Endocrine Flashcards
Serum glucose values
Fasting 5.5 7
OGTT 6.8 11
HbA1C 42. 48
Impaired GTT Fasting >5.5,<7 & OGTT >6.8,<11
Diagnosing DM2
Either 2 abnormal Sr glucose values i.e fasting and hba1c even without symptoms or 1 abnormal value with symptoms of DM.
Hypoglycemia
Presents with sweating, confusion, unconscious, tachycardia.
Check RBG< 4.
M/c/c: Alc, drugs,
If patient conscious and can swallow give 200ml of fruit juice.
If patient conscious but cannot swallow give 200ml 10%G or 1mg glucagon i.m /s.c
If patient unconscious give either 75ml of 20%G or 50 ml 10% G i.v or 1mg glucagon i.m/s.c
DKA
Patient presents with Kussmaul’s breathing, and pain, vomiting.
Check G >11, ABG- pH<7.3, Bicarb<15, ketone 3+
Give i.v fluids (0.9% NS over 1 hour if SBP>90 or over 15-20 mins if SBP<90).
i.v insulin infusion
When G<12 give 10%G as well along with NS.
Stress hyperglycaemia
Check FBS after precipitating factor subsides.
Check Hba1c to properly differentiate from DM.
Maturity onset diabetes in young (MODY)
Latent autoimmune diabetes of adulthood (LADA)
MODY Seen in <25 yr olds. Strong fam h/o LADA Seen in 30-50 yr olds. GAD Ab present.
Surgery and diabetes
Major or minor surgery: Stop sulfonylureas on the day of surgery till pt starts taking feeds orally after Sx. Other OHAs can be taken as usual.
Minor surgery: Stop insulin on the morning of surgery
Major surgery: Start sliding scale insulin
Diabetes drugs and treating DM2.
Hyperkalemia
Check Sr K+ and ECG:
If no egg changes stop the offending agent.
If ecg changes of tall tented T waves and wide QRS are present- give i.v calcium gluconate or i.v calcium chloride first and then give Insulin + G or salb neb.
Hypercalcemia
Presents with: Stones - renal Bones - pain Thrones- constipation Psychiatric overtones- confusion Polyuria Polydypsia Treat with i.v 0.9%NS first. Then give bisphosphonates.
Hypocalcemia
Presents with:
Circumoral paresthesia
Tingling
Trousseau sign: Tighten and inflate BP cuff around arm- carpedal spasm
Chovsek sign: Tap over cheek- twitching of facial muscles
Treat with i.v calcium gluconate.
Acromegaly
High GH from a pituitary adenoma.
Initial test: Check IGF-1 levels- will be high. ( GH acts on liver which produces insulin like growth factor-1 IGF-1 which carries out the function of GH on tissues).
Definitive test: OGTT ( Normally G would inhibit GH but in acromegaly GH would remain high despite giving G).
Treat with somatostatin analog (octreotide).
Prolactinoma
First check Sr prolactin levels- will be high.
Do MRI.
Patient would have amenorrhoea d/t less production of FSH, LH d/t mass effect of prolactinoma.
Galactorrhea.
Treat with Dopamine agonist (dopamine inhibits prolactin)- Cabergoline > bromocriptine.
On MRI if prolactinoma <10mm - micoradenoma- medical management.
If >10mm- macro adenoma- first give medical management if symptoms persist transsphenoidal resection f/b supplement all hormones.
Amenorrhea
Hypothalamic: Low GnRH so low FSH and LH hence low oestrogen.
Post pill:
Secondary: Amenorrhea for >6m after established menses.
Premature ovarian failure: In <40 yr olds- High FSH and LH but no oestrogen. Prolactin normal. FSH high on 2 tests 4 wks apart.
Early menopause: Between 40-50 yr old
Diabetes Insipidus
Presents with passing high volume urine >3litres per day.
Check Ur Osm- will be low.
Do fluid deprivation- Check Ur Osm- No change as body is not producing ADH or is not sensitive to ADH so body is not able retain fluid.
Give desmopressin- in central DI Ur Osm would increase but nephrogenic DI there would be no change in Ur Osm.
