: A to E
Intensive monitoring
Steroids (i.e. IV hydrocortisone 100mg stat then 100mg/6h
IV fluid resus
Correct hypoglycaemia
Monitor electrolytes and fluid balance
