Endocrine Flashcards
Name the features that suggest severe DKA
- Blood ketones > 6mmol/l
- Bicarbonate < 5mmol/l
- Blood pH <7.1
- Hypokalaemia
- GCS <12
- Sats <92%
- Systolic BP <90mmHg
- Tachycardia or bradycardia
Describe the management of DKA
Hour 1: 1L 0.9% saline and Actrapid
Hour 2: 1L 0.9% saline and continue actrapid while BG>14
Hour 3: 500ml 0.9% saline +/- KCl
Hours 4-discharge: reduce rate of saline and restart s/c regime when eating and drinking
Name the potential complications of DKA
- Hyper and hypokalaemia
- Hypoglycaemia
- Rebound ketosis
- Arrhythmias
- Acute brain injury
- Cerebral oedema
- Aspiration pneumonia
- Arterial and venous thromboembolism
- ARDS
How does diabetic retinopathy present?
- Non-proliferative: retinal capillary dysfunction, platelet dysfunction and blood viscosity abnormality
- Proliferative: retinal ischaemia, new blood vessel formation, vitreous haemorrhage and retinal tears/detachment
How does hyperosmolar hyperglycaemic state present?
- Usually T2DM
- Osmolality >320mOsm/kg
- Hyperglycaemia > 30mmol/l
What causes HHS?
- Inadequate insulin/non-compliance
- Acute illness
- Endocrine
- Drugs: B-blockers, anti-psychotics, steroids and immunosuppressants
How is HHS managed?
- IV fluids
- IV insulin
- IV potassium
- Gradual treatment
- Treat underlying causes
Name the options for managing hypoglycaemia
- 15-20g quick acting carbohydrates
- 1.5-2 tubes of glucogel
- 1mg Glucagon IM
- IV glucose: 75ml 20% or 150ml 10% glucose
How can type 2 diabetes be managed?
- 1st line: metformin or sulfonylurea
- 2nd line: Thiazolidinedione, DPP-IV inhibitor or SGLT-2 inhibitor
- 3rd line: any of the 2nd line agents + GLP-1 agonist or insulin
Give two examples of sulfonylureas
- Glimepiride
- Gliclazide
Give an example of a thiazolidinedione
Pioglitazone
Give an example of a DPP-IV inhibitor
Sitagliptan
Give an example of a SGLT-2 inhibitor
Empagliflozin
Give an example of a GLP-1 agonist
Lixisenatide
Name some of the side effects of metformin
- Lactic acidosis
- Nephrotoxic
- GI side effects
Name some of the side effects of sulphonylureas
- Hypoglycaemia
- Weight gain
- Blood disorders
Name some of the side effects of thiazolidinediones
- Fluid retention
- Weight gain
- Fractures in females
Name some of the side effects of DPP-IV inhibitors
- Headaches
- Changes in bowel movements
- Gallstones
- Pancreatitis
Name some of the side effects of GLP-1 agonists
- Acute pancreatitis
- Nausea and vomiting
- Renal impairment
- Atrioventricular block
Name some of the side effects of SGLT-2 inhibitors
- UTIs
- URTI
- Increased urination
- Dyslipidaemia
- Genital yeast infections
At which HbA1c level should you consider adding another diabetes drug?
58mmol
Describe the TFT results for primary hypothyroidism
- Raised TSH
- Low T4
- Compensated: raised TSH and normal T4
Describe the TFT results for secondary hypothyroidism
- Low TSH
- Low T4
How would a solitary thyroid nodule be investigated?
- TFTs
- USS
- FNA
Name the types of thyroid cancer
- Papillary (commonest)
- Follicular
- Anaplastic
- Lymphoma
- Medullary (MEN 2)
How does subacute thyroiditis present?
- Young patients
- Viral trigger
- Painful goitre +/- fever/myalgia and raised ESR
How can subacute thyroiditis be managed?
Short term steroids and NSAIDs
How can hypercortisolism be investigated?
- Overnight dex test
- 24 hour urine free cortisol
- ACTH cortisol
- MRI/CT
How can hyperaldosteronism be investigated?
- Plasma aldosterone renin ratio
- 24 hour urine aldosterone
- CT scan of adrenal glands
- Adrenal vein sampling
- Potassium (hypokalaemia)
How does a phaeochromocytoma present?
- Hypertension
- Headache
- Sweating and palpitations
- Tremor
- Pallor
- Anxiety/fear
What are the different types of hyperparathyroidism?
- Primary: parathyroid gland produces excess PTH
- Secondary: low calcium because of kidney, liver or bowel disease
- Tertiary: autonomous secretion of PTH because of CKD
How can acromegaly be investigated?
- Blood glucose
- IGF-1
- OGTT
- MRI Pituitary
- Visual field tests
How can acromegaly be managed?
- Trans-phenoidal surgery
- Radiotherapy
- Octreotide and lanreotide
How can Cushing’s syndrome be investigated?
- FBC and U&Es
- 24 hour urinary free cortisol
- Low dose dexamethasone suppression test
- Midnight cortisol levels
- Plasma ACTH test
How can Cushing’s syndrome be managed?
- Tumour removal
- Metyrapone and ketoconazole
- Pituitary radiotherapy
How can diabetes insipidus be managed?
- Cranial: desmopressin
- Nephrogenic: well hydration, correct metabolic abnormalities and desmopressin (+ NSAIDs and thiazide diuretics)
