Endocrine Flashcards
Management of gastroparesis in T1D
Motility agents e.g. metoclopramide/domperidone
Or gastric pacemaker
Management of severe hypoglycaemia
200ml 10% dextrose IV
1mg/kg glucagon
WHich of the drugs for T2D can cause lactic acidosis?
Metformin
Autonomic neuropathy presents with
Nocturnal diarrhoea
Erectile dysfunction/impotence
Poor BP and temp regulation
Initial management of moderate DKA in kids
V 0.9% sodium chloride
How are thyroid hormones secreted into bloodstream?
Colloid containing thyroid hormone is pinocytosed by follicular cells. Lysosomes then fuse with this intracellular vesicle to digest thyroglobulin and release T3 and T4. T3 and T4 are secreted into the bloodstream by diffusion and membrane transporters
How thyroid hormone secretion regulated?
High levels of thyroid stimulating hormone (TSH), T3 and/or T4 are detected by the hypothalamus, which inhibits release of thyrotropin-releasing hormone (TRH) which decreases secretion of TSH and therefore also T3, T4
How does pituitary compress optic chiasm?
From below
Thiazides cause what electrolyte abnormality?
Hypercalcaemia, hypokalaemia
Where is ADH secreted from?
Posterior pituitary
Anti-diabetic drug assoc with incr risk of bladder cancer
Pioglitazone (TZD)
What condition of pregnancy is associated with high hCG and abnormal TSH/fT4?
Hyperemesis gravidarum
- usually resolves by 20 weeks, no TRab
- manage with H1 antagonist
Describe negative feedback loop of thyroid hormones
High levels of thyroid stimulating hormone (TSH), T3 and/or T4 are detected by the hypothalamus, which inhibits release of thyrotropin-releasing hormone (TRH) which decreases secretion of TSH and therefore also T3, T4
Pubertal delay and poor secondary sexual development, combined with the anosmia and cleft palate suggests?
Kallmann syndrome
Brown bone tumours are assoc with?
Hyperparathyroidism
Mechanism of ADH
Antidiuretic hormone promotes water reabsorption by the insertion of aquaporin-2 channels
MEN1 clinical manifestations
Parathyroid (hyperpara)
Pancreas
Pituitary
(adrenal and thyroid)
Presents with hypercalcaemia
MEN2a clinical manifestations
Parathyroid
Phaeochromocytoma
(medullary thyroid)
MEN2b clinical manifestations
Phaeochromocytoma
(marfanoid, neuroma)
What changes should be made to hypothyroidism management in pregnancy?
Levothyroxine - dose increased by at least 25-50 microgram
Monitor TSH very closely
When can insulin be used outwith diabetic management?
To reduce hyperkalaemia
Management of phaeochromocytoma pre-surgery
Alpha blocker
e.g. phenoxybenzamine
What is DKA in absence of acidosis?
Diabetic ketosis
Diagnostic test for insulinoma
72 hour fast
Pathophysiology of Graves’ disease
Formation of IgG antibodies to TSH receptors on thyroid gland
Which electrolyte must you be most aware of in DKA as it may become depleted in the body even though plasma concentrations may seem normal?
Potassium
What is a psammoma?
Clusters of calcium buildup
- characteristic of papillary thyroid cancer
Most common bacterial cause of Waterhouse-Friderichsen syndrome
Neisseria meningitides
Most common deficiency cauding CAH
21-hydroxylase deficiency
Newly diagnosed diabetic child is managed on 1 unit of insulin a day - why such a low dose?
Patient still has some residual beta cell function
- honeymoon phase
Loss of lateral 1/3 of eyebrow can be a sign of which endocrine condition?
Hypothyroidism
- Hertoghe sign
Worst prognosis thyroid cancer
Anaplastic = awful
Impaired glucose tolerance on fasting and 2h glucose
Fasting: <6.1 (normal)
2h: 7.8-11 (impaired)
Which visual symptom suggests severe thyroid eye disease?
Diplopia/proptosis
First line investigation of suspected panhypopituitarism?
Insulin tolerance test
- will illicit stress response and can measure ACTH/cortisol and GH
Most common cause of hyperparathyroidism
Parathyroid adenoma
Management of neuropathic pain in patients not able to tolerate oral medications
Capsaicin cream (0.075%)
Young person, hyperthyroid features, swollen and painful goitre but tired and rundown?
Subacute DeQuervain’s thyroiditis
Which heart condition can be a complication of hyperthyroidism?
Atrial fibrillation
Drug that can impair absorption of thyroxine
Ferrous sulphate
- for anaemia
Management of post-partum thyrotoxiosis
Propanolol
- symptom control
How to differentiate between hyperthyroid phase of DeQuervain’s and Grave’s disease?
DeQuervain’s - reduced uptake on radioiodine isotope scan
Grave’s - increased uptake on radioiodine isotope scan
Gestat
Most common cause of cellulitis in diabetes
Strep pyogenes
When would you give zolendronate rather than alendronate?
If oral bisphosphonate can’t be tolerated
Management of hypoglycaemic patient who is alert and able to swallow water
Oral glucose tablets
Which medications should be stopped while T2 diabetic patient is fasting for surgery?
Meds causing hypoglycaemia e.g. gliclazide
Recurrent candidiasis indicates the need for which blood test?
HbA1c
- recurrent infection is suggestive of diabetes
What should always be ruled out before water deprivation test in suspected diabetes insipidus?
Hypercalcaemia
- measure serum clacium
First line investigation in suspected thyroid cancer/thyroid nodule
Thyroid ultrasound
Investigation of diabetic patient unable to weight bear with history of foot ulcers
MRI foot and ankle
- suspect Charcot’s arthropathy
Persistent hyperglycaemia in patients on enteral feeding - what anit-diabetic drug?
Insulin
Management of steroid induced diabetes
Gliclazide
What is required to confirm diabetes diag with one HbA1c?
Repeat HbA1c
