Endocrine 2 Flashcards
side effects of metaformin
rash GI - subside can interfere with b12 and folate defic lactic acidosis - rare discontinue if liver failure or cirrhosis renal failure stop if gfr <30 or creat >150 half if EGFR 30-45 temp withhold if IV contrast
SU SEs
hypos in elderly, alcohol abuse, liver disease weight gain GI upset, headaches h/s avoid in renal and liver failure
TZDs
weight gain
heart failure
fractures
DPP-IV inhibitors
pancreatitis
pancreatic cancer
SGLT inhibitors
thrush
UTIs
GnRH synthesised where
released how
simulates synthesis and release of what
by neurones in hypothalamus
pulsatile release
low pulses for FSH and high for LH
FSH secreted by what
does what
ant pit
stimulates follicular development and thickens endometrium
LH secreted by what
does what
ant pit
peak stimulates ovulation
stimulates CL development
thickens endometrium
what peaks before ovulation
oestrogen
what peaks following ovulation
progesterone
oestrogen secreted by what
stimulates what
blocks what and stimulates what
secreted by ovaries (follicles), adrenal cortex and placenta in pregnancy
stimulates thickening of endometrium
responsible for fertile cervical mucus
high oestrogen concentration inhibits prolactin and FSH and stimulates secretion of LH
progesterone does what
decorated by CL to maintain pregnancy
inhibits LH
responsible for thick cervical infertile mucus
maintains thickness of endometrium
has thermogenic effect (increased basal temp)
relaxes smooth muscles
hypothalamic hormones
GnRH
PRH
TRH
CRH
Somatostain - inhibits release of GH from a ant pit
Dopamine - inhibits prolactin release from ant pit
Ant pit hormones
LH FSH PRL TSH ACTH GH - stimulates IGF-1 from liver
post pit hormones
oxytocin - stimulates milk secretion/utrine contraction
ADH
addisons is what ABs signs ix rx
AI primary adrenal insufficiency - decreased cortisol and/or aldosterone
ABs produced against adrenal cortex or an enzyme called 21 hydroxylase
hyper pigmentation. hypotension
ACTH synacthin test - cortisol doesn’t rise in addisons
hydrocortisone and fludrocortisone
addiosns crisis treatment
0.9% saline
IV/IM hydrocortisone
glucose if hypoglycaemic
cushings is what
causes
test
rx
increased cortisol pit (cushings dx) - adenoma adrenal (cushings syndrome) - adenoma/hyperplasia ectopic - SCLC prolonged exposure to steroids
dexa supression test
if cause not found - bilateral adenectomy to prevent nelsons syndrome - lifelong hydro
pseudocushings
fails to be suppressed by dexa
conns is what
test
rx
increased aldosterone
saline suppression test
adrenelectomy - definitive. spironolactone/amiloride
phaemocromocytoma is a what secretes what signs/symp what disease can be linked to them treatment
adrenal medullary tumour
catecholamines
headache, tremor, hypertension, fever, palpitations
MEN2
alpha blocker phenoxybenzine
BBs - propanolol, atenolol, metoprolol. surgical
10% tumour
extra renal
biologically malignant
bilateral
not assoc with hypertension
25% familial (bilateral, young)
hyperthyroidism TFTS
rx
decreased TSH increased T4T3
carbimazole BBs for symptoms
graves antibodies
goitre
scintogrophy
treatment
anti TPO, TSH receptor ABs smooth symm goitre high uptake @18m 50% will relapse and 50% will resolve carb decrease dose over 12-18m then stop
primary hyperparathyroidism
increased Ca, increased PTH, low phosphate
adenoma
secondary hyperparathyroidism
increased PTH, decreased Ca
increased phosphate in renal disease
decreased in vit D deficiency
tertiary hyperparathyroidism
increased PTH, increased calcium, increased phosphate
parathyrectomy indications
<50
end organ damage present
increased calcium
GFR <60
De Quiuervincs presentation TFTs scintogrophy treatment
painful following viral infection hyper first then become hypo low uptake self limiting
hypothyroidimg
goitrous
non goitrous
treatment
increased TSH, low T4T3
goitrous - hashimotos, drug induced
non goitrous - congenital, atrophic, post radio/ablastive
thyroxine (increase during pregnancy)
hasimotos goitre
antibodies
painless with rubber consistency and irregular surface
Anti tPO and anti thyroglobin ABs
hypoparathyroidism
signs
rx
low calcium
increased phosphate
decreased/normal PTH
chovesteks - tapping the facial nerve causes facial muscles to contact
trousu - occluding the arm circulation for 3m causes carpopedal spasm
calcium and vit D supplement
IV calcium if severe
subclinical hypothyroidism
increased TSH normal T4/T3
secondary hypothyroidism
normal TSH decreased T3/T4
subclinical hyperthyroidism
low TSH normal T3T4
transcription factor MODY
adolescent/young adult
progressive hyperglycaemia
1/3 diet 1/3 OHD 1/3 insulin
cx frequent
glucokinase MODY
onset at birth
stable hyper glycaemia
diet control
cx rare
DKA biochem dx
DKA cx
ketonuria >3 or >2 on dip
BG >11 or known DM
bicarb <15 or ph<7.3
children - cerebral oedema
adults get - aspiration pneumonia, ARDS, hypokalaemia
treatment for DKA
0.9 NaCl when glucose falls to 15 switch to dextrose
insulin
potassium
HHS who
type 2 DM elderly osmolarity 400 high glucose 60 increased sodium
peripheral neuropathy treatment
analgesia
amitriptyline, gabapentin, prcegablin
neuropathy treatment
ACEI/ARB
retinopathy stages and treatment
mild non prolif - haemorrhages and microaneurysms
mod non porlfi - haem, MA, hard exudates
severe non prolif - haem, venous beading
prolif - new vessel formation
laser, vitrectomy, anti VEGF
Diabetes insipidus types
symp
ix
rx
cranial - decreased secretion of ADH nephrogenic - renal resistance to ADH polyuria, polydipsia, nocturia water deprivation test desmopressin
hypogonadotrophic hypogonadism causes symp ix rx
stress, eating disorders, trauma, kallmasn, drugs
amen
decreased FSH/LH, oestrogen defic
stabilise weight, pulsatile GnRH, injections (USS monitoring of response)
PCOS symp
dx
treatment
10-20% amen 80% oligo
50-80% have insulin resistance
oligo/amen
polycystic ovaries
acne/hirsutism
clomifene citrate (+ metaformin) injections laparoscopic ovarian diathermy
complications of ovulation induction
hyprsitmualtion
multiple preg
ovarian cancer
what is linked to ovulation induction
hyperprolactinoma
treatment dopamine agonist
what test confirm normal regular cycles
mid luteal day 21 progesterone test
>30 on 2 samples confirms regular cycles
hirsutism causes
PCOS, familial, idiopathic, CAH
adrenal or ovarian tumour - high testosterone and signs of vitalisation
treatment for hirsutism
PCOS - OCP, anti androgens
Late onset CAH - low dose glucocorticoid to suppress ACTH drive
pseudohypoparathyroidism
decreased calcium
increased PTH
psedopseduohypoparathyroidim
normal calcium and PTH
acute hypocalcaemia
IV calcium gluconate 10ml 10% over 10 mins in 50mls saline or dextrose
acute hypercalcaemia
0.9% saline 46L in 12 hours
loop diuretics once rehydrated
bisphosphonates
osteoporosis common fractures
neck of femur
vertebral body
distal radius
humeral neck
osteopenia
osteoporosis
severe osteoporosis
> 1 SD below
=2.5 below
= 2.5 and a fragility fracture
pagets treatment
analgesia
if still in pain then bisphosphonates
