Endocrine Flashcards
diabetic HbA1c 7% BMI - 40 what drug you want to prescribe ?
Semaglutide - GLP1 Analogue
No caution in renal impairment and not contraindicated in IBD patients
what are the steps of DKA management ?
IV fluids, Insulin infusion, Potassium and Bicarb infusion if ph <7.2
What is DKA diagnostic criteria?
Blood ketones >_ 3 mmol/L
Urine ketone dipstick 2+
Blood glucose >11 mmol/L
Bicarbonate <15 mmol/L
or venous ph <7.3
What is diabetic gastroparesis?
It is an autonomic neuropathy causing delayed gastric emptying in the absence of mechanical obstruction
Presence of food in stomach who fasted for endoscopy - gastroparesis
Treatment - initially with prokinetic- Domeperidone
Severe cases - gastric pacemaker
Standard measure for gastric emptying - scintigraphy
Uncontrolled type 2 Dm patient with 3 OHAs with HbA1c 11% - presents with proximal muscle weakness what s diagnosis?
Diabetic Amyotrophy - wasting and weakness of hip and thigh muscles with burning , lancinating pain, often asymmetrical
Treatment - good glycemic control and for this HbA1c … insulin is recommended
What is the cause of sweating in Acromegaly?
Sweat gland hyperplasia due to excess GH- leads to excessive sweating
What is the initial investigation for acromegaly?
IGF -1 elevated in acromegaly since it has a long half life and can be measured at any time of the day
-Glucose tolerance test confirmatory…
What is the first line treatment and alternative therapy in acromegaly?
First line - Trans-sphenoidal surgery- to resect the pituitary tumour
Alternative therapies if surgery unsuccessful or patient is unsuitable for surgery
- dopamine agonists ( bromocriptine, cabergoline, quinagolide, pergolide) reduces GH secretion
- somatostatin analogue - inhibit GH secretion
- GH antagonist ( pegvisomant)
- pituitary radiotherapy
What will happen to GH after glucose load test??
Normal subjects exhibit GH suppression to <0.3 ( undetectable) values during the test.
Acromegaly- GH levels are more than >1 ng/ mL
What are the clinical features of acromegaly?
Sweating - >80% cases
Hypertension- 40%
impaired Glucose Tolerance- 40%
Type 2 DM - 20%
Which cancer associated with acromegaly and why?
Due to increase in IGF - 1 , changes in enterohepatic circulation and bile salt loss into the GI tract and increased incidence of FAP - colorectal cancer occurs
What is mode of action of Lanreotide?
It’s a Long acting somatostatin analogue. Stimulation of the somatostatin receptor leads to inhibition of production of hormones- gastrin, cholecystokinin, glucagon, growth hormone, insulin and secretin.
What happens when patient with GH deficiency gets GH treatment?
Increase in muscle mass, decrease in body fat, improvement in exercise capacity though not in muscle strength , improvement of BMD in men but not women
What is most appropriate confirmatory test for anterior hypopituitarism?
Insulin tolerance test - gold standard dynamic test for diagnosis of ACTH and GH deficiency in patients with suspected hypopituitarism
What is short Syncthen test?
The gold standard normal response - cortisol of >550nmol/l 30 min post ACTH stimulation.
If the test is positive - screening for ACTH insufficiency, Insulin tolerance test , ( ITT) - recommended with measurement of growth hormone reserve and cortisol
