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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
Q

treatment of pituitary dependent Cushing’s

A

transphenoidal hypophysectomy

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26
Q

management of addisonian crisis

A

hydrocortisone 100mg IV

6 hourly fluid replacement - IV normal saline

glucose if hypoglycaemic

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27
Q

first line oral hypoglycaemics for T2DM

A

metformin

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28
Q

common cause of acromegaly

A

GH secreting pituitary adenoma

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29
Q

investigations for working up Addison’s disease

A
  • cortisol and ACTH serum levels (low cortisol and high ACTH)
  • synacthen test (ACTH infusion) –> will show no increase in cortisol
  • adrenal antibodies
  • adrenal imaging
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30
Q

what is the definition of a micro or macroadenoma

A

micro less than 1cm

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31
Q

prolactinoma treatment

A

dopamine agonists

  • bromocriptine
  • cabergoline
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32
Q

action of DPP-4 enzyme

A

inactivates GLP-1

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33
Q

what causes visual field defects with pituitary masses

A

nasal retinal fibres compressed by superior extension of the mass

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34
Q

how do you investigate for Cushing’s syndrome

A
  • 24 hour urine free cortisol
  • will show elevated levels
  • overnight dexamethasone suppression test
  • will not suppress cortisol in Cushings
  • imaging (MRI)
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35
Q

action of DPP-4 inhibitors

A

enhances the effects of GLP-1 –> improved beta cell signalling

36
Q

explain HPA of GH

A

GHRH stimulates GH –> IGF-1 somatostatin inhibits GH release

37
Q

symptoms of phaeochromocytoma

A

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
Q

what are the macrovascular and microvascular complications of diabetes

A

macro - cardiovascular disease, peripheral vascular disease, cerebrovascular disease

micro - retinopathy, nephropathy, neuropathy

39
Q

action of acarbose

A

inhibits gut alpha-glucosidase (breaks down starch)

40
Q

treatment of adrenal adenoma or carcinoma

A

adrenal surgery

41
Q

action of metformin

A

inhibits hepatic glucose production

42
Q

action of GLP-1

A

slows gastric emptying

suppresses appetite

inhibits glucagon release

43
Q

what is phaeochromocytoma

A

a tumour of chromaffin cells located in the adrenal medulla derived from neural crest cells

44
Q

what causes the skin pigmentation in Addison’s

A

high ACTH –> stimulates melanocytes –> melanin

45
Q

Multiple endocrine neoplasia syndrome type 1 causes tumours of

A

pituitary

pancreas

parathyroid

46
Q

criteria for diagnosing Diabetes mellitus

A

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
Q

karyotype of Klinefelters

A

XXY

48
Q

how is exercise good for diabetes

A

promotes glucose uptake into the muscles via insulin independent GLUT4 receptor –> increased insulin sensitivity

49
Q

example of a drug that is a SGLT2 inhibitor

A

dapagliflozin

50
Q

explain the screening for BP, eyes, feet and lipids when you have DM

A

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
Q

treatment principles of ketoacidosis

A

Resuscitation

rehydration

correct electrolyte imbalance - potassium

insulin therapy

search for an underlying cause

52
Q

causes of congenital primary androgen deficiency

A

klinefelter syndrome

cyrptorchidism

myotonic dystrophy

53
Q

what are the clinical features of prolactinoma in men

A

hypogonadism –> decreased libido, infertility, impotence, gynaecomastia, rarely galactorrhoea

54
Q

acute treatment of hypoglycaemia

A

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
Q

What are the syndromes called when you have excessive adrenal hormone production

A

Conn’s syndrome - aldosterone excess

catecholamine excess - phaeochromocytoma

56
Q

what hormones does prolactin suppress

A

LH and FSH

57
Q

treatment of acromegaly

A

first line - transphenoidal hypophysectomy to remove tumour

if not cured surgically: - radiotherapy - ocreotide - bromocriptine

58
Q

function of inferior petrosal sinus sampling

A

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
Q

effect of prolactin on other hormones

A

inhibits LH producing cells in pituitary –> reduced LH –> reduced testosterone and oestrogen

60
Q

side effects of GLP-1 analogues

A

N&V

61
Q

at what time of the day should you measure testosterone

A

first thing in the morning

62
Q

what are the 3 types of functioning pituitary tumours

A

prolactinoma - secretes prolactin

acromegaly - secretes GH

Cushing’s - secretes ACTH

Very rarely - TSH secreting or gonadotrophin secretin

63
Q

why is acarbose not widely used for the treatment of T2DM

A

not well tolerated due to increased flatus

64
Q

clinical features of acromegaly

A

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
Q

two causes of adrenocortical insufficiency

A

insufficient secretion of ACTH by the pituitary (hypopituitarism)

Addison’s disease (destruction of adrenal glands)

66
Q

non-palpable testes are associated with..

A

anorchism

bilateral cryptorchidsm

67
Q

guidelines for HbA1C in diabetics

A

less than 6.5-7%

68
Q

clinical features of prolactinoma in women

A

hypogonadism - infertility, amenorrhoea/oligomenorrhoea galactorrhoea

69
Q

long term complications of diabetes depends on…

A
  • duration of diabetes
  • degree of glucose control
  • degree of blood pressure control
  • control of other CV risk factors
  • individual genetic susceptibility
70
Q

types of administration of testosterone therapy

A

injection (deep IM) - 3 monthly (most common)

transdermal patch or gel oral

71
Q

what electrolyte imbalances do you get in ADdison’s disease

A

hyponatraemia

hyperkalaemia

moderate acidosis

increased urea

hypoglycaemia

72
Q

why is testosterone therapy contraindicated in men with a desire to have a child

A

suppresses their own HPA –> reduction in LH –> reduced sperm production

73
Q

which Antibodies are commonly associated with T1DM

A

anti-islet

anti-GAD

74
Q

example of a drug that is a DPP-4 inhibitor

A

sitagliptin

75
Q

long term management of Addison’s disease

A

Glucocorticoids and mineralocorticoids

Education on increasing steroid during times of stress

76
Q

in which patients is metformin contra-indicated in

A

those with renal failure - can cause lactic acidosis

(eGFR less than 30)

77
Q

how do you investigate for phaeochromocytoma

A

urine catecholamines (24 hour collection)

plasma catecholamines (marked variability)

78
Q

what causes CSF rhinnorhea with pituitary masses

A

downward extension of tumour

79
Q

what causes cranial nerve palsies and temporal lobe epilepsy with pituitary tumours

A

due to lateral extension of tumour

80
Q

symptoms and signs of androgen deficiency

A
  • 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
Q

treatment of hyperglycaemic hyperosomalr state

A

Fluids

Insuilin

Potassium

Prophylactic heparin

82
Q

action of SGLT2 inhibitors

A

inhibits main glucose transporter in the renal tubule promoting glucosuria

83
Q

why would peridopril be prescribed to a diabetic even if they aren’t hypertensive

A

to act on the affert arteriole to try and reduce the amount of albumin in the urine to preserve kidney function

84
Q

what do you have to keep in mind when interpreting HbA1c level checks

A

any condition that causes increased production of RBCs (eg haemolysis) will artificially lower HbA1c

85
Q

action of sulphonylureas

A

stimulate beta cell insulin release

86
Q

typical abnormality in lipids in a diabetic

A

high TG, low HDL, small dense LDL

Z MD 2 (15 decks)

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