Endocrine Flashcards
What do we use on top of metformin in T2DM pts with cardiac disease?
SGLT-2 inhibitors should be used in addition to metformin as initial therapy for T2DM if CVD, high-risk of CVD or chronic heart failure, like empagliflozin
Some Hormones Create Funny Knockers
Spironolactone, Hormones, Cimetidine, Finasteride, Ketoconazole:
“Some Hormones Create Funny Knockers (gynaecomastia)
What is HONK, and how is it characterised?
This patient has hyperglycaemic hyperosmolar non-ketotic coma (HONK). HONK is characterised by:
1.) Severe hyperglycemia
2.) Dehydration and renal failure
3.) Mild/absent ketonuria
How do we manage HONK?
The central management of HONK is supportive care and slow metabolic resolution. Patients with HONK often have a deficit of over 8 litres. Caution to avoid rapid fluid replacement as rapid osmolar shifts can cause cerebral oedema.
How do we treat DKA?
This patient is presenting in diabetic ketoacidosis (DKA) as evidenced by her known diabetes diagnosis, glucose > 11 mmol/L, pH < 7.3, bicarbonate < 15 mmol/L and ketones > 3 mmol/L. She needs treatment with fixed-rate insulin and fluids. While this takes place, her normal long-acting insulin should be continued, but her short-acting insulin should be stopped.
How do we alter the glucocorticoids and the fludrocortisone in a pt with recurring illness in Addison’s?
Double the glucocorticoids, maintain the fludro
How does bendroflumethiazide cause hypercalcaemia?
Bendroflumethiazide is a thiazide diuretic which can cause hypercalcaemia by increasing renal tubular reabsorption of calcium.
How does hypercalcaemia present?
Stones: Kidney stones, nephrocalcinosis, and diabetes insipidus (polyuria and polydipsia)
Bones: Osteoporosis (weak bones)
Groans: Abdominal pain, such as pancreatitis or reflux disease
Psychic moans: Mental issues, such as depression, irritability, worsening concentration, and worsening short-term memoryloss of appetite, nausea, fatigue
How do we manage hypercalcaemia?
Rehydration with 3-4L IVI, followed by ? bisphosphonates
How does Subacute (De Quervain’s) thyroiditis present?
Subacute thyroiditis (also known as De Quervain’s thyroiditis) is thought to occur following viral infection and typically presents with hyperthyroidism
Features
hyperthyroidism
painful goitre
raised ESR
globally reduced uptake on iodine-131 scan
How do we manage De Quervain’s thyroiditis?
Management
usually self-limiting - most patients do not require treatment
thyroid pain may respond to aspirin or other NSAIDs
in more severe cases steroids are used, particularly if hypothyroidism develops
What is the difference in presentation between DKA and alcoholic ketoacidosis?
Normal glucose in AKA
How do we use PTH to determine the cause of hypercalcaemia?
A parathyroid hormone that is normal or raised suggests primary hyperparathyroidism.
What is gliclazide? Common SE?
Sulfonylurea, weight gain
Which diabetes med is linked to Fournier’s Gangrene?
SGLT-2 inhibitors, like dapagliflozin, have been linked to necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)
