Endocrine Flashcards
Addisons has reduced output of what two hormones
Cortisol and aldosterone (steroid hormones)
What colour can skin go in addisons
bronze
electrolyte imbalances in addisons
low na
high k
test of choice for adrenal insufficiency (addisons)
short synacthen (synacthen is synthetic ACTH- expect cortisol to rise >double baseline in normal)
Cotton wool sign on XR
pagets
Addisons rx
Steroid replacement:
-hydrocortisone to replace cortisol as a glucocorticoid
-fludrocort to replace aldosterone as mineralocort
Double in acute illness - generally glucocorticoid dose should be doubled, with the fludrocortisone dose staying the same
Addisonian crisis rx
IV hydrocort 100mg stat then 6 hourly
Phaeochromocytoma is assoc with which inherited disease
MEN2
Phaeochromocytoma Rx
alpha blockers eg phenoxybenzamine
beta blockers once established on alpha blockers otherwise can cause HTN crisis
Adrenalectomy is definitive but should be medically managed first to reduce risks in surgery/anaesthetic
Isolated ALP rise with normal ca, phos and vit D suggests what
Pagets disease of bone
Pagets Rx
bisphos
Calcitonin (endogenously inhibits PTH)
Surgery if symptomatic
Most common type of thyroid ca
papillary
Monitoring of previous thyroid ca
thyroglobulin levels
MEN1 cancers
parathyroid
pituitary
pancreas
MEN 2 gene
RET oncogene
MEN 2a cancers
Phaeochromocytoma
Parathyroid
Medullary thyroid ca
Men 2b cancers
Phaeochromocytoma
Medullary thyroid ca
What happens to testosterone, aldosterone and cortisol in congenital adrenal hyperplasia
Aldosterone and cortisol are low
Testosterone is high
This is because progesterone’s conversion to A and C is blocked so all the excess becomes T.
congenital adrenal hyperplasia mx
replace steroid hormones with hydrocort and fludrocort
?surgery for female genitalia
When to offer statin for T1dm
-Aged over 40 years.
-Has had diabetes for more than 10 years.
-Has established nephropathy.
-Has other CVD risk factors (such as obesity and hypertension).
Diabetes insipidus symptoms
Polyuria and polydipsia
2 types of diabetes insipidus
cranial (deficiency of ADH) and nephrogenic (insensitivity to ADH)
Diabetes insipidus has _____ blood and _____ urine
Concentrated blood
Dilute urine
Sodium high or low in Diabetes insipidus
High
Test for diabetes insipidus
Water deprivation test
Desmopressin suppression test
Treatment for diabetes insipidus
Nephrogenic- thiazides, low salt/protein diet, high dose desmopressin
Cranial- desmopressin
Tender thyroid goitre
De quervains
Goitre plus thyroid eye signs, pretibial myxoedema, acropachy
Grave’s disease
Increased TSH and bitemporal visual defect
TSHoma (pituitary)
High TSH normal T4
subclinical hypothyroid
Preceding systemic illness, low T4, TSH normal, clinically euthyroid
sick euthyroid
De Quervains rx
supportive
can give B blockers or NSAIDs for sx
Hyperthyroid medical management
Carbimazole
Propylthiouracil second line, risk hepatic reaction
Radioactive iodine
Anti TPO antibodies are present in what
autoimmune thyroiditis (hashimotos) and graves
myxoedema is in hyper or hypo thyroid
hypo (severe)
Treatment for myxoedema
IV liothyronine
IV hydrocort until co-existing adrenal insufficiency is excluded
What is the issue with levothyroxine in suspected adrenal insufficiency
can precipitate an addisonian crisis
When do you give levothyroxine in subclinical hypothyroid?
Pregnancy
Serum TSH >10
Goitre
Symptomatic
High serum antithyroid peroxidase Ab
Cushings DISEASE rather than sydrome is what
excess ACTH from pituitary (eg adenoma)
(stimulates adrenals to release excess cortisol)
Cushings investigations
urinary free cortisol
dex suppression test (give at night then measure morning cortisol- should be low if healthy)
What happens to potassium in cushings
low
Medical management of cushings
metyrapone
ketoconazole
mitotane
Fasting glucose ranges for IGT and diabetes
6.1-6.9 impaired
>7 diabetes
OGTT ranges for IGT and diabetes
Impaired 7.8-11.1
Diabetes >11.1
Which oral diabetes drugs have hypo risk
pioglitazones if used in combo
Sulfonylureas (gliclazide)
Oral diabetes meds to be cautious in renal impairment
metformin
Sulphonylureas (gliclazide)
oral diabetes meds that risk wt gain
pioglitazones
Sulfonylureas
SGLT2 inhibitors example and side effect
flozins
wee out sugar
UTI, thrush, frequency
Euglycaemic DKA!!
Oral diabetes med to avoid in heart failure
pioglitazone
What is a drawback of gliptins (DPP-4 inhibs)
Often stop working
Headache,URTI and sinus infection SEs
What diabetes med has cardiovascular benefit
SGLT-2 inhibitor eg dapagliflozin
When do you start SGLT-2 inhibitors (flozins) in diabetics regardless of regime
If the patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ 10%)
the patient has established CVD or develops it
the patient has chronic heart failure
can you get galactorrhoea in acromegaly
yes in 1/3
drug to improve gastric paresis in diabetes
metoclopromide
what is the single most important blood test to assess a patient’s response to treatment with levothyroxine for Hashimoto’s thyroiditis.
TSH
HONK is characterised by
1.) Severe hyperglycemia
2.) Dehydration and renal failure
3.) Mild/absent ketonuria
First line treatment for prolactinomas
Dopamine agonists (eg cabergoline, bromocriptine)
What electrolyte imbalance do thiazides cause
hypercalcaemia
Calcitonin is a tumour marker in what type of thyroid cancer
medullary thyroid cancer
would hyper or hypoparathyroidism cause raised ALP
hyper
