Endocrine Flashcards
What is the first line treatment approach in a newly diagnosed T2D?
If HbA1C fails to improve, what is the next step?
Lifestyle modification (diet, exercise, smoking, alcohol etc)
Metformin = 1st line medication
What condition may SGLT2 inhibitors be prescribed to manage?
What is the mechanism of action of SGLT2 inhibitors?
Type 2 Diabetes
Increase the excretion of glucose from the body
What side effects are commonly experienced after initiating metformin?
GI upset: nausea, vomiting, diarrhoea, bloating
Give an example of a commonly used sulfonylurea. - What condition are they commonly used to manage?
What is the mechanism of action of sulfonylureas?
Gliclazide - Type 2 Diabetes
Increase insulin release from the pancreas
A 65 year old man with diabetes has developed painful peripheral diabetic neuropathy.
Name a medication & it’s drug class, used as 1st line in treating this.
Amitriptylline - tricyclic antidepressant
What is the 1st line medication for hyperthyroidism?
When would this drug be contraindicated & what would be used instead?
Carbimazole
Contraindicated in pregnancy - Propylthiouracil used instead
What are the signs of hypercalcaemia?
“Stones, bones, abdominal moans & psychiatric groans”
Renal stones
Painful bones
GI: nausea, vomiting, constipation, indigestion
Neuro: fatigue, memory loss, depression, psychosis
A blood sugar below what is considered as hypoglycaemia?
4mmol/L
Delayed puberty & anosmia (lack of smell) would suggest what condition?
What is the physiological cause behind delayed puberty in this condition?
Kallmann’s syndrome
Hypogonadotropic hypogonadism: hypothalamus doesn’t secrete enough GnRH to stimulate anterior pituitary to secrete LH & FSH → little testosterone/ oestrogen secreted
What condition are biguanides used to treat?
What is the most commonly used biguanide?
What is the mechanism of action of biguanides?
Type 2 Diabetes
Metformin
They increase sensitivity to insulin in the peripheries PLUS increase glucose uptake in the liver
What are the 5 main characteristic features of Cushing’s Syndrome?
High levels of cortisol can cause what 4 clinical conditions?
1) Moon face
2) Central obesity
3) Proximal limb muscle wasting
4) Abdominal striae
5) Buffalo hump
1) Hypertension
2) Insulin resistance (hyperglycaemia → T2DM)
3) Osteoporosis
4) Easy bruising
Women with a RF for gestational diabetes are investigated for gestational diabetes at what gestational week?
How is this investigated?
What additional investigation are women with a history of gestational diabetes given?
Week 24-28
OGTT
Women with a history of GD are given an OGTT at their booking appointment (~10 weeks) - if this is normal, it is repeated at weeks 24-28
What is the 1st line investigation of Cushing’s Syndrome?
Explain how this is conducted and the potential results:
What is the treatment of Cushing’s syndrome?
Dexamethasone suppression test
Patient takes low dose of dexamethasone at night & cortisol & ACTH levels are measured in the morning. If cortisol is high, test is repeated with a high dose of dexamethasone to work out the cause.
-
Low dose dexamethasone results:*
1) low cortisol & ACTH → normal (no cushings)
2) normal/ high cortisol → cushing’s syndrome -
High dose dexamethasone results:*
1) low cortisol & ACTH → pituitary adenoma
2) low ACTH, normal/ high cortisol → adrenal adenoma
3) normal/ high cortisol & ACTH → ectopic ACTH secreting tumour
Surgical removal of the tumour!
~ trans-sphenoidal resection of pituitary adenoma
What the are diagnostic values of type 2 DM:
1) Random blood glucose
2) Fasting plasma glucose
3) 2h glucose tolerance
4) HbA1C
What is required for a T2DM diagnosis in:
a) symptomatic patient
b) asymptomatic patient
1) Random blood glucose: 11.1 mmol/l
2) Fasting plasma glucose: 7 mmol/l
3) 2h glucose tolerance: 11.1 mmol/l
4) HbA1C: > 48 mmol/mol
a) 1 of the above criteria + symptoms
b) 2 of the above criteria from 2 days (if asymptomatic)
List some clinical features of hypoglycaemia: (7)
Shaking
Sweating
Palpitations
Headache
Blurred vision
Hunger
Confusion
What is cushings syndrome?
Name the hormonal control underlying the release of this compound, & the locations where each hormone are released from:
List the 4 main causes of cushings syndrome:
Excess cortisol
CRH (hypothalamus) → ACTH (anterior pituitary) → cortisol (adrenal cortex: zona fasiculata)
1) Long term steroid use (commonest cause)
2) Cushings disease (ACTH producing pituitary adenoma)
3) Adrenal adenoma
4) Ectopic ACTH secreting tumour (eg, small cell lung cancer)
If a T2D cannot tolerate metformin, what class of drugs are they switched to instead? (These are usually the 2nd line treatment option)
Give an example of a drug within this class.
What is the mechanism of action of these drugs?
What is a severe side effect that needs to be monitored?
Sulfonylureas
Gliclazide
They increase insulin secretion from the pancreas
Hypoglycaemia
What is “primary adrenal insufficiency” also known as?
List some common symptoms/signs of this condition: (7)
Addisons disease
- Fatigue
- Nausea
- Muscle cramps
- Abdominal pain
- Reduced libido
- Bronze skin
- Hypotension
What is the 1st line investigation of adrenal insufficiency?
At what time of day should this test be performed? - why?
What results would you see if someone has primary adrenal insufficiency (aka addisons)?
Short synacthen test
In the morning (cortisol levels naturally rise in the morning to wake you up)
Primary adrenal insufficiency: failure of cortisol to rise to at least double the baseline (baseline being the cortisol levels before synacthen was given)
