Endocrine Flashcards
What HbA1C level is diagnostic of diabetes mellitus?
48mmol/L or more
What is the immediate treatment for thyrotoxic storm?
Beta-blockers, PTU and Hydrocortisone
What is the investigation of choice for suspected Cushing’s?
Overnight dex suppression test
Where are sex hormones produced?
Zona reticularis of adrenal gland
Where is cortisol produced?
Zona fasciculata of adrenal gland
Where is aldosterone produced?
Zona glomerulosa of adrenal gland
Which adrenal condition may lead to Cushing’s syndrome?
Adrenocortical tumour
What is Addison’s disease?
Primary adrenocortical failure
Give causes of Addison’s disease.
90% due to autoimmune destruction
Others: Infection, adrenal haemorrhage/infarct, metastatic invasion
What are the features of Addison’s disease?
Cortisol deficiency: Fatigue, weight loss, orthostatic dizziness and anorexia
ACTH over-secretion: Skin hyperpigmentation
Give causes of Addisonian Crisis.
Can occur in increased cortisol req. Eg. infection, surgery
Adrenal haemorrhage
Inadequate cortisol dosing
Which biochemical abnormalities may be found in Addisonian Crisis?
hyponatraemia, hyperkalaemia, raised urea
What is the maintenance therapy for Addison’s disease?
Hydrocortisone & Fludrocortisone
What is Conn Syndrome?
Primary Hyperaldosteronism - excess aldosterone production
What is the most common cause of Conn’s syndrome?
unilateral adrenocortical adenoma
What is the key feature of Conn Syndrome?
Resistant hypertension +/- hypokalaemia
What is the investigation of choice in Conn Syndrome?
paired renin and aldosterone serum levels
What is the treatment for pheochromocytoma?
alpha blocker then beta-blocker, then surgery
What is the most common form of Congenital Adrenal Hyperplasia?
21-hydroxylase deficiency
How may CAH present?
failure to thrive or ambiguous genitalia in females
How can serum osmolality be estimated?
2 * Na+ + glucose + urea
How do gliptins work?
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
What should diabetics patients who are on insulin do if they are unwell?
Continue with normal insulin regimen but check blood sugars more frequently
What is the first-line agent for Grave’s disease?
Carbimazole
What glucose level is diagnostic of diabetes?
fasting > 7.0, random > 11.1 - if asymptomatic need two readings
High glucose and normal C-peptide would suggest…
T2DM
Glicazide is an example of which class of medication?
Sulphonylurea
Sitagliptin is an example of which medication class?
DDP-4 inhibitor
Dapagliflozin is an example of which drug class?
SGLT2 inhibitor
Which diabetic medications can cause weight loss?
GLP-1 agonists, SGLT2 inhibitors
Which diabetic medications are associated with hypoglycaemia?
Insulin, SUs, TZDs
What is the investigation of choice for phaeochromocytoma?
24 hour urine collection of metanephrines
painful thyroid swelling, usually triggered by a viral infection suggests…
De Quervain’s thyroiditis
Which auto-antibodies are associated with Grave’s disease?C
Anti-TSH and anti-TPO
What is the first-line agent for Grave’s disease?
Carbimazole
How is Grave’s disease treated in pregancy?
1st trimester = PTU
2nd and 3rd = Carbimazole
Reduced uptake on thyroid uptake scan suggests…
Thyroiditis
Which complication can occur with Carbimazole?
Agranulocytosis
Hashimoto’s thyroiditis is associated with which auto-antibodies?
anti-TPO and anti-thyroglobulin
What is the most common type of thyroid cancer?
Papillary
Thyroid mass and raised calcitonin suggests…
Medullary thyroid cancer
What is the rarest and most aggressive form of thyroid cancer?
Anaplastic
What is the treatment for myxoedema coma?
IV Thyroxine & Hydrocortisone
What is the first-line treatment for prolactinoma?
Dopamine agonist such as Cabergoline/Bromocriptine
In DKA, should patients continue their normal insulin?
Continue long-acting but stop short-actin
How many readings are needed to diagnose diabetes?
2 if asymptomatic, 1 if symptomatic
What is the treatment for HHS?
Saline solution
Which HbA1C level indicates that another anti-diabetic agent should be considered?
> 58 mmol/L
What is the diagnostic test for Addison’s disease?
Short synacthen test
Which medication should always be initiated in diabetic patients with CVD?
SGLT2 inhibitor
Which anti-diabetic medications promote weight loss?
SGLT2 inhibitor and DDP4-inhibitors
Which anti-diabetic agents promote weight gain?
Insulin, SUs, TZDs, glinides
Which anti-diabetic agents are associated with hypoglycaemia?
Insulin, SUs, TZDs, glinides
