Endocrine Flashcards
Dose of calcium for >50
1300mg daily
Starting dose of thyroxine
1.6mcg/kg
Adjust 4-8 weekly
OR
Partial treatment
25-50mcg adjust 4-8 weekly
*better for oldies and mild derrangement
Automatic high risk for diabetes (AND screening type and frequency)
- GDM
- Overweight and >40
- First degree relative w diabetes
- CVD
- Pacific islander, indian subcontinent,ASTI
- PCOS
FBG or HbA1c EVERY 3 YEARS
Starting dose for hyperthyroidism
Carbimazole 10-20mg in 2-3 divided doses
adjust dose 4-6 week interval
If severe (ie t3-t4 2.5 x normal) then 30-40mg
When to use radioidoine or thyroidectomy for graves?
- Severe graves or large goitre
- Toxic adenoma or multinodular goitre
- When TSH receptor antibody remains elevated despite therapy
Signs of adrenal insufficiency
- Malaise
- Weakness
- Anorexia
- Weight loss
- HYPERPIGMENTATION
Diagnosis of adrenal insufficiency
- Morning serum cortisol
- Urinary cortisol measurement
- SHORT SYNACTHEN TEST
Cushing’s syndrome diagnosis
- 24hour urinary free cortisol (measured twice)
- 1mg overnight dexamethasone suppression test
Signs and symptoms of Cushing’s syndrome:
Features:
- Truncal obesity
- Hirsutism
- Acne
- Weakness
- Thin skin
- Bruising
- Insomnia
- Depression
Signs
- Moon facies
- Buffalo hump
- purple striae
Exercise restriction for diabetics (specific example/condition)
- Proliferative retinopathy
Diabetic ideal range for BGL pre-exercise & when to check (HINT: which meds)
5-13.9
Insulin or sulfonylureas
Diabetes exercise guidelines (hint: aerobic and resistance)
1) 150 min mod-vigourous aerobic over at least 3 days with no more than 2 days without activity
2) 60mins resistance exercise
2-3 sessions/ week non- consecutive days
also: interrupt sitting every 30 mins
Minimal trauma fracture when to inititate treatment vs when to refer to specialist (hint T score cut off)
T score <-1.5 start treatment
if T score >-1.5 then refer for specialist review
Diabetes in pregnancy: pre-conception hba1c target
<6.5
Hypoglycaemia emergency management
1) able to eat
2) not able to eat
15g short acting carbohydrate (eg 6 jellybeans)
1mg glucagon IM
Frequency for diabetes screening for ATSI patients >18
yearly
Low risk individuals: how often to assess AUSDRISK? and from what age?
Every 3 years from 40
Licence restriction for severe hypoglycaemia episode (severe = not able to treat themselves)
- 6 weeks
- must see specialist
Incidental adrenal mass investigation next step:
- 1mg dexamethasone supression test
- 24hr urine metanephrines and catecholamines
If HTN
Then aldosterone- renin ration
When do we use Cabergoline?
- Prolactinoma
- Medically indicated suppression of lactation (still birth, severe mastitis)
Diet advice for diabetes (lifestyle)
- 1.5 serves of dairy
- 3 serves of wholegrains
Pharmacotherapy principles for diabetic retinopathy
- Optimise BGL
- Control BP
- Add: fenofibrate 145mg daily
- Treat hypercholesterolaemia
Assessment for diabetic peripheral neuropathy (clinical)
- 10g monofilament pressure sensation at MTJ
- Ankle reflex
- Vibration sensation with 128hz fork
- Pinprick sensation
Neuropathic pain treatment (pharmacology) be specific
Amitriptyline 10mg nocte
OR
Pregabalin 75mg nocte
or
Duloxetine 30mg daily
Addison’s crisis treatment
IV 100mg Hydrocortisone or prednisolone 40mg orally
IV fluid resuscitation 10-20ml/kg bolus
Addisons (adrenal insufficiency) symptoms
- Diarrhoea
- Vomiting
- Weight loss
- Fatigue,
- postural hypotension
- HYPERpigmentation
Cushings sydnrome tests
ONE OF THE FOLLOWING
- Late night saliva cortisol
- 24hr urinary free cortisol
- Dexamethasone 1mg supression test
When to order Thyroid scintigraphy
- HIGH T3/T4
HYPERthyroidism
Looking for - graves
- toxic adenoma
- thyroiditis
Inital dose for HYPERthyroidism
Carbimazole 10-20mg (mild symptoms)
Carbimazole 30-50mg (severe)
Rare side effect of Carbimazole
Agranulocytosis
3 main blood tests to distinguish T1DM from T2D
- Insulin auto-antibodies (IAA)
- Islet cell auto-antibodies (iCA)
- GAD
- C peptide (lower in type 1)
GDM Cut off values (Hba1c and OGTT)
Hba1c 5.5
OGTT >8
Investigation for primary aldosteronism
- Change antihypertensive to verapamil SR, Prazosin, moxonidine or hydralazine.
- Wait 6 weeks
- Test Renin: aldosterone ratio
Acromegaly:
Too much what ?
Excessive growth hormone
(pituitary adenoma)
Acromegaly:
What test?
Serum insulin like growth factor-1 (IGF-1)
Signs of Acromegaly
- Frontal bossing
- Enlargement of hands and feet
- Oily Skin
- Sweating
- OSA
Post partum raised T3 & 4 potential diagnoses
- Postpartum thyroiditis
- Graves
Thyroid autoantibodies in Graves
TSH Receptor ab positive
TPO sometimes elevated
Frequency for diabetes screening in ATSI population
YEARLY hba1c or FBG
6 causes for thyrotoxicosis
Graves
Toxic multinodular goitre
Toxic adenoma
Painless thyroiditis
Post partum thyroiditis
Painful subacute thryoiditis
Hypothyroidism in pregnancy dose change to thryoxine advice
25% increase as soon as falls pregnant (4-6 weeks)
Hypothyroidism in pregnancy rate of testing in early pregnancy
4-6 weeks
Causes for moderate hypophosphataemia
Vit D deficiency
Iron infusion
Primary Hyperparathyroidism
Antacid abuse
Adrenal insufficiency/Addisons signs on exam?
- HYPERpigmentation
- Postural hypotension
- Dehydration
- Decreased body hair
- Vitiligo
- Tachycardia
When to order thyroid scintigraphy?
Hyperthyroidism
Timing pattern in Painless postpartum thyroiditis
1-6 months PP
Thyrotoxicosis followed by hypothyroidism (20% of the time permanent)
Pathogenesis in painless postpartum thyroiditis
Autoimmune destruction of thyroid follicles causing release of stored thyroid hormone
6 main causes of HYPERthryoidism
- Graves
- Painless post partum thyroiditis
- Toxic adenoma/multinodular goitre
- Exogenous thryoid hormone
- PAINFUL subacute thyroiditis (De-Quervain’s)
- Amiodarone
Threshold for TSH in pregnancy to commence thyroxine (regardless of T3/4)
4
between 2.6-4 controversial
What do you give to someone with Postpartum thyroiditis?
NO thyroid medication (transient)
–> if symptomatic then for propanolol
Raised TSH approach (diagram given) tests and imaging
Causes of hyperthyroidism
- Graves disease
- Toxic multinodular goitre
- Toxic adenoma
- Postpartum thryoiditis
- Exogenous thyroid hormone
- Painless sporadic thyroiditis
- Painful subacute thryoiditis
- Amiodarone induced thyroiditis
