Endocrine Flashcards
Acromegaly investigations
IGF-1 (initial)
confirmation (growth hormone and glucose tolerance test, glucose should inhibit growth hormone)
MOA alendronic acid
Inhibits osteoclasts
Non classical congenital adrenal hypoplasia
Presents similarly to PCOS but also will have raised 1-17 OH progesterone
Signs of Graves disease only
lid lag and lid retraction
periorbital oedema
exopthalmos
opthalmoplegia
optic nerve compression
Is carbimazole safe in pregnancy
yes
Addisons, hormone
Cortisol and aldosterone
Main cause of Addisons?
autoimmune destruction of adrenal glands
Cause of skin hyperpigmentation in Addisons
XS ACTH
Cause of amenorrhoea in Addisons
High levels of prolactin
Conns disease
XS aldosterone
Diabetes drug that doesn’t need to be adjusted in renal impairnment
Linagliptin
Diabetes meds that cause weight loss
GLP-1 analogue (-glutide)
SGLT-2i (-flozin)
Diabetes meds that cause weight gain
Insulin
Pioglitazone
Sulfonylurea
Diabetes med that is at risk of hypoglycaemia
Insulin
Diabetes meds that cause ketoacidosis
DPP-4i (-gliptin)
GLP-1 analogue (-glutide)
SGLT-2i (-flozin)
Diabetes medication to be avoided in HF
Pioglitazone
Diabetes medication to be avoided in bladder cancer
Pioglitazone
Diabetes medication to be avoided in gastro disease
GLP-1 (-glutide)
How does an insulinoma present
Hypoglycaemia
Rapid weight gain may be seen
high insulin, raised proinsulin:insulin ratio
high C-peptide
What is an insulinoma
Neuroendocrine tumour deriving mainly from pancreatic Islets of Langerhans cells
Management of insulinoma
Surgery (if not fit for somatostatin)
Where are insulinomas normally found
Pancreas - requires a CT pancrease
Familial hypocalciuric hypercalcaemia
moderately high calcium with low calcium excretion (autosomal dominant)
Mx:
Management of acromegaly
Transphenoidal surgery (can use somatostatin analogue to reduce the size)
Dopamine analogue example
Pramipexole
Ropinirole
MODY 2
Fasting glucose is normal and increase when given glucose only increases very slightly
If patients relatives have remained well for a while MODY type 2 > type 3
MODY 3
Present very similarly to type 1
MODY 5
Renal cysts and diabetes
Treated with insulin
Cushing’s investigation
24 hour urinary cortisol
Dexamethasone suppression test
Tamoxifen MOA
Mixed oestrogen receptor antagonist and partial agonist
Post menopausal breast cancer
Letrozole (aromatase inhibitor)
Pre menopausal breast cancer
Tamoxifen
Hormone that stops growth and fuses the epiphyseal plates
Oestrogen
How to measure the volume of the thyroid gland
USS
Hyperemesis and thyroid bloods
Appears to have hyperthyroidism but this is driven by BHCG, can observe and wait to normalise if no symptoms
Thyroid lymphoma management
RCHOP + external beam radiotherapy
Medullary carcinoma
Calcitonin
Type of cancer causing stridor and regional lymphadenopathy
Anaplastic carcinoma
Thyroid lymphoma
Seen in over 60s
Acromegaly cancer link
Colorectal cancer
How is denosumab given
SC 6 monthly
How is teriparatide given
Daily injection
When is metformin CI
eGFR <30
Why does metaclopramide cause galactorrhoea
It is a dopamine antagonist that binds to the D2 receptors on pituitary lactotrophs stimulating prolactin. Prolactin causes galactorrhoea (also inhibits GnRH so can cause amenorrhoea)
Diabetic amyotrophy presentation
Proximal muscle weakness
Hashimotos antibodies
HYPOTHYROIDISM anti-TPO or anti-Tg
Graves disease
HYPERTHYROIDIDM
anti TSH or anti-TPO
What is prolactin controlled by
Under negative control of dopamine
Nelsons syndrome
Cushings and development of an ACTH producing tumour –> causes skin pigmentation and bitemporal hemianopeia
Acromegaly hormone and ix
XS GH, serum IGF-1/OGTT
Cushings hormone and ix
XS cortisol, dexamethasone suppression test or 2x 24 hour urinary cortisol levels
Addisons hormone and ix
Decrease in cortisol
SynACTHen test
Conns hormone and ix
XS aldosterone
aldosterone:renin
MRI/renal vein sampling
Early pregnancy hyperthyroid management
Propyluracil
Late pregnancy hyperthyroid management
Carbamazapine as propyluracil has an increased risk of hepatic toxicity
Insulinoma investigation
72 hour supervised fast