Endo - useful passmed facts Flashcards
Which T2DM drug increases insulin sensitivity?
Pioglitazone
Side effects of Thiazolidinediones (like pioglitazone)
Adverse effects:
weight gain
liver impairment: monitor LFTs
fluid retention - therefore contraindicated in heart failure, the risk of fluid retention is increased if the patient also takes insulin
recent studies have indicated an increased risk of fractures
bladder cancer: recent studies have shown an increased risk of bladder cancer in patients taking pioglitazone (hazard ratio 2.64)
Diabetes drugs with side effects of weight gain
Thiazolidinediones (Pioglitazone) causes weight gain
Sulphonylureas
Insulin
What drug is weight neutral?
DPP-4 inhibitors are weight neutral
Examples - sitagliptin, Vildagliptin
What T2DM causes weight loss?
Patients taking SGLT-2 (sodium-glucose transport protein 2) drugs often lose weight, which can be beneficial in type 2 diabetes mellitus
Example - Dapagliflozin
SGLT2 inhibitors prevent the resorption of glucose from the proximal renal tubule, resulting in more glucose being secreted in the urine
Key info about thyroid cancers
Most to least common: Paul’s (Hollywood) Focaccia Most Awarded Loaf
Papillary > Follicular > Medullary > Anaplastic > Lymphoma
Papillary: good prognosis, young women, cervical lymphadenopathy
Medullary: Associated with MEN type II
Anaplastic: very bad prognosis
Calcitriol, also known as?
Calcitriol, also known as 1,25-dihydroxycholecalciferol is the active form of vitamin D
Calcitriol results in an increased uptake of calcium from the intestines and therefore increases serum calcium level. As such it is used in the management of conditions resulting in hypocalcaemia including hypoparathyroidism and osteomalacia.
What is sick euthyroid syndrome?
In sick euthyroid syndrome (now referred to as non-thyroidal illness) it is often said that everything (TSH, thyroxine and T3) is low. In the majority of cases however the TSH level is within the >normal range (inappropriately normal given the low thyroxine and T3).
T2DM blood glucose ranges
Cortisol effect on glucose
Cortisol acts on the liver, muscle, adipose tissue, and pancreas
In the liver, high cortisol levels increase gluconeogenesis and decrease glycogen synthesis
Diabetes Insipidus clinical features and effect on sodium
Polyuria
Polydipsia
HYPERnatraemia
Postural HTN
Nocturia
Mechanism of how the T2DM drugs work
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1 increTIN = glipTIN (sitagliptin)
Metformin increases peripheral insulin sensitivity and reduces hepatic gluconeogenesis
Sulfonylureas augment pancreatic insulin secretion, Increased insulin secretion can lead to hypoglycaemia
GLP mimetics, e.g. exenatide, augment pancreatic insulin secretion, suppress glucagon release, slow gastric emptying and promote satiety
Klinefelter’s and Kallman’s FSH/LH levels
FSH/LH Climb in Klinefelter’s
FSH/LH Fall in Kallman’s
What blood picture do you get with Cushing’s Syndrome?
A hypokalaemic metabolic alkalosis
Cushing’s syndrome causes hypokalaemic metabolic alkalosis because when the levels of cortisol are high, the cortisol that is not inactivated by 11β-hydroxysteroid dehydrogenase is free to bind to mineralocorticoid receptors. This causes an increase in water and sodium retention, increased potassium excretion, and increased hydrogen ions excretion, (like what aldosterone does) Lower levels of hydrogen ions cause alkalosis and less potassium causes hypokalemia
Which drug can you give in Phaeochromocytoma that blocks both alpha and beta receptors?
Labetalol blocks both alpha and beta receptors
lABetalol
How does myoxedema coma commonly present?
Myxoedema coma typically presents with confusion and hypothermia
treatment with:
- IV thyroid replacement
- IV fluid
- IV corticosteroids
Method to help remember multiple endocrine neoplasia?
MEN 1 - 3Ps
MEN 2a - 2Ps 1M - PTH, phaeo, Medullary Ca
MEN 2b - 1P 2M - Phaeo, Marfan, Medullary
1 pancreas, 1 pituitary = MEN-1
2 adrenals :. phaeochromocytoma = MEN-2
Causes of hypoglycaemia can be remembered by the mnemonic EXPLAIN
- Exogenous drugs (typically sulfonylureas or insulin)
- Pituitary insufficiency
- Liver failure
- Addison’s disease
- Islet cell tumours (insulinomas)
- Non-pancreatic neoplasms
hyperosmolar hyperglycaemic state (HHS) is characterised by:
hyperosmolar hyperglycaemic state (HHS). HHS is characterised by:
- 1.) Severe hyperglycaemia
- 2.) Dehydration and renal failure
- 3.) Mild/absent ketonuria
- Hypovolaemia
- Marked Hyperglycaemia (>30 mmol/L) without significant ketonaemia or acidosis
- Significantly raised serum osmolarity (> 320 mosmol/kg)
- Note: A precise definition of HHS does not exist, however the above 3 criteria are helpful in distinguishing between HHS and DKA. It is also important to remember that a mixed HHS / DKA picture can occur
Phaeochromocytoma triad
Phaeochromocytoma typically presents with a triad of sweating, headaches, and palpitations in association with severe hypertension
Sick euthyroid syndrome T3, T4 and TSH levels
Sick euthyroid syndrome = low T3/T4 and normal TSH with acute illness
Causes of a normal anion gap metabolic acidosis are ABCD:
- Addison’s
- Bicarb loss
- Chloride
- Drugs
Pack years and smoking
1 pack year is defined as 20 cigarettes per day for 1 year,
Example: patient has smoked for 25 years, 40 cigarettes per day for 1 year is equivalent to 2 pack years, 2 pack years x 25 years = 50 pack years
HbA1c levels patients should aim for in T2DM?
Aim for Lifestyle/Metformin monotherapy < 48
Aim for multitherapy/hypoglycaemia drug < 53
What drugs are oto
