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Z MD 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

side effects of SGLT2 inhibitors

A

genital candidal infections

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2
Q

benefits of metformin over other drugs

A

not associated with inducing hypoglycaemia

no weight gain (tends to assist weight loss)

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3
Q

What are the causes of ACTH-dependent Cushing’s sydnrome

A

Cushing’s disease = pituitary adenoma producing cortisol

Ectopic ACTH (eg. from bronchial carcinoid)

ectopic CRF

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4
Q

where do the different hormones come from in the adrenals

A

Glomerulosa - mineralocorticoids (aldosterone)

Fasciculata - glucocorticosteroids

Reticularis - sex hormones

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5
Q

when are DPP-4 inhibitors used

A

usually 2nd line therapy if metformin doesn’t work and sulphonylureas are contraindicated

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6
Q

what hormone result will you see in Conn’s syndrome

A

high aldosterone/renin ratio

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7
Q

testosterone replacement therapy is contraindicated in men with

A
  • evidence of prostate cancer
  • breast cancer
  • erythrocytosis or hyperviscosity
  • untreated OSA
  • severe Lower Urinary tract Sx
  • class 3 or 4 heart failure
  • desire to have child
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8
Q

what hormone levels do you test for when investigating androgen deficiency

A

total testosterone

free testosterone (calculated through SHBG)

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9
Q

clinical features of Cushing’s

A

central obesity

moon facies

buffalo hump

wasting of buttocks

atrophy of epidermis –> thin skin, easy bruising, striae,

plethoric face

depressed mood and concentration and memory

insomnia

decreased libido

proximal myopathy

osteopaenia

hirsutism

hypertension

menstrual

disorders impaired glucose tolerance –> diabetes

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10
Q

which class of diabetes drug is contraindicated in CCF

A

thiazolidinedione

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11
Q

side effects of testosterone replacement

A
  • erythrocytosis
  • acne and oily skin
  • detection of subclinical prostate cancer
  • growth of metastatic prostate cancer
  • reduced sperm production and fertility
  • gynaecomastia
  • male pattern balding
  • worsening of BPH symptoms
  • growth of breast cancer
  • induction or worsening of OSA
  • atrophy of testes
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12
Q

example of a drug that is a GLP-1 analogue

A

exenatide

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13
Q

what are the causes of ACTH-independent Cushing’s syndrome

A

adrenal adenoma

adrenal carcinoma

micronodular hyperplasia

macronodular hyperplasia

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14
Q

main features of Kleinfelters syndrome

A

firm small, peak like testes with azoospermia

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15
Q

limitations of the use of sulphonylureas

A

associated with hypoglycaemia and weight gain

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16
Q

action of thiazolidenediones

A

stimulate ppar gamma receptor to reverse insulin resistance

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17
Q

guidelines for optimal fasting and 2 hour blood glucose level in diabetes

A

4-8mmol/L - fasting

6-10 - 2 hour post meal

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18
Q

hormone results in a person with Klinefelters

A

TT low

LH high

more rapid decrease in total testosterone with ageing

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19
Q

what hormone results do you get if your patient has acromegaly

A
  • increase GH
  • increased IGF-1
  • diabetes or impaired glucose tolerance
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20
Q

local effects of pituitary tumours

A

headache

visual field defect

cranial nerve palsies

temporal lobe epilespy

CSF rhinorrhea

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21
Q

clinical triad of symptoms of Conn’s syndrome

A

hypertension

hypokalaemia –> headaches, palpitations, polydispia, polyuria, noctura

metabolic alkalosis

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22
Q

how does hyperaldosteronism present clinically

A

hypertension and hypokalaemia

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23
Q

what is the preoperative treatment of phaeochromocytoma

A
  • alpha adrenergic blockage (phenoxybenamine)
  • beta blockers if necessary, but never before alpha-blockade
  • treatment of arrhythmias, cardiac failure and diabetes as required
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24
Q

what inhibits prolactin

A

dopamine

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25
treatment of pituitary dependent Cushing's
transphenoidal hypophysectomy
26
management of addisonian crisis
hydrocortisone 100mg IV 6 hourly fluid replacement - IV normal saline glucose if hypoglycaemic
27
first line oral hypoglycaemics for T2DM
metformin
28
common cause of acromegaly
GH secreting pituitary adenoma
29
investigations for working up Addison's disease
- cortisol and ACTH serum levels (low cortisol and high ACTH) - synacthen test (ACTH infusion) --\> will show no increase in cortisol - adrenal antibodies - adrenal imaging
30
what is the definition of a micro or macroadenoma
micro less than 1cm
31
prolactinoma treatment
dopamine agonists - bromocriptine - cabergoline
32
action of DPP-4 enzyme
inactivates GLP-1
33
what causes visual field defects with pituitary masses
nasal retinal fibres compressed by superior extension of the mass
34
how do you investigate for Cushing's syndrome
- 24 hour urine free cortisol - will show elevated levels - overnight dexamethasone suppression test - will not suppress cortisol in Cushings - imaging (MRI)
35
action of DPP-4 inhibitors
enhances the effects of GLP-1 --\> improved beta cell signalling
36
explain HPA of GH
GHRH stimulates GH --\> IGF-1 somatostatin inhibits GH release
37
symptoms of phaeochromocytoma
sudden and severe symptoms: - pallor - perspiration - palpitations --\> tachyarrhythmias - labile BP --\> accelerated HT - headache spontaneous or elicited by exercise, bending over, defecation, abdominal pressure or drugs
38
what are the macrovascular and microvascular complications of diabetes
macro - cardiovascular disease, peripheral vascular disease, cerebrovascular disease micro - retinopathy, nephropathy, neuropathy
39
action of acarbose
inhibits gut alpha-glucosidase (breaks down starch)
40
treatment of adrenal adenoma or carcinoma
adrenal surgery
41
action of metformin
inhibits hepatic glucose production
42
action of GLP-1
slows gastric emptying suppresses appetite inhibits glucagon release
43
what is phaeochromocytoma
a tumour of chromaffin cells located in the adrenal medulla derived from neural crest cells
44
what causes the skin pigmentation in Addison's
high ACTH --\> stimulates melanocytes --\> melanin
45
Multiple endocrine neoplasia syndrome type 1 causes tumours of
pituitary pancreas parathyroid
46
criteria for diagnosing Diabetes mellitus
HbA1C - more than 6.5% or 48mmol/L fasting glucose more than 7mmol/L symptoms + resting blood glucose more than 11.1mmol/L glucose tolerance - 2 hour blood glucose more than 11.1mmol/L (needs to be confirmed with a second measurement)
47
karyotype of Klinefelters
XXY
48
how is exercise good for diabetes
promotes glucose uptake into the muscles via insulin independent GLUT4 receptor --\> increased insulin sensitivity
49
example of a drug that is a SGLT2 inhibitor
dapagliflozin
50
explain the screening for BP, eyes, feet and lipids when you have DM
BP - at diagnosis and then 3-6 monthly for T2 and yearly for T1 Eyes - at diagnosis and then 2 yearly. Yearly if have retinopathy Feet - at diagnosis and then yearly. If have neuropathy - 3-6 monthly Lipid - at diagnosis and then yearly
51
treatment principles of ketoacidosis
Resuscitation rehydration correct electrolyte imbalance - potassium insulin therapy search for an underlying cause
52
causes of congenital primary androgen deficiency
klinefelter syndrome cyrptorchidism myotonic dystrophy
53
what are the clinical features of prolactinoma in men
hypogonadism --\> decreased libido, infertility, impotence, gynaecomastia, rarely galactorrhoea
54
acute treatment of hypoglycaemia
oral - fluids containing sugar if unconscious - IV 50% dextrose (25-50ml) volus via antecubital vein or IM/SC glucagon 1mg if no IV Then administer longer acting carb recheck glucose 20-30mins later
55
What are the syndromes called when you have excessive adrenal hormone production
Conn's syndrome - aldosterone excess catecholamine excess - phaeochromocytoma
56
what hormones does prolactin suppress
LH and FSH
57
treatment of acromegaly
first line - transphenoidal hypophysectomy to remove tumour if not cured surgically: - radiotherapy - ocreotide - bromocriptine
58
function of inferior petrosal sinus sampling
very specialised test used to determine if the cause of excessive ACTH production causing Cushing's is from the pituitary or from an ectopic cause
59
effect of prolactin on other hormones
inhibits LH producing cells in pituitary --\> reduced LH --\> reduced testosterone and oestrogen
60
side effects of GLP-1 analogues
N&V
61
at what time of the day should you measure testosterone
first thing in the morning
62
what are the 3 types of functioning pituitary tumours
prolactinoma - secretes prolactin acromegaly - secretes GH Cushing's - secretes ACTH Very rarely - TSH secreting or gonadotrophin secretin
63
why is acarbose not widely used for the treatment of T2DM
not well tolerated due to increased flatus
64
clinical features of acromegaly
enlarged jaw, hands and feet --\> dental problems, tight rings, increased show size coarsening of facial features, enlarged frontal bones and nose thickened nose enlargement of tongue deepening of voice
65
two causes of adrenocortical insufficiency
insufficient secretion of ACTH by the pituitary (hypopituitarism) Addison's disease (destruction of adrenal glands)
66
non-palpable testes are associated with..
anorchism bilateral cryptorchidsm
67
guidelines for HbA1C in diabetics
less than 6.5-7%
68
clinical features of prolactinoma in women
hypogonadism - infertility, amenorrhoea/oligomenorrhoea galactorrhoea
69
long term complications of diabetes depends on...
- duration of diabetes - degree of glucose control - degree of blood pressure control - control of other CV risk factors - individual genetic susceptibility
70
types of administration of testosterone therapy
injection (deep IM) - 3 monthly (most common) transdermal patch or gel oral
71
what electrolyte imbalances do you get in ADdison's disease
hyponatraemia hyperkalaemia moderate acidosis increased urea hypoglycaemia
72
why is testosterone therapy contraindicated in men with a desire to have a child
suppresses their own HPA --\> reduction in LH --\> reduced sperm production
73
which Antibodies are commonly associated with T1DM
anti-islet anti-GAD
74
example of a drug that is a DPP-4 inhibitor
sitagliptin
75
long term management of Addison's disease
Glucocorticoids and mineralocorticoids Education on increasing steroid during times of stress
76
in which patients is metformin contra-indicated in
those with renal failure - can cause lactic acidosis (eGFR less than 30)
77
how do you investigate for phaeochromocytoma
urine catecholamines (24 hour collection) plasma catecholamines (marked variability)
78
what causes CSF rhinnorhea with pituitary masses
downward extension of tumour
79
what causes cranial nerve palsies and temporal lobe epilepsy with pituitary tumours
due to lateral extension of tumour
80
symptoms and signs of androgen deficiency
- poor concentration, tiredness, poor stamina, depression, irritability - reduced libido - rarely erectile failure - reduced muscle mass and strength - osteoporosis and fracture - increased fat mass - gynaecomastia - loss of body hair - small or shrinking testes - infertility - hot flushes, sweats
81
treatment of hyperglycaemic hyperosomalr state
Fluids Insuilin Potassium Prophylactic heparin
82
action of SGLT2 inhibitors
inhibits main glucose transporter in the renal tubule promoting glucosuria
83
why would peridopril be prescribed to a diabetic even if they aren't hypertensive
to act on the affert arteriole to try and reduce the amount of albumin in the urine to preserve kidney function
84
what do you have to keep in mind when interpreting HbA1c level checks
any condition that causes increased production of RBCs (eg haemolysis) will artificially lower HbA1c
85
action of sulphonylureas
stimulate beta cell insulin release
86
typical abnormality in lipids in a diabetic
high TG, low HDL, small dense LDL

Z MD 2 (15 decks)

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