endocrine Flashcards
Manage CVS in diabetes
- Statin
- Antihypertensives
- Anti-glycemics
Management of nephrogenic diabetes insipidus
Sildenafil, a phosphodiesterase inhibitor, has been shown to substantially reduce urine output in patients with congenital x-linked nephrogenic diabetes insipidus
indications for orlistat
BMI>30
exercise and diet not working
Stop if <5% weight loos/weight gain during treatment
treatment for hypertriglyceridemia
fibrates
Features of Klienfelters
Hypertrophic hypogonadism (rasied FSH/LH in response to low testoderone) Tall stature Mental retardation Scant hair 47XXY
Fibromuscular dysplasia causes hypertension how
renal artery stensois
high aldosterone, high renin
high Na, low K
Fibromuscular dysplasia causes hypertension how
renal artery stensois
high aldosterone, high renin
high Na, low K
Bartters’ syndrome
salt wasting syndrome
hypotension
low sodium
hypoglycemia
check paired insulin and c-peptide levels and blood sulphonyl urea levels
hyponatremia
if no seizures, fluid restrict
correct slowly to avoid central pontine myellinosis
Numerous psychiatric medications, particularly antipsychotics such as haloperidol, quetiapine, and clozapine can cause SIADH
Gauchers diease
Gaucher disease is inherited as an autosomal recessive disease. The disease is caused by a deficiency of the enzyme glucocerebrosidase, essential for the metabolism of glycolipids.
There are three types of Gaucher disease:
Type 1: Chronic non-neuropathic; adult Gaucher disease
Type 2: Acute neuropathic; infantile Gaucher disease
Type 3: Subacute neuropathic; juvenile Gaucher disease
Patients with all types of disease have hepatosplenomegaly and large glucocerebroside-rich cells (Gaucher cells) infiltrating the bone marrow.
Type 2, infantile Gaucher disease, carries the worst prognosis, with children seldom surviving beyond 2 years.
Type 1 disease is the commonest, usually presenting in childhood with hepatosplenomegaly, but not uncommonly in middle or old age.
Bone marrow replacement and hypersplenism result in anaemia and thrombocytopenia.
Pathological bone fractures and avascular necrosis of the femoral heads are not uncommon.
Bony disease may be confined to the distal ends of the femurs, with formation of characteristic ‘Erlenmeyer flask’ shaped cysts.
The skin may show a grey-brown discolouration, especially around the forehead, hands and pre-tibial regions. Characteristic yellow or yellow-brown papules (pingueculae) develop at the sclerocorneal junctions.
treatment of paillary thyroid ca
Papillary thyroid cancer is treated with total thyroidectomy followed by therapy with radioiodine-131 (131I). Radioiodine ablation destroys the normal thyroid tissue remnants and microscopic foci of residual tumour.
graves and thyroid ca
This woman has hyperthyroidism but the prominent nodule which is ‘cold’ on uptake scanning is highly suggestive of thyroid carcinoma and the mostly likely diagnosis is Graves’ disease (periorbital puffiness and thyroid bruit) associated with papillary thyroid carcinoma.
Thyroid cancer associated with Graves’ disease is not uncommon1 and usually due to papillary carcinoma and must be considered in suspicious/expanding nodules rather than attributing purely to Graves’ disease.
Thyroid peroxidase antibodies are found in more than 70% of cases of Grave’s disease
T score
T scores greater than −1 are normal
T scores between −1 to −2.5 reflect osteopenia and
T scores less than −2.5 reflect osteoporosis.
Factitious hypoglycaemia due to insulin treatment
This patient has developed hypoglycaemia with suppression of her 3 beta-hydroxybutyrate (a ketone), elevated insulin, yet suppressed C peptide. This would suggest that this is insulin induced hypoglycaemia, and as C peptide is suppressed indicates exogenous administration of insulin.
Sulphonylureas would produce raised insulin and C peptides and could be assessed in suspicious cases by measuring a sulphonylurea concentration.
Insulinoma would be associated with proportionately elevated insulin and C peptide.
