Endocrine Flashcards
Primary ammenorhea
Failure to establish menstruation by the time of expected menarche
Secondary ammenorrhoea
Cessation of menstruation in women with previous menses
Definition of oligomenoorhoea
Menses occuring less frequently than < 35 days
Causes of primary amenorrhoea in those with normal secondary sexual characteristics
Constituional delay
Pregnnacy
GU malformations
- imperforate hymen
- transverse septum
- absent vagina or uterus
Endocrine
- hypothyroidism
- hyperthyroidism
- hyperprolactinaemia
- cushings
- PCOS
Androgen insensitivity syndrome
Causes of primary ammenorhoea in those with no secondary sexual characteristics
POI
- chromoosomal irregularities (e.g. turners and gonadal agensis)
- chemotherapy
- pelvic irridation
- autoimmune disease
hypothalamic dysfunction
- stress / execive exercise / weight loss
- chronic systemic illness (uncontrolled DM, severe renal and cardiac disorders, coeliac, cancer, infection)
- hypothalamic or pituitary tumours
- cranial irridation
- head injury
- kallmans syndrome
Causes of ambigious genitalia
5-alpha-reductase deficiency
androgen secreting tumours
congenital adrenal hyperplasia
WHat is sheehans syndrome
Pituitary infarction after major obstetric haemorrhage
Pathology of T2DM
Peripheral insulin resistance (exists in overweight individuals)
Inadequate insulin secretion by pancreatic B cells
Decreased glucose transport into cells, causing hyperglycaemia
If you suspect LADA (latent autoimmune diabetes in adults) what do you measure
Islet cell antibodies
Impaired fasting glucose
> 5.6 but < 7
Impaired glucose tolerance
2hr post OGTT value of 7.8 - 11.1
HbA1c diagnostic of T2DM
> 48
HbA1c of pre diabetes
> 42
Examples of autonomic neuropathy
Postural hypotension
gastroporesis
Gustatory sweating
What is assosiated with more severe symptoms of exopthalmos
Smoking
Risk factors for thyroid eye disease
Genetics
Female
Smoking
Radioiodine therapy
Advanced age
Stress
Poorly controlled hypothyrodisim
What is secondary hyperthyroidism usually secondary to
A TSH secreting tumoura
What is subclinical hyperthyroidism
T3 AND T4 normal
TSH is supressed
Most common cause of thyrotoxicosis
Graves disease
Management thyrotoxicosis
Drugs
- carbimazole
- prophythiouracil
- CCBs
- BBs
Radioiodine therapy
Partial or total thyroidectomy
What is the most common cause of thyrotoxicosis in people over 60
toxic multinodular goitre
WHat can cause subclinical thyrotoxicosis
Thyroxine excess
Steriod therapy
Non thyroidal illness
Dopamine infusion
Autoantibodies in thyrotoxicosis
TSH receptor Abs
Antithyroglobulin abs
Antimicrosomal abs (75% graves disease)
What is proximal neuropathy in DM?
Patients develop severe burning/aching and lancinating pain in the hip and thigh
Followed by weakness and wasting of the thigh muscles, which often occur asymmetrically
Antibodies of hashimotos
Antithyroid microsomal
Antithyroglobulin antibodies
Treatment of graves in early vs late pregnancy
early - propothiouracil
late - carbimazole
What is urinary 5HIAA used to indicate
Neuroendocrine (carcinoid) tumours
Metabolic acidosis
Low Ph
Low HCO3
Metabolic alkalosis
High Ph
High HCO3
Respiratory acidosis
Low pH
higher PCO2
Respiratory alkalosis
High pH
Low PCO2
What is the anion gap
Sodium - (Chloride + Bicarb)
Normal anion gap
8-12
What does an anion gap of >20 indicate
an anion gap acidosis
What does an anion gap of 12 - 20 indicate
MAYBE an anion gap acidosis
Causes of non anion gap metabolic acidosis
Acute or chronic kidney disease
Renal tubular acidosis
GI loss
Causes of anion gap metabolic acidosis
Methanol intoxication
Uraemia
DKA
Paraldehyde
Isoniazid or iron overdose
Lactate
Ethylene glycol intoxication
salicylate overdose
Causes of chloride responsive metabolic alkalosis (i.e. will correct with NaCl)
Severe HF
Vomiting / NG suction
Loop and thiazide diuretics
Causes of chloride unresponsive metabolic alkalosis
primary hyperaldosteronism
Barter syndrome
Cushings syndrome
Depletion of magnesium
Causes of respiratory acidosis
Hypoventilation (accumulation of PCO2) due to problems with ventilation
Caues of respiatory alkalosis
Hyperventilation
What is pre proliferative diabetic retinopathy defined by
Cotton wool spots
Venous changes
Intra retinal vascular abnormalitie
WHat does background retinopathy comprise of
Haemorrhages
Hard exudates
Micro haemorrhages
What is proliferative diabetic retinopathy defined by
Retinal neovascularisation at the disc or elsewhere
What are the earliest lesions detected in diabetic retinopathy
Microaneurysms
Treatment of diabetic foot ulcer
Non removeable casting
To offload pressure
Diagnostic features of HHS
Glucose > 30
Serum osmolality >320
Profound dehydration
ph >7
Bicarb > 15
Small or absent ketonuria
Some alteration in consciousness
May also cause
Neurological signs
Hyperviscosity/increased risk of clots
When is PTH secreted
In response to low calcium
What is secondary hyperparathyroidism usually caused by
CKD
Low vit D
What is tertiary hyperparathyroidism usually caused by
Longstanding CKD
Features of hypercalcaemia
Weakness
Mood instability
Dehydrated
Abdominal pain
Cause of raised prolactin levels
Prolactin secreting pituitary tumour
Hypothyroidism
Acromegaly
Presentation of raised prolactin
Galactorrhoea
Ammenorhoea
What is the most common cause of hypercalcaemia in patients with non metastatic solid tumours and in some patients with NHL?
Secretion of parathyroid hormone related protein
Also called humeral hypercalcaemia of malignancy
Mutation of MEN1
mutation in MENIN gene
MEN1 predisposes patients to what
Pancreatic neuroendocrine tumours
Primary hyperparathyroidism (due to 4 gland hyperplasia)
Pituitary adenomas
Benign skin tumours - angiofibromas
High urinary calcium excretion
What do 80% of patients with MEN1 present with?
Hypercalcaemia due to hyperparathyroidism
Inheritance of familial hypocalcuiric hypercalcaemia and pathology
AD
Defect in the calcium sensing receptor
Features of familial hypocalcuric hypercalcaemia on investigation
Slightly elevated calcium and PTH levels
Urinary calcium excretion low
Mutation of MEN2a
RET gene
What does patients with MEN2a present with
Primary hyperparathyroidism (due to pituaitary adenoma)
Medullary thyroid cancer
Phaechromocytoma
What is pseudohyperparathyroidism and blood findings
Rare condition
caused by resistance to PT hormone
Results in low phosphate and calcium levels
High PTH
Treatment of prolactinoma
Dopamine agonists (usually cabergoline)
Diagnosis of cushings
1mg overnight dexamethasone suppression test
two midnight salivary cortisol levels
two 24 hr urinary free cortisol levels
Treatment of mild symptomatic subacute thyroiditis
Propranolol
NSAIDs
Presentation of subacute (De Quervians) thyroiditis
Mod-severe pain in thyroid often radiating to ears, jaw and throat
Several weeks Hx
Malaise
Low grade fever
What comes before subacute / de quervians thyroiditis
A viral illness
What is cranial Diabetes insipidus common after
Head injury
Presentation of cranial diabetes insipidus
Polyuria
Polydipsia
Hypernatraemia
NORMAL glucose
Two classes of diabetes inspidius
Cranial
Nephrogenic
Common causes of nephrogenic DI
Electrolyte derangements (hypercalcaemia, hypokalaemia)
Lithium
Diagnosis of diabetes inspidius
Water deprivation test
Treatment of cranial DI
Treating underlying cause
Ensuring adequate hydration
Sometimes high doses of DDAVP
Treatment of nephrogenic DI
Treating underlying cause
BFM may be trialled
Initial water deprivation test results in cranial DI
High plasma osmolality
Low urine osmolality
Urine osmolality post DDAVP in cranial DI
High > 600
Initital water deprivation test results in nephrogenic DI
High plasma osmolality
Low urine osmolality
Urine osmolallity post DDAVP in nephrogenic DI
Low urine osmolality
What is MEN1 assosiated with?
THE PS
Parathyroid tumours
Pitutary tumours
Pancreas tumours
Angiofibromas
What is MEN2a assosiated with
Parathyroid tumour
Phaechromocytoma
Medually thyroid cancer
WHat is Men 2b assosiated with
Phaechromocytoma
Medullary thyroid cancer
Marfanoid appearance
Mucosal neuromas
What is important in MEN2
Prophylactic Thyroidectomy
Genetics of MEN1
Defect in tumour suppressor gene
Menin gene
Chromosome 11
AD
10% of cases are sporadic
Genetics of MEN2
Mutations are rearranged during transfection (ret) proto-oncogene
AD
Defect in tumour supressir gene
Chromosome 10
What can both MEN syndromes be assosiated with
hypercalcaemia
Investigation for phaechromocytoma
24 hr urine catecholamines
Vanillymandelic acid
MIGB scan
MRI
What do medually thyroid cancers cause
Elevated calcitonin
Genetics of MODY
HNF1 alpha mutation
What cells does MODY affect
Beta cells of the pancreas
Delta cells of the pancreas prodcue what
somatostatin
Features of Batters syndrome
Increased urinary calcium excretion
Hypokalaemia
Metabolic alkalosis
Raised RAAS levels
What does secondary hyperparathyroidism occur from
CKD
Investigation for cushings
Overnight low dose dexamethsone suppression test
Presentation of porphyria cutanea tarda (PCT)
Hyperpigmentation and scarring
Blisterign and crusted lesions on back of hands and other areas that are prone to sun exposure
Hypertrichosis
Dark or reddish urine
Scarring alopecia
Oesotrens can precipitate development
Investigation findings of PCT
Substantial increase in porphyrins in plasma or urine
Assay of red bloods cells for UROD activity
Where is metformin metabolised
Liver
What drug can worsen thyroid eye disease
RAI
Treatment of amoidarone induced thyrotoxicosis
Proprothiouracil
+/- steriods if mixed picture
Diagnosis with hypercalcaemia and low urinary calcium excretion
Familial hypocalcuric hypercalcaemia (FHH)
Treatment of FHH
None
What does failing to concentrate urine post water deprivation test indicate
Diabetes insipidus
Diagnosis of insulinoma
Low glucose
High insulin
High C peptide
In weight restricted adults, what hormone is often high and why
Cortisol
Permanent state of physical stress on the body related to starvation or catabolic state
Pathology of hypercalcaemia in patients with carcinomas which are non metastatic
Secretion of parathyroid hormone related peptide by the tumour
Features of anaplastic thyroid carcinoma
Hard
Rapidly evolving
Regional lymphadenopathy
Stridor due to tracheal compression
What is the medical term for someone with a low BMI who has ammenorrhoea
Functional hypothalamic ammenorhoea (FHA)
Management of symptoms of hyperadrogenism in PCOS
co-cyprindiol
Features of androgen insensitvity syndrome
External female genitalia
Testes remain undescended
They do not menstruate at all
LH:FSH ratio in PCOS
Elevated
Features of turners syndrome
Short stature
Primary ammenorhoea
Delayed secondary sexual characteristics
Dyspraxia
Poor spatial awareness
Mild intellectual impariement
AS
Bicuspid aortic valve
Coarctation of the aorta
Increased risk of hypothryoidism
FSH and LH in primary ovarian failure
Elevated
FSH and LH in secondary ovarian failure
Normal or low
Treatment of macroprolactinoma
Dopamine agonist
Features of primary hyperaldosteronism
Hypokalaemia
Hypernatraemia
Metabolic alkalosis
Resistant HTN despite 3 agents
What is primary hyperaldosteronism secondary to a aldosterone secreting adenoma called
Conns syndrome
Investigation for primary hyperaldosteronism
aldosterone to renin ratio (HIGH)
Features of Liddles syndrome
Profound HTN
Hypokalaemia
Alkalosis
Suppressed RAAS
Genetics of turners syndrome
45X
How does glucagon cause rapid reversal of hypoglycaemia
Acitvates adenylate cyclase
Investigations of conns syndrome
Hypokalaemia
Suppressed renin
Elevated aldosterone to renin ratio
Saline suppression test
Adrenal venous sampling to localise the disease
Why is linagliptin beneficial
Not renally excreted
No increased risk for weight gain or hypoglycaemiaT
Thyroid cancer assosiated with hashiomotors
Thyroid lymphoma
Gases of DKA
Metabolic acidosis
Raised anion gap
Gases of addisons disease
Metabolic acidosiso
Normal anion gap
WHat is adrenal insufficiency
Inability of the adrenal glands to produce mineralcorticoids e.g. aldosterone
What is primary hypoadrenalism called
Addisons
Causes of secondary hypoadrenalism
Exogenous steriod use (most common cause)
ACTH deficiency, most commonly caused by a pituitary lesion
Withdrawl of longstanding steriod therapy
Presentation of CAH
Salt wasting
Ambigious genitalia
Non classical CAH presentation
Presents later in life
Hyperadronagism
Elevated testosterone and 17-OH progesterone
Which hormone is under continuous inhibition
Prolactin
By dopamine
Characteristic skin rash of a glucagonoma
Necrolytic Migratory Erythema
What is a glucangonoma
pancreatic alpha cell tumour that secretes glucagon
Investigation for a glucangonoma
Plasma glucagon levels
WHat test would confirm adrenal failure
Short synacthen test
WHat hormone causes increased skin pigmennation when it is in excess
ACTH
Most common functioning pituitary tumour
Prolactinoma
What molecule lingers and continues to cause a mild acidosis after DKA
Beta hyroxybuutryate
Treatment of gastroporesis in DM
Domperidone
How does glucagon resolve bradycardia
Promotes the formation of cyclic AMP
Treatment of ?DM in a pregnant patient who has no complications and fasting glucose < 7
1-2 weeks of lifestyle advice
If continues despite above, for metformin
Metabolic gas of cushings
Hypocholeraemic metabolic alkalosis
Increased incidence of which cancer is assosiated with acromegaly
CRC
What would make you concerned of a presentation of acromegaly
Normal weight
Skin tag formation
Excessive acne
Carpal tunnel syndrome
Investigation for acromegaly
ILGF1
What odd blood test can be coupled in addisons diseaseE
Elevated TSH
Diagnosis of graves disease
High TSH receptor antibody titres
Treatment of hyponatraemia in patients with SiADH
Fluid restriction
What part of the bone is impaired in osteoporosis
Trabecular bone
What is reidels thyroiditis
Rare chronic inflammatory disease of the thyroid gland characterised by dense fibroiss that replaces the normal thyroid parenchyma
Investigation for hyperadrenalism
Saline suppression test
How does tamoxifen work
Oestrogen receptor antagonist and partial agonist
Confirmatory test if you suspect hyperglycaemia secondary to acromegaly
GTT and GH levels
(high glucose and high GH)
Treatment of acromegaly
Cabergoline (dopamine agonist)
Octerotide (somatostain analogue)
Lanreotide (somatostatin anaglogue)
What is of significance of a rise in LH
Indicates ovulation will occur about 24 hrs after the LH peak
What is MODY characterised by
Raised HDL cholesterol levels
Preserved insulin sensitivity
Low renal threshold for glucose (glycosuria)
Is there any antibodies in MODY
No
What is the direct precursor to oestrogen
Testosterone
What is the prescence of maternal autoantibodies assosiated with
Miscarriage and pre term delivery
Which HLA subtype is most assosiated with type 1 diabetes and autoimmune thyroid disease
DR3
What renal condition can occur alongisde multiple autoimmune conditions and causes hypokalaemia?
Renal tubular acidosis type I
Treatment of solitary thryoid nodule causing thyrotoxicosis
RAI
Treatment of phaechromocytoma
urgent alpha blockade (phenoxybenzamine)
then B blockcade if required
Unilateral adrenectomy
OGGTT and GH
Should suppress GH to an undetectable level
WHat causes hirsituism in non classicical CAH
DHEA
Presentation of congential homocystinuria
Skeletal (marfan like features, scoliosis, OP)
ocular (lens dislocation or myopia)
neurological/psychiatric difficulties
Predisposition to thrombosis
Later development
- thrombosis, CV or cerebrovascular disease
Two categories of homocystinuria
Pyridoxine B6 resposnive or unresponsive
Pathology of type I homocystinuria
Problem with enzyme cysathione beta synthase (CBS)
AR inheritance
Blood tests of PCOS
Low sex hormone binding globulin (SHBG)
Raised free androgen index
Treatment of hyperlipidaemia in hypothyroidism
Will resolve with thyroxine therapy
How do bisphosphonates work
Inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis (cell death) and thereby slowing bone loss
What hormone is chiefly responsible for epiphyseal fusion and cessation of growth
Oestrogen
Examples of drugs causing hyperprolactinaemia
Haloperidol
Dopamine receptor agonists
Antidepressants
Verapamil
Metyhldopa
Opiates
H2 antagonists
WHat hormone is assosiated with endometrial shedding
Progesterone
Example of treatment for severe OP
Denosumab
How is melatonin naturally synthesised
Increased serotonin N-acetyltransferase
Most common S/Es of HRT
Breast tenderness
Bloating
Nausea
Leg cramps
Headache
Hyperlipoproteinaemia type IB has mutations for the gene coding for which protein
Apolipoprotein CII (APO CII)
When does barter syndrome present
< 5 yrs old
Prednisolone dose vs hydrocortisone dose
Pred dose - 25% of hydrocortisone dose
Mechanism of action of levonogestrel in emergency contraception
Delays ovulation
What is a serious potential S/E of anti thyroid drugs
Agranulocytosis
Ideal insulin regime for a new T1DM
Basal bolus regime
What is a pituitary apoplexy
Haemorrhage or infarction of the pituitary gland
Usually occurs in a pre-exisiting adenoma
Presentation of pituitary apoplexy
CN palsies
Headache
Collapse
Hypotension
Investigations of pituitary apoplexy
Pituitary hormone screen
MRI
Treatment of pituitary apoplexy
IV steriods
Primary cause of DKA
Lipolysis
Over 90% of people who have hypothyroidism have what
Dyslipidaemia
Assosiations of myoxedema coma (profound hypothyroidism)
Reduced T4
High TSH
Hypothermic
Unconscious
Heart failure
Antibodies assosiated with adrenal insufficiency
21-hyroxylase antibodies
Not always positive when measured
Blood tests of PCOS
High LH (ratio of LH to FSH high)
Normal FSH
Normal oestrogen
High testosterone
Low SHBG
Genetics of klenfielters syndrome
XXY genotype
(extra X chromosome)
Presentation of klenfielters syndrome
Usually diagnosed in late pubertal or adult life because of delayed sexual development or infertility
Tall stature
Gynaecomastia
Small testicular volumes
Infertility
Investigation for klenfelters syndrome
Chromosomal analysis
What is the common presentation of pagets disease
High ALP levels
Mixed lytic and sclerotic lesions
In a man who is otherwise systemically well
Treatment of pagets disease
Bisphosphonates
What is kallman syndrome assosiated with
A decreased sense of smell
Genetics of kallman syndrome
Familial
X linked
Features of kallman syndrome
Isolated GnRH deficiency
Hypogonadism (testosterone < 6)
Small and soft testes
Sparse axillary and pubic hair
Example of sulphonyura
Gliclazide
Example of GLP1 inhibitor
Semgaglutide
Liraglutide
WHat diabetic drug should be stopped in patients who have an unstable circulation post MI?
Metformin
Investigation for ACTH and GH deficiency in patients with suspected hypopituitism
Insulin stress test
WHat causes hypokalaemic periodic paralysis
muscle voltage gated calcium channel mutation
WHat can long term treatment with lithium cause
Frank hypothyroidism
Who are GLP1 inhibitors contraindicated in?
People with gastroporesis
Treatment of thyroid lymphoma
NOT treated by surgical excision
Chemotherapy and external beam radiotherapy
WHat part of the nephron is affected in CDI
Cortical and medullary collecting tubules
Investigation of conns syndrome
Aldosterone to renin ratio
(elevated aldosterone, suppressed renin)
WHat kind of drug is dapagliflozin
an SGLT2 inhibitor
How does dapagliflozin work
Increases renal glucose excretion
Time for rpt HbA1c
3 months
Cushings disease vs cushings syndrome
Disease - excess ACTH from anterior pituitary
Syndrome - excess cortisol from any source
S/Es pitoglitazone
HF due to water retention
How does metaclopramide cause hyperprolactinaemia
Binds to D2 receptors on pituitary lactotropes
How does sarcoidosis cause hypercalcaemia
Increased hydroxylation of vitamin D
Mechanism of action of silagliptin
DDPIV inhibitor
WHat mutation is seen in MODY
HNF 1 aplha mutation
Best imaging modality to assess for retrosterna extension of a thyroid goitre
CT chest
What happens to the urine osmolality post vasopressin administration in CDI
Rises > 50%
What kind of DI does lihtium cause
nephrogenic
What happens to the urine osmolality post vasopressing administration in NDI
The urine will fail to concentrate fully
Rise < 45%
What happens in men2b as opposed to men 2a
marfanoid appearance
Treatment of MODY
GLICLAZIDE
Which thyroid cancer has a very low risk of recurrence
Papillary
WHat is gietleman syndroem
Hypokalaemic metabolic alkalosis
Normal BP
Low calcium excretion
Inheritance of polyglandular syndrome 1
AR
Presentation of polyglandular syndrome 1
Hypoparathyroidism (90%)
Mucocutaneous candidasis
Adrenal insufficiency (60%)
Primary gonadal failure
Primary hypothyroidism
Hypopituitism/diabetes inspidus (rarely)
Malabsorption
Pernicious anaemia
Chronic active hepatitis
Inheritance of polyglandular syndrome 2
AR or AD or polygenic
Presentation of polyglandular syndrome 2
Adrenal insufficency (all patients)
Hypothyrodisim
T1DM
Gonadal failure
Diabetes insipidus (rare)
Vitiligo
Myasthenia gravis
alopecia
ITP
Pernicious anaemia
Treatment of secondary hyperparathyroidism
1-aplha calcidol
How is the diagnosis of carney complex made
Two features out of the following (or one in a first degree relative)
- spotty skin pigmentation
- myxoma
- endocrine tumours
- PMS
Genetics of carney complex
AD
Inactivating mutation of protein kinase A on chromosome 17
Which hormone drives the development of secondary sexual characteristics
Dihyrostestosterone
What test is the best for investigation of thyroid size
USS
When does psuedo cushings syndrome occur
Response to heavy alcohol consumption and obesity
Assosiated with elevated in cortisol but not to the extent that is seen in cushings syndrome itselt
What would suggest milk alkali syndrome
Young age
Dyspepsia
Raised bicarbonate
What is gordons syndrome also known as
Pseudohypoaldosteronism (mimics hypoaldosteronism)
Pathology of gordons syndrome
Failure of response to aldosterone
Aldosterone elevated due to lack of feedback inhibition
Presentation of gordons syndrome
short stature
intellectual impariement
dental abnormalities
Muscle weakness
Severe HTN by 3rd decade of life
Low fractional excretion of NA
Normal renal function
Hypercholeraemic metabolic acidosis
Low renin
High aldosterone
Hyperkalaemia
What are the features of von Hippel-Lindau disease
CNS and retinal hemangioblastomas
Renal cysts and carcinomas (occuring later)
Phaeochromocytoma
Pancreatic tumours (50% non functioning)
What does thyroid eye disease predispose your eyes to and why
Optic nerve compression
swelling of extraorbital muscles and orbital fat compresses the nerve
Treatment to induce ovulation in ladies with PCOS
Clomiphene
Mechanism of action of ondansetron
5-HT3 antagonist
What nerve is most suspceptible to damage during thyroid surgery and why
Right recurrent laryngeal nerve
Close to the bifructation of the right inferior thyroid artery
Mechanism of action of carbimazole
Thyroid perioxidase inhibitor
What DEXA scan finding confirms osteoporosis
T score of - 2.5 SD or below
Treatment of osteoporosis
Aledronate (significant GI S/Es)
Vitamin D
Calcium
Secondary prevention of osteoporosis
Oral bisphosphonate
Second line; alfacalcidol or calcitriol
Biochemical findings of pagets disease
Normal calcium
Normal phosphate
Raised ALP
RBCs in multiple myeloma
Rouleux formation
Levels of what are indicative of poor prognosis in multiple myeloma
Raised B2-microglobulin
Low levels of albumin
S/E sildenafil
Blood discolouration of eyes
Action of dapagliflozin
SGLT2 inhibitor
Mechanism of action of gliclazide
Increases glucose independent insulin release
What type of drug is gliclzide
Sulphonyurea
Treatment of raynauds
- Nifedipine
- Sildenafil
Guidelines for hydrocortisone and pred dosing in adrenal insufficiency
15-25mg/day in two divided doses of hydrocortisone
pred is 4x more potent than hydrocortisone
How to assess prognosis post operatively after removal of a phaechromocytoma
24 urinary catecholamines 2 weeks post removal
What type of receptor is the insulin receptor
Tyrosine kinase receptor
How does insulin primarily work
Inhibition of gluconeogenesis
What causes osteomalacia
Vitamin D deficiency
Alongside single joint disease, what can pagets disease present with
Hearing loss
What maternal pituitary hormone is recognised to fall in pregnancy
GH
MOST COMMON TYPE OF MODY
MODY-3
Mode of action of bisphosphonates
Impairment of osteoclast bone adherence
Which antibodies are the likely cause of neonatal hyperthyroidism
Thyrotropin receptor Abs
Drugs that reduce thyroxine absorption
Omeprazole
PO iron
Antacids
Bile acid resins
How does calcitonin work
Inhibitis osteoclast activity
Which malignancy is most at risk of in patients with hashimotos
NHL
What is the initital driver for the development of T2DM
Ectopic fat deposition
What vitamin deficiency is seen commonly in patients following gastric bypass surgery
zinc
WHat causes increased urination during drinking alcohol
Decreased aquaporin 2 channels
How does metofrmin primarily reduce blood glucose
Reduces hepatic glucose output
What should asymmetric diabetic retinopathy raise a suspicision of
ocular ischaemic syndrome on the side affected worse
What is ocular ischaemic syndrome usually due to and investigation
atherosclerosis in those aged 50 or over
Carotid doppler ultrasound
How does pioglitazone therapy work
Increases insulin sensitivity
