Endocrine Flashcards
Primary vs Secondary vs tertiary hyperparathyroidism causes and calcium levels
Primary - primary parathyroid adenoma. High PTH, High Ca
Secondary - low vit d or CKD. High PTH, low ca
Tertiary - prolonged untreated CKD, High PTH, High ca
Sx of hypoglycaemia
Pallor
Sweating
Restless
Tremor
Tachycardia
Anxiety
Confusion
Drowsiness
Rf for hypoglycaemia in hospital/ post admission
Change in diet during stay
Missed or delayed meals
Elderly pts
Mobilisation and physio regimes after illness
Prev ep of hypos
Medication changes
Medication errors
Comirbidities eg sepsis
Mild vs moderate vs severe hypoglycaemia features
Mild - <4, conscious, orientated, can swallow
Moderate - <4, conscious, able to swallow. Disorientated
Severe - <2.6 unconscious/agressive. Can not swallow
Rx of mild. If doesnt work what do you do
Give 5-7 dextrose tablets
Or glucojuice
Or lift juice shots
Stop any insulin in situ
Repeat x3 times, checking bm every 10-15mins. If still hypo, consider 1mg glucagon IM or 50/ml/hr of 20% iv glucose
Rx of moderate hypoglycaemia
If capable and cooperative treat like mild. If not, but can swallow, give 2 tubes of glucogel.
Max 3 times then IM glucagon or 50ml/hr 20% glucose
What should you do once bm rise above 4 in hypoglycaemia rx and why
What if glucagon has been administered
Give a long acting carbohydrate (20g) such as a slice of toast, glass of milk, 2 biscuits to replenish glycogen stores
If glucagon has been used, double the carbs (40g)
Presentation of DKA
Nausea vomiting
Sweet smelling breath
Abdo pain
Kussmaul breathing
What should you wait for before stopping IV insulin infusion
30mins after SC short acting insulin has been administered
Complications of HHS
MI, stroke, thrombosis
Seizures
Cerebral oedema
Central pontine myelinolysis
3 main features of HHS
Marked hypovolaemia/dehydration
Marked hyperglycaemia (>30)
Raised serum osmolarity >320
Calculate osmolarity
2(Na)+glucose+urea
Rx of HHS
Fluids
Insulin once glucose is no longer being reduced by fluids alone
Correct electrolyte imbalances - particularly potassium
VTE prophylaxis
Which diabetes drug can rarely cause mourners gangrene
SLGLT2 inhibitors (gliflozin)
ix for acromegaly
MRI head
Serum IGF 1 levels (GH not accurate enough as released in pulsatile manner)
OGTT - rapid increase in blood glucose should supress GH but GH levels not supressed
rx of acromegaly
transphenoidal surgery
what is Sheehans
rf for it
necrosis of pituitary after birth
PPH increases risk
causes of hypopituitarism
pituitary apoplexy
sheehans
tumour
trauma
radiotherapy
hyperprolactinaemia causes
anti psychotics
pituitary adenomas
prolactinomas
liver cirrhosis
pregnancy
acromegaly
Domperidone (common! used to induce lactation in breastfeeding)
rx of hyperprolactinaemia
dopamine agonists eg bromocriptine, cabergoline
side effects of the dopamine is addiction! and risky behaviours
ix results in diabetes insipidus
hypernatraemia
low urine osmolality
high serum osmolarity
diagnostic ix for DI
results for craniotomy and nephrogenic
water deprivation test (desmopressin stimulation test)
crania low urine osmolality before and high after
nephrology low urine osmolality before but also low afterwards
causes of nephrogenic DI
genetic
hypercalcaemia
lithium
pyelonephritis
sickle cell
causes of cranial DI
head injury
pituitary adenoma
sarcoidosis
sheehan
ix results in SIADH
dilutional hyponatraemia
high urine osmolality
low serum urine osmolality
which lung cancer causes SIADH
small cell lung cancer
causes of SIADH
Post-operative after major surgery
Lung infection, particularly atypical pneumonia and lung abscesses
Brain pathologies, such as a head injury, stroke, intracranial haemorrhage or meningitis
Medications (e.g., SSRIs and carbamazepine)
Malignancy, particularly small cell lung cancer
Human immunodeficiency virus (HIV)
top 3 - SSRI, small cell lung cancer, post surgery
rx SIADH and what to monitor for
fluid restrict
demiclocycline
ADH antagonists
central pontine myelinisis - rx slowly, do not correct sodium levels too quickly
rx of cranial DI
desmospressin
rx of nephrogenic DI
thiazides and low salt diet
features of hyperthyroidism
Rapid heartbeat (palpitations).
Feeling shaky and/or nervous.
Weight loss.
Increased appetite.
Diarrhea and more frequent bowel movements.
Vision changes.
Thin, warm and moist skin.
Menstrual changes.
Intolerance to heat and excessive sweating.
Sleep issues.
Swelling and enlargement of the neck from an enlarged thyroid gland (goiter).
Hair loss and change in hair texture (brittle).
Bulging of the eyes (seen with Graves’ disease).
Muscle weakness.
antibodies in hyperthyroidism
TSH stimulating hormone
anti tpo
rx of hyperthyroid
propanolol for adrenegeric effects
then carbimazole and thyroxine (block and replace)
radioactive iodine
what drug not to give with methotrexate
trimethoprim!! risk of agranulocytosis!!
someone come in with sore throat on carbimazole, what should you do
urgent FBC!!
thyroid storm triad
fever, tachycardia, delirium
what is the most common type of thyroid cancer
papillary
what is AIN and features
hypersensitivity reaction causing inflammation of the space between the cells and the tubules of the kidney. It occurs in response to drugs (often antibiotics, including penicillin), infection (including staphylococcal infection) and systemic disease (such as systemic lupus erythematosus or systemic sclerosis). The presentation involves an allergic-type response, with an acute kidney injury (AKI) and hypertension.
rash, fever, arthralgia and aki
what other endocrine condition should people with acromegaly be screened for
Diabetes mellitus due to insulin resistance
features of acromegaly
frontal bossing, macroglossia, hypertension, bitemporal hemianopia, voice changes, sleep disturbance due to OSA, large hands and feet, prognathism
