Endocrine Flashcards
What are the numbers to diagnose T2DM in a symptomatic patient? (OGTT)
Fasting glucose >7 or Random glucose> 11 if symptomatic. If asymptomatic need to repeat on 2 separate occasions
What is the HBA1C to diagnose T2DM ?
HBA1C >48
How are De Quervans and Graves differentiated?
Both are hyperthyroid. De Quevrans presents with a tender goitre
What would bloods show in anorexia nervosa?
Most things are LOW eg hypokaemia, low FSH and LH. However the C’s and G’s are raised. Eg raised cortisol, raised glucose, growth hormone, cholesterol.
What HBa1c is diagnostic for pre diabetes?
42-47
What is the treatment for De Qeurvans thyroiditis? (First line)
First line tx is conservative with ibuprofen
Which diabetes medication is contraindicated in heart failure?
Pioglitazone as they cause fluid retention
What are the side effects of Pioglitazone?
Fluid retention, liver dysfunction, weight gain.
How does hypocalceamia present?
Muscle cramps and parathesiae
What are the ECG findings of hypocalceamia?
Isolated QT interval elongation.
With an OGTT test, what fasting glucose is abnormal?
6.1 - 7.0 implies impaired fasting glucose (IFG)
With an OGTT test what values are considered impaired glucose tolerance?
OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
What drug is first line in painful diabetic neuropathy?
Duloxetine
What is the first line management of T2DM (without CVS risk factors?)
Metformin
What is the first line management of T2DM (WITH CVS risk factors/ or HF)
Metformin + SGLT2 inhibitor
What is an example of an SGLT 2 inhibitor?
the flozins…. dapagliflozin, and empagliflozin.
What is the biochemical presentation of addisons?
Hyponatraemia/ Hyperkaemia/ low BP.
What test diagnoses addisons?
Short synachten
What is the blood picture in sick euthyroid?
Low T3/T4 and normal TSH with acute illness
What would the C peptide show in T1DM?
Low in T1DM
In the management of T2DM if metformin in contraindicated and the patient has CHD what drug is offered?
dapagliflozin. SGLT2 monotherapy
Primary hyperaldosteronism can be caused by which 2 processes?
eg CONNS.
1. adrenal adenoma (managed surgically)
2. adrenal hyperplasia (managed with Sprinolactone)
What is your blood picture with secondary hyperparathyroidism due to CKD?
Low calcium
High PTH
High Phosphate
High ALP
What is the HBA1C target in T1DM?
48
What are the principles of pre op T2DM oral medications?
Continue them all (metformin etc) apart from FLOZINS SGLT2 inhibitors.
What are the pre diabetes targets?
42-47
Addisions- what are the biochemical markers?
Hyponatraemia, hyperkaemia
Gliclazide is what type of drug and what are the 2 main side effects?
Sulphonylurea
Side effects 1. Hypoglycaemia 2. Weight gain
What is the Hba1c target for a type 2 diabetic being treated with metformin?
48
Sickle cell does what to the HBA1C?
Lower than expected!
What should you do with long acting insulins pre op?
Reduce long acting insulin dose by 20% on day of surgery.
What is the significance of c peptide in differentiating between T1/T2 diabetes?
T2 diabetes C peptide will be high!
What is the blood picture in Pagets?
All normal apart from raised ALP.
Primary hyperparathyroidism- what are the bloods?
High calcium
Low phosphate
Normal or raised PTH
What is HONK?
High blood sugar
Dehydration and renal failure
Ketonuria
What to do with metformin pre op?
Day before surgery- keep going with metformin
Day of surgery- continue. If TDS can omit lunchtime dose.
Oral diabetic meds- what to do day prior to surgery?
Continue them!
What are the causes of cushings syndrome?
ACTH dependent- eg (Cushing disease) pituitary tumour secreting ACTH
Or ACTH from another source eg small cell lung ca.
ACTH independent - STEROIDS
Adrenal adenoma, adrenal carcinoma.
What tests confirm cushings syndrome?
Low dose dexamethasone suppression test confirms cushings syndrome and then needs additional tests to localise.
What test confirms Cushings disease?
High dose dexamethasone suppression test
Primary hyperaldosteronism presents how?
Hypertension, low potassium, metabolic alkalosis
Treatment of addisonian crisis?
Fluids and IV/IM Hydrocortisone
What are the causes of hypothyroid?
Hashimotos
Subacute thyroiditis
Postpartum thyroiditis
Iodine defiency
Lithium
(Amiodarone)
Riedels
What is the reference range for TSH and free T4?
TSH (0.5-5.5)
Free T4 (9-18)
What is the presentation of Cushings syndrome?
(excess steroid) eg weight gain, thirst, easy bruising, hirstiusm, striae.
Management of hypoglycaemia in unconscious patient?
20% dextrose
What are the features of HONK?
Hyperglycaemia,
Hypovolemia,
Raised osmolality
What is the commonest cause of hypercalcemia?
Primary hyperparathyroidism
Tests to investigate acromegaly? (2)
iGF 1 is the firstline line
Diagnostic test- OGTT with GH levels
What is the measurement for macro vs micro pituitary adenoma?
1cm! Macroadenoma >1cm
Cushings disease - what are the 3 management options and potential problems
- remove pituitary tumour that is secreting ACTH
- Pituitary radiotherapy
- BILATERAL ADRENOLECTOMY (Problems 1. Hypoadrenal crisis needing lifelong replacement. 2. Nelson syndrome where pituitary grows ++ mass effects).
Most common thyroid cancer?
Papillary is the most common
Kallmans syndrome- how does it present?
Cause of delayed puberty
Usually presents with boys/ delayed puberty and anosmia
What are the criteria for impaired fasting glucose?
Over 6.1 but less than 7
What are the criteria for impaired glucose tolerance
2hour glucose over 7.8 but less than 11. (AND fasting less than 7)
What are some of the clinical features of graves?
Thyroid acropachy (swollen hands, digital clubbing and new bone formation)
Lid lag (not specific to graves)
Eye features
Pretibial myoxodema
What are the antibodies in Graves?
TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)
What is the first line management for adults with T1DM?
multiple daily injection basal–bolus insulin regimens
eg: long acting insulin + novorapid PRN
T2DM- what is the HBA1C target with metformin and when would you add in a second agent?
48 with metformin alone
Add in another agent at 58
What is the first line management of T2DM?
Normal people= Metformin
Any CVS risk factors or CVS disease= Metformin and once established add SGLT 2 inhibitor eg Flozin
How does hyponatraemia present?
N+V
Diminished reflexes
What are the complications of Cushings syndrome?
HYPERtension
Left ventricular hypertrophy
Arrythmias due to hypokaemia
Atherosclerosis
Psuedohypoparathyroidism - what are the bloods?
Other features
High PTH
Low calcium
High Phosphate
Short stature
Unusual skeletal defects
4th and 5th metatarsal short
Diagnosis of Addisons - what test?
Short synacten
Biochemical picture in Addisons?
Low Na
High K
Biochemical picture in Primary aldosteronism (Conns)
Hypokaemia (LOW K)
Classic is hypertension with hypokaleamia
How does Kleinfelters present vs Kalmanns?
Kalmans= delayed puberty with anosmia
Klenfelters= No secondary sex characertistics/ small testes/ taller than average/ gynaecomastia.
What are the 3 types of hormone secreting pituitary tumours?
ACTH secreting adenoma - present with Cushings
GH secreting adenoma (eosinophillic)- present with acromegaly
Prolactinoma - present with galactorrhea
Phaeochromocytoma- presentation, arises from?/ secretes ?
Hypertension/ flushing/ headaches
Arise from ADRENAL MEDULLA
Secrete catecholamines
Acromegaly- cause and complications?
Most common cause is a GH secreting adenoma in pituitary.
- Complications
Hypertension
CVS
Diabetes
What is Wolfram syndrome?
DIDMOAD is the association of
- cranial Diabetes Insipidus, Diabetes Mellitus,
- Optic Atrophy
- Deafness
Treatment of diabetes inspidius ( cranial vs nephrogenic)
Cranial DI= Desmopressin
Nephrogenic= Thiazide like diuretic (benzoflumethazide)
What are the 4 examples where the PTH is high?
- Primary/ secondary and tertiary hyperparathyroidism
- Psuedohypoparathyrodism
What happens to PTH/ Ca2+/ Phosphate?
- Primary/ secondary and tertiary hyperparathyroidism
- Psuedohypoparathyrodism
Primary- elevated PTH, HIGH calcium and low phosphate.
Secondary. elevated PTH, low calcium and high phosphate.
Tertiary. elevated PTH. High calcium and high phosphate
Psudeohypoparathyroidism- High PTH, Low calcium and high phosphate (same as secondary)
What are the bloods in primary hypoparathyroidism?
Low PTH
Low calcium
High phosphate
What are the bloods in Osteomalacia? (Calcium/ phosphate and ALP)
Low calcium
Low Phopshate
Raised ALP
Addisions - what is the biochemical picture?
Low NA
High K
How do these diabetic neuropathies present?
Sensory diffuse polyneuropathy
Painful diabetic neuropathy
Mononeuropathy
Autonomic neuropathy
Mononeuritis multiplex
Diabetic amylotrophy
Sensory diffuse polyneuropathy - glove and stocking
Painful diabetic neuropathy - burning/ pins and needles
Mononeuropathy - Peripheral or cranial nerves. Most common 3rd cranial nerve oculomotor.
Autonomic neuropathy - Dizzyness/ postural hypotension/ sweating
Mononeuritis multiplex - subacute loss of sensory + motor loss in an individual nerve.
Diabetic amylotrophy - unilateral pain in buttocks/ thigh. Absent reflexes
What is the first/earliest sign of diabetic retinopathy?
First sign is microanuerysms
What is the diagnostic test in Conns?
Aldosterone/ renin Ratio
What are the 4 features of a phaeochromocytoma? and they are a/w with what?
Severe Hypertension
Diaphoresis
Headaches
Palpitations
A/W: Neurofibromatosis/ MEN/ VHL
What diabetic drug increases the risk of Bladder ca?
Pioglitazone
What is a side effect of Metformin?
Decreased Vitamin B12
Hashimotos has which antibodies?
Anti TPO/ Thyroglobin
What is the treatment of CAH?
Lifelong replacement of hydrocortisone
Presentation of CAH?
Autosomal recessive
Salt wasting crisis when a newborn
Hypoglycaemia with concurrent illness
What are the principles of anti thyroid medication in pregnancy
PTU is used in first trimester (up to week 12) and pre pregnancy
Carbimazole thereafter
What are these signs in hypocalcaemia
- Chvostek’s sign
-Trousseau’s sign
Chvostek = tapping over facial nerve causes twitching
Trousseau’s sign- blood pressure cuff causes wrist flexion and carpal spasm
Kussmall breathing is seen in?
Severe Metabolic Acidosis
eg DKA
Toxic multi nodular goitre- features
2nd cause of hyperthyroid after graves
Nodules can suddenly become secretory and thyrotoxicosis
AF and acute heart failure is the presentation
“Plummers disease”
Tx- radioactive iodine ablation
What are the principles of treatment for subclinical hypothyroid?
If TSH if above 10 then start levothyroxine
If TSH 5-10- can repeat in 6 months if asymptomatic
- if symptomatic can consider starting levothyroxine.
What are the blood test results in Cushings?
Hypokalaemia
Hyponatraemia
Hypoglycaemia
Can get a metabolic alkalosis
What would the bloods be for a pituitary tumour secreting TSH
High free T4
Normal TSH
TSH isn’t inhibited due to ++secretion from pituitary tumour. May have an accompanying bitemporal hemianopia
Diagnosis of T2DM- criteria
If symptomatic need 1 of the following
- Fasting >7
- Random >11.1
- HBa1c > 48
If asymptomatic single reading needs to be demonstrated twice
What is impaired glucose tolerance?
Fasting less than 7 AND
2hr glucose test between 7.8 and 11.1
What is the difference between
- low dose dexamethasone test (overnight)
-high dose dexamethasone test?
Low dose (overnight) to confirm cushings SYNDROME
High dose to confirm cushings DISEASE
How do you modify patients on insulin pre op?
Minor surgery- reduce long acting by 20% the day before
Major surgery- put them on a variable rate infusion
