Endo part 2 Flashcards
how to thiazolidinediones work?
- used in T2DM treatment
- agonists to PPAR- gamma receptor
- reduce peripheral insulin resistance
absolutely contraidicated in heart failure patients as cause fluid retention
Hypothermia, hyporeflexia, bradycardia and seizures, think …
myxoedemic coma
- thin and brittle hair
- periorbital oedema
- more specific to hypothyroidism
general features of hypothyroidism
weight gain
lethargy
cold intolerance
skin features of hypothyroidism
dry (anhydrosis), cold, yellowish skin
non-pitting oedema (e.g. hands, face)
dry, coarse scalp hair, loss of lateral aspect of eyebrow
GI feature of hypothyroidism
constipation
gynae feature of hypothyroidism
menorrhagia
neurological feature of hypothyroidism
decreased deep tendon reflexes
carpal tunnel syndrome
patient with T1DM has blood glucose of 7.6mmol/L indicating his control requires improvement.
however his HbA1c level suggests good control. why might this be?
- HbA1c depends on average bg concentration and RBC lifespan
- in sickle cell anaemia, hereditary spherocytosis and G6PD deficiency there is reduced RBC lifespan
- hence can artificially lower HbA1c levels
what is the incretin effect?
- in normal physiology
- an oral glucose load results in greater release of insulin
- than if the load was given IV
incretin effect largely mediated by
GLP-1
incretin effect decreased in T2DM
classes of drugs for DM
- GLP-1 drugs
- increase [GLP-1] with analogues - DPP-4 inhibitors
- inhibit breakdown
teritary hyperparathyroidism is characterised by…
- extremely high serum PTH with moderately raised serum calcium
which conditions account for 90% of cases of hypercalcaemia?
- primary hyperparathyroidism (commonest cause in non-hospitalised patients)
- malignancy (commonest cause in hospitalised patients)
what occurs in Conn’s syndrome?
- there is excess aldosterone production independent of RAAS
- leads to hypertension, hypernatraemia and hypokalaemia
what is the underlying pathophys of DKA?
- uncontrolled lipolysis
- results in excess of free fatty acids
- these converted to ketone bodies
the following features are consistent with what diagnosis:
- abdominal pain
- polyuria, polydipsia, dehydration
- kussmaul respiration (deep hyperventilation)
- acetone-smelling breath
diabetic ketoacidosis
what are sulfonylureas?
- oral hypoglycaemic drugs
- used in management of t2dm
- increase pancreatic insulin secretion
- only effective if functional b-cells are present
common adverse effects of sulfonylureas?
- hypoglycaemic episodes
- weight gain
Rarer adverse effects hyponatraemia secondary to syndrome of inappropriate ADH secretion bone marrow suppression hepatotoxicity (typically cholestatic) peripheral neuropathy
65 y/o male
- PC, difficulty climbing stairs, worsening bruising on arms, weight gain
- PMH , COPD, RA, polymylagia rheumatica
- Dx, long term steroids
patients symptoms are suggestive of:
Cushing’s syndrome
- due to prolonged exposure to corticosteroids
what findings would be found on a venous blood gas of patient with Cushing’s syndrome?
hypokalaemia or hyperkalaemia
metabolic alkalosis
hypokalaemia
- excess aldosterone
- increases acid and K+ excretion
- in kidney
In Addison’s disease why are patients often hyperkalaemic?
- insufficiency of aldosterone
- decreases acid secretion in kidney
- leads to retention of potassium
Features - ‘bones, stones, abdominal groans and psychic moans’
polydipsia, polyuria peptic ulceration/constipation/pancreatitis bone pain/fracture renal stones depression hypertension
indicative of:
primary hyperparathyroidism
what is the most common cause of primary hyperaldosteronism?
- bilateral idiopathic adrenal hyperplasia
while reviewing a 4 y/o boy with constipation you notice small mass in left lower abdomen. does not cause him distress to palpate.
previous GP had noticed this, thought it was stool due to constipation.
child is fit and well, no other concerns,
what is next appropriate step?
- discuss with on-call paediatric registrar as
- child with palpable abdominal mass or unexplained enlarged abdomen need urgent referral
- assessment for neuroblastoma or wilm’s tumour
48 y/o with 3 year history of HT, muscle weakness and nocturne.
blood test show:
- low potassium
- high aldosterone-to-renin ratio
most likely cause of this patient’s presentation?
primary hyperaldosteronism
what is the most common cause of primary hyperaldosteronism?
bilateral idiopathic adrenal hyperplasia
over replacement of thyroxine increases the risk for…
osteoporosis
A HbA1c in what range is indicative of prediabetes.
of 42-47 mmol/mol
A second drug should be added in type 2 diabetes mellitus if the HbA1c is
what should be prescribed?
> 58 mmol/mol
prescribe DPP-4 inhibitor
scintigraphy showing:
diffuse enlargement of both thyroid lobes, with uniform uptake throughout.
indicative of:
Grave’s disease
autoimmune
A 34-year-old woman is referred to the endocrinology clinic with symptoms of anxiety and significant weight loss. She reports feeling unusually hot all the time.
raised T4, decreased TSH
The endocrinologist arranges a nuclear scintigraphy scan which reveals patchy uptake.
indicative of:
toxic multi nodular goitre
nelsons syndrome is
rare
- abnormal hormone secretion
- enlargement of pituitary
- often post surgical removal of adrenal glands for Cushings disease
The standard HbA1c target in type 2 diabetes mellitus
48 mmol/mol
first line treatment of Grave’s disease
carbimazole
an elevated TSH with normal T4 indicates
subclinical hypothyroidism
32 y/p T1DM PC bloating and vomiting.
erratic blood glucose control, bloating and vomiting
indicative of:
- gastroparesis
- neuropathy of vagus nerve in diabetes –> causing abnormal gut movement –> gastroparesis
initial hyperparathyroidism, painful goitre and globally reduced uptake of iodine-131 indicative of:
De Quervain’s thyroiditis
Acromegaly: if patients are not suitable for trans-sphenoidal surgery, or have residual symptoms,
what might be used?
octreotide
30 y/o male T1DM, confused, drowsy. Bloods show hyperglycaemia, ketones ++ urinalysis
management
IV fluids
peptic ulceration
galactorrhoea
hypercalcaemia
in a patient leads to a diagnosis of:
multiple endocrine neoplasia type 1
- genetic
- development of neoplastic lesions in pituitary gland, parathyroid gland and pancreas
prognosis of what thyroid cancer is deemed to be excellent
papillary thyroid cancer
which result established a diagnosis of diabetes mellitus?
- symptomatic patient
- random glucose 12.0 mol/L on one occasion
Diabetes diagnosis: fasting > 7.0, random > 11.1 - if asymptomatic need two readings
sitagliptin is an example of a …
DDP-4 inhibitor
dipeptidyl peptidase-4 inhibitor
reduces peripheral breakdown of incretins such as GLP-1.
role of incretins
inhibit glucagon secretion
thus increases insulin secretion
hence reduces gastric emptying and blood glucose levels
which endocrine hormones are reduced in stress response
- insulin
- testosterone
- oestrogen
SGLT-2 inhibitors are not linked to necrotising fasciitis of the genitalia or perineum
SGLT-2 inhibitors have been linked to necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)
TRUE
what is the classical visual field defect of a pituitary adenoma?
bitemporal hemianopia
due to compression of the optic chiasm
what test is best to diagnose Addison’s disease?
short synacthen test
The test is based on the measurement of serum cortisol before and after an injection of synthetic ACTH
If lifestyle measures have failed to bring a patients blood pressure down they should then be offered an:
ACE inhibitor
which antibodies are found in a patient with Hashimoto’s thyroiditis?
anti-thyroid peroxidase
