Endocrine Flashcards
Name 5 essential components to clinically assess, investigate & manage in order to treat & prevent recurrence of diabetic foot complications.
- Peripheral neuropathy
- Peripheral vascular disease
- Ulceration
- Infection
- Maximise diabetes control
At what toe pressure is an ulcer unlikely to heal?
How do you diagnose infection of an ulcer?
- Purulent discharge
OR - Two or more of: pain, swelling, redness, warmth
What are serological markers of osteomyelitis from a foot ulcer?
- Elevated WCC, CRP/ESR
- Elevated ALP
What serum test is most diagnostic of prolactinoma?
Elevated serum prolactin
What are the clinical features of prolactinoma in women & in men?
Women: galactorrhoea, oligomenorrhoea, amenorrhoea, infertility
Men: decreased libido, infertility, impotence, gynaecomastia (rarely galactorrhoea)
What is the usual treatment for prolactinoma?
Dopamine agonists (cabergoline, bromocriptine)
What common test is useful for the diagnosis of acromegaly?
Oral glucose tolerance test - failure to suppress GH release is diagnostic
Pituitary macroadenoma =
GH-secreting
Pituitary microadenoma =
Prolactinoma
What is the first-line treatment of acromegaly?
Transphenoidal-hypophysectomy
What blood test results could you expect in Cushing’s syndrome?
FBE: high-normal Hb, high WCC with low neutrophils
Glucose: elevated
Electrolytes: hypokalaemia & metabolic acidosis in ectopic ACTH
Hypercalciuria (urine test)
What tests are used to diagnose Cushing’s syndrome?
- 24-hour urine free cortisol
- Dexamethasone suppression test (lack of suppression is diagnostic)
What blood test results could you expect in Addison’s disease?
- Electrolytes: hyponatremia, hyperkalaemia, moderate acidosis, increased urea
- Hypoglycaemia
What are some clinical features of Addison’s disease?
- Postural hypotension
- Fatigue
- Unintentional weight loss
- Hypoglycaemia
- Hyperpigmentation
- Unexplained hyperkalaemia
What test is diagnostic of Addison’s disease?
Synacthen test (ACTH infusion test) - shows whether the adrenals can respond to an appropriate stimulus or not
What is the management of an Addisonian crisis?
- Hydrocortisone 100mg IV 6 hrly
- Fluid replacement: IV N saline
- Glucose if hypoglycaemic
What is the clinical triad of Conn’s syndrome?
- Hypertension
- Hypokalaemia
- Metabolic alkalosis
What is diagnostic of primary hyperaldosteronism?
High aldosterone/renin ratio
What are the treatment options in primary hyperaldosteronism (Conn’s syndrome)?
- Adrenal adenoma removal
- Aldactone (aldosterone antagonist)
- Amiloride (decreases potassium excretion)
