Endocrine Flashcards
Impaired glucose tolerance (IGT) is defined as … ( fasting plasma glucose and oral glucose tolerance test (OGTT) )
fasting plasma glucose less than 7.0 mmol/l
and
OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
An OGTT result below 11.1 mmol/l but above 7.8 mmol/l indicates
that the person doesn’t have diabetes but does have IGT.’
According to WHO guidance, an HbA1c of greater than or equal to …% (… mmol/mol) is diagnostic of diabetes mellitus
6.5%, (though less than this doesn’t exclude diabetes)
48 mmol/mol
7 situations where you can’t use HbA1c for diagnosis:
haemoglobinopathies haemolytic anaemia untreated iron deficiency anaemia suspected gestational diabetes children HIV chronic kidney disease
Features of subacute (de Quervain’s) thyroiditis:
raised T4, low TSH, accompanied by tender goitre and raised ESR. A globally reduced uptake on technetium thyroid scan is typical
Management of subacute thyroiditis?
Usually self limiting; steroids if severe. Pain may respond to aspirin or other NSAIDs.
Which receptor ro thaizaolidinediones (eg pioglitazone) act on?
What side effects does it have?
PPAR-gamma peripheral oedema/fluid retention (so contraindicated in heart failure) Liver failure (monitor LFTs) weight gain Increased risk of bladder cancer
Management of Addison’s
hydrocortisone (glucocorticoid) + fludrocortisone (mineralocorticoid)
Management of intercurrent illness with Addison’s?
(in simple terms) the glucocorticoid dose should be doubled
Inheritance of MODY (maturity onset diabetes of the young)?
Genes involved?
Strong family history, autosomal dominant condition.
Doesn’t present with ketoacidosis.
Glucokinase or HNF-1 alpha genes
Most common cause of thyrotoxicosis in the UK?
Graves’ disease (50-60% of cases)
What happens in the late phase of Hashimoto’s thyroiditis?
Hypothyroidism can develop
What’s the best investigation to confirm the suspected diagnosis of Addison’s?
Short ACTH/synacthen test
4 associated electrolyte abnormalities found in Addison’s?
- hyperkalaemia
- hyponatraemia
- hypoglycaemia
- metabolic acidosis
Renal colic, increased PTH (or can be normal) and increased calcium (with normal serum urea and electrolytes) is suggestive of…
Which is associated with?
primary hyperparathyroidism (most commonly due to a solitary adenoma)
Associations:
hypertension
multiple endocrine neoplasia: MEN I and II
Features of primary hyperparathyroidism:
‘bones, stones, abdominal groans and psychic moans’
polydipsia, polyuria
peptic ulceration/constipation/pancreatitis
bone pain/fracture
renal stones
depression
hypertension
Features seen in Graves’ but not in other causes of thyrotoxicosis:
eye signs (30% of patients): exophthalmos, ophthalmoplegia pretibial myxoedema thyroid acropachy (pseudoclubbing, with periosteal bone changes)
Autoantibodies in Graves?
anti-TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (50%)
When should patients over the age of 40 years with type 2 diabetes mellitus be started on a statin?
If they have any other risk factors for cardiovascular disease, such as smoking, hypertension or a ‘high-risk’ lipid profile.
A high-risk lipid profile may be defined as:
total cholesterol > 4.0 mmol/L, or
low-density lipoprotein cholesterol > 2.0 mmol/L, or
triglycerides > 4.5 mmol/L
What is the diagnostic test for acromegaly? (may present with large jaw/forehead, hands, cardiomegaly, possibly bitemporal hemianopia)
Oral glucose tolerance with growth hormone measurements (no GH suppression = positive result)
NICE guidance on the management of diabetic neuropathic pain? (1st and 2nd line drugs)
First-line: oral duloxetine. (amitriptyline if duloxetine is contraindicated).
Second-line treatment: if on duloxetine, switch to amitriptyline or pregabalin, or combine with pregabalin.
If first-line treatment was with amitriptyline, switch to or combine with pregabalin.
other options to manage neuropathic pain
Pain management clinic, tramadol (not other strong opioids), topical lidocaine for localised pain.
Gastroparesis in DM - symptoms?
symptoms include erratic blood glucose control, bloating and vomiting
Gastroparesis in DM - management options?
These include metoclopramide, domperidone or erythromycin (prokinetic agents)
Type 2 diabetes blood pressure target (with and without evidence of end-organ damage)?
no organ damage: < 140 / 80
end-organ damage: < 130 / 80
