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endocrine Flashcards

1
Q

GLP-1 stimulated by

A

oral glucose load

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2
Q

GLP-1 secreted by

A

small intestine L cells

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3
Q

What is the Incretin Effect?

A

a higher insulin spike is seen with oral glucose than IV glucose
Mediated by GLP-1, decreased in T2DM

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4
Q

example of a GLP-1 mimetic

A

exenetide
s/c injection 60mins before morning and evening meals
can be combined with metformin/sulphonylurea

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5
Q

When should exenatide be started?

A

when insulin would be started
obesity a problem (BMI >35)
continue if beneficial (decrease HbA1c and weight loss)

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6
Q

Risks of exenatide

A

SE nausea and vomiting

risk of pancreatitis and renal impairment

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7
Q

example of Dipeptidyl peptidase-4 (DPP-4) inhibitors

A

sitagliptin,

Vildagliptin

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8
Q

act of DPP-4i

A

DPP-4 inactivates GLP-1, therefore potentiating the effect of GLP-1 (increase insulin release, inhibit glucagon)

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9
Q

do DPP-4’s cause weight gain?

A

no

no evidence of increased hypoglycaemias

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10
Q

another name for subacute thyroiditis

A

De Quervain’s

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11
Q

cause of subacute thyroiditis

A

ususally following a viral infection

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12
Q

Mx of subacute thyroiditis

A

usually self limiting
NSAIDs
may need steroids, particularly if hypothyroidism develops.

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13
Q

Organs affected in Multiple endocrine neoplasia type 1

A

Parathyroid (95%) - hypercalcaemia
Pituitary (70%) - most commonly prolactinoma
Pancreas (50%) - most commonly insulinoma

From the MEN1 gene

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14
Q

how is an insulinoma diagnosed

what is the management

A

supervised prolonged fasting +/- CT

Mx: surgery or diazoxide/somatostatin if unfit for surg.

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15
Q

Mx of diabetic neuropathy

A

1st: duloxetine (SNRI),
2nd: amitriptyline
3rd: + pregabalin
4th: + tramadol

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16
Q

Haemochromatosis:
inheritance
pathology
features

A

auto rec
iron accumulation
bronzing of skin, ED, tired, arthralgia (esp hands)
chronic liver disease (and cirrhosis)
DM
cardiac failure (2ndary to dilated cardiomyopathy)
hypogonadism (2ndary to cirrhosis and pituitary dysfunction)

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17
Q

action of pioglitazone

A

PPAR gamma receptor agonist

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18
Q

SEs of pioglitazone

A 
weight gain
fluid retention - C/I in HF
liver impairment - monitor LFTs
increased risk of bladder ca
increased risk of fractures
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19
Q

causes of low potassium with a raised BP

A 
things affecting RAS system:
Cushing's (and metabolic alkalosis)
Conn's (primary hyperaldosteronism)
Liddle's (increased renin)
11 beta hydroxylase deficiency
liquorice
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20
Q

causes of low potassium with normal BP

A

diuretics
RTA (type 1 (distal) and 2 (proximal))
GI loss (d&v)
Bartter’s (genetic defect in loop of henle - like diuretics)
Gitelman’s (same as above but less severe)

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21
Q

Causes of hirsutism

A 
PCOS (most common)
cushing's syn
obesity (peripheral conversion of oestrogen to androgens)
androgen secreting tumour
adrenal tumour
CAH
drugs: phenytoin
22
Q

Mx of hirsutism

A

weight loss if obese

COCP

23
Q

Ix for acromegaly

A

oral glucose tolerance test with GH measurements

normally GH is suppressed by hyperglycaemia

24
Q

screening for gestational diabetes

A

previous gestational DM: OGTT 16-18w, and at 28w if 1st was normal
other RFs: test at 24-28w

25
Q

Mx of pre-existing diabetes in pregnancy

A

lose weight if BMI >27
stop oral hypoglycaemics apart from metformin and start insulin
folic acid 5mg OD until 12/40

26
Q

Mx of gestational DM

A

responds to diet and exercise in 80% of women
if poor glucose control or complications (macrosomia) ; metformin or glibenclamide (sulfonylurea) or insulin
stop hypoglycaemics post delivery, OGTT 6weeks postpartum

27
Q

C/I for radioiodine in Graves

A

pregnancy (and should be avoided 4-6/12 post Rx)
<16 yrs
thyroid eye disease (relative C/I)

28
Q

conditions that can give higher than expected HbA1c levels

A

increased RBC lifespan:
B12/folate deficiency
iron deficiency
splenectomy

29
Q

most common cause of primary hyperparathyroidism

A

solitary adenoma (80%)

30
Q

classical features of primary hyperparathyroidism

A

elderly female with unquenchable thirst and inappropriately normal/raised PTH
raised calcium, low phosphate

31
Q

indications for orlistat

what is the target weight loss

A

BMI >28 with RFs
BMI >30 with no RFs
aiming for >5% weight loss at 3 months.

32
Q

Causes of hypercholesterolaemia rather than hypertriglyceridaemia

A

nephrotic syn
cholestasis
hypothyroidism

33
Q

Diagnostic features of metabolic syndrome

A 
>3 of:
increased waist circumference (central obesity)
increased TG
reduced HDL
HTN
raised fasting glucose/T2DM
34
Q

associated features of metabolic syndrome

A

PCOS
non-alcoholic fatty liver disease
raised uric acid levels.

35
Q

What is the risk of thyroid eye disease in Graves’ disease?

A

25-50%
Increased risk in smokers
Radio iodine may worsen eye disease

36
Q

What are the criteria for familial hypercholesterolaemia Dx?

A

LDL >4.9
TC > 7.5
+/-Tendon xanthoma, FHx
Heterozygous disease, if homozygous most die before 10 of MI

37
Q

What is the inheritance of familial hypercholesterolaemia?

A

Auto dom

38
Q

Mx of hyperthyroid pt during pregnancy

A

Propylthiouracil - safe in pregnancy

Aim to keep free T4 levels in upper 2/3rds of normal to avoid foetal hypothyroidism

39
Q

Diagnostic criteria for DKA

A

BM >11
Ketonaemia >3mmol/l
pH <7.3

40
Q

Mx of DKA

A

ABCDE
IV fluids - usually need 5-8 litres
Insulin infusion - initially 0.1U/kg/hr
Replace potassium in second bag

41
Q

features of autoimmune polyendocrinopathy type 1?

A

type 1:
rare auto rec AIRE1 gene defect
oral candidiasis, Addisons, hypoparathyroidism

42
Q

features of autoimmune polyendocrinopathy type 2?

other name?

A

Schmidt’s syndrome
Addison’s disease plus T1DM or autoimmune thyroid
more common than type 1
10% of Addison’s disease patients have other endocrinopathies

43
Q

mechanism of action of pegvisomant?

uses

A

GHr antagonist, once daily SC injection
used in acromegaly if not surgically fit. decreases IGF-1 to normal in 90% of patients
doesn’t reduce tumour size

44
Q

Multiple endocrine neoplasia type 2 features

gene

A

2a: medullary cancer, parathyroid, phaeochromocytoma
2b: medullary cancer, phaeochromocytoma. Marfanoid body

RET oncogene

45
Q

Repaglinide/nateglinide
mechanism of action
uses
SEs

A

ATP dependent K channel activators on pancreatic beta cells -> increase insulin release
used for patients not controlled on metformin with eratic lifestyles
hypoglycaemias (not as bad as sulphonylurea (gliclazide)), weight gain

46
Q

Ix for MTC

A

pentagastrin stimulation test

gastrin normally leads to calcitonin release, in MTC there is a marked elevation in calcitonin

47
Q

Features of carcinoid syndrome

which hormones released?

A

carcinoid tumours release serotonin and kallikrein
Flushing
diarrhoea
n&v
bronchoconstriction - histamine induced
2ndary restrictive cardiomyopathy - serotonin induced valvular fibrosis (mainly R heart)

48
Q

Ix and Mx of carcinoid syndrome

A

24 urine 5-HIAA (breakdown product of serotonin)
octreotide scan may clarify distribution of the disease.
Mx: somatostatin analogues (octreotide) for symptomatic control +/- surgery

49
Q

Biochemical changes in congenital adrenal hyperplasia

A

Low-normal cortisol
Markedly raised 17-hydroxyprogesterone

Due to 21-hydroxylase deficiency in steroid synthesis pathway -> decreased cortisol produced -> increased ACTH as decreased NF

50
Q

Features of a glucagonoma

A

diabetes mellitus
weight loss
diarrhoea
necrolytic migratory erythema (red blistering rash of the groin buttocks and perineum)

MRCP (15 decks)

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