Endo Long

Question 1

Indications for DEXA

Answer 1

1. Fracture after minimal trauma
2. Women >65 and men >70
3. Monitoring of known low BMD after at least 1 year
4. Monitoring of bone loss after prolonged steroid use or as a result of hypogonadism
5. Monitoring of bone loss in primary hyperparathyroidism, CLD, CKD, Crohns, malabsorption, RA
6. Measurement of BMD 12 months after change in treatment of known low BMD

Question 2

Causes of hypercalcemia

Answer 2

1. Primary hyperparathyroidism
2. MAlignancy
3. Increased Vit D (ingestion, granulomatous disease)
4. Increased bone turnover (hyperthyroid, thiazide, Vit A toxicity)
5. REnal failure and secondary hyperparathyroidism
6. Familial hypocalciuric hypercalcemia
7. Other (lithium, increased parathyroid hormone)

Question 3

Complications of PAgets

Answer 3

OA
Gout
PAthological fracture
REnal Calculi
Sarcoma
CCF
NEurlogical involvement

Question 4

Mx of Pagets

Answer 4

1. Simple Analgesia for bone pain
2. Othopedic procedures such as THR
3. ORal bisphosphonates - Reduces bone turnover, and more normal bone is produced
4. IV Bisphosphonates - more prolonged suppression without adverse effect on bone mineralisation and formation
5. Calcitonin - improves bone pain and neurological complications. SE Nausea, flushing, diarrhea; Risk of resistance in 1-2 years
6. Mithramycin - reserved for emergencies (spinal cord compression) rapid remission. Increased bone lysis, and fractures and bone marrow depression
7. Monitoring for osteosarcoma

Question 5

Acromegaly Ix

Answer 5

IGF-1 elevated
Glucose tolerance test (no suppression of GH <0.3)
Check prolactin as can be elevated in 25%
Check baseline pituitary function: Cortisol, TSH + T4, FSH, LH, testosterone and estrodiol
MRI B

Question 6

Complications of Acromegaly to Ix

Answer 6

Diabetes - Hba1c, metabolic panel
OSA - Sleep study
CCF - TTE
Colon Cancer - Cscope
MSK - CTS, arthropathy
Thyroid - TFTs

Question 7

Mx of Acromegaly

Answer 7

1. Trans Sphenoidal pituitary surgery
   - Cx: CSF rhinorrhea, DI, Stroke, Hypopituitarism
2. Long acting somatostatin analogue (octreotide)
3. RTx

Question 8

Criteria for diagnosis of diabetes

Answer 8

• HBA1c >6.5
• Fasting BSL >7 on 2 occasions
• 2 Hour post prandial glucose >11
• Symptomatic Diabetes and random BSL >11.1

Question 9

Metformin SE

Answer 9

Cease if egfr <30

-Diarrhea, anorexia, nausea, lactic acidosis, vitamin B12 malabsorption

Question 10

Sulfonylureas SE

Answer 10

Hypos

Weight gain

Question 11

DPP4 SE

Answer 11

Gliptins

• Weight neutral
• HEAdache
• PAncreatitis

Question 12

GLP1 SE

Answer 12

• Weight loss!

- Nausea, pancreatitis

Question 13

SGLT2 SE

Answer 13

WEight loss, lower BP fewer CVS deaths

-Nausea, hypoglycemia, candida, UTIs, euglycemic ketoacidosis

Question 14

Causes of insulin resistance

Answer 14

Obesity
Insulin antibodies
Circulating antagonist hormones - GH, cortisol, thyroxine, glucagon

Question 15

Cx of poorly controlled diabetes in pregnancy

Answer 15

Congenital malformation: spina bifida
Macrosomia
Intrauterine fetal death
Hypo post delivery
Cx related to immaturity; RDS, jaundice

Question 16

OHG choce: CVD/CKD

Answer 16

SGLT2i

GLP1 agonist

Question 17

OHG choice: REducing hypos

Answer 17

DPP4 i
GLP 1 agonist
SGLT2i

Question 18

OHG choice: weight loss

Answer 18

GLP1

SGLT2