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MD2 lectures > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What disease can lithium cause?

A

Diabetes insipidus (no ADH)

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2
Q

What are the features of DI?

A

Hypernatraemia, polyuria, polydipsia

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3
Q

In DKA, is total body K+ high or low?

A

Low

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4
Q

What is the mode of action of metformin?

A

Biguanide that activates AMPK which inhibits hepatic glucose production

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5
Q

What are some adverse effects of metformin?

A

Weight loss, GI intolerance (nausea, diarrhoea)

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6
Q

Why is metformin contraindicated in renal failure?

A

Lactic acidosis

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7
Q

What are some common causes of DKA?

A

Medication non-compliance, surgery, infection, inflammatory states, alcohol abuse, poor dosage of insulin, first presentation

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8
Q

What are the 4 principles of Mx of DKA?

A
  1. Fluid replacement

2. K+ replacement if

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9
Q

What do you need to take into account when measuring testosterone levels?

A
  • Diurnal variation
  • Must repeat if low
  • Conditions that affect SHBG may alter TT
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10
Q

What testosterone replacement options are available?

A
  • IM testosterone ester: every 2-3 weeks
  • IM testosterone undecanoate: every 3 months
  • Testosterone gels: less site irritation
  • Testosterone patches: daily, not C/I in bleeding disorders
  • S/C testosterone implants: every 6 months
  • Oral testosterone: 2-3 times/day
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11
Q

What are the potential A/E of testosterone replacement?

A
  • Prostate cancer, BPH
  • Sleep apnoea
  • Acne
  • Breast cancer
  • Reduced fertility
  • Gynaecomastia
  • Polycythemia
  • Mood fluctuations
  • Dependent on route
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12
Q

What is the mechanism of action of glibenclamide?

A

Stimulates beta cell insulin release

Note = sulphonylurea (gliclazide, glipizide, glimepride)

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13
Q

What is the mechanism of action of acarbose? Why is it not well tolerated

A

Inhibits enzyme that breaks down starches and disaccharides

Flatulence

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14
Q

What is the mechanism of action of glitazones?

A

Stimulate PPAR-gamma and reverse insulin resistance

Many A/Es: weight gain, fluid retention and CCF, bone fractures, bladder cancer

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15
Q

What is the mechanism of action of GLP-1 analogues?

A
  • Improve pancreatic islet glucose sensing and release

- Slow gastric emptying and improve satiety

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16
Q

What is the mechanism of action of DPP4 inhibitors?

A

Prolong GLP-1 activity

17
Q

What is the mechanism of action of SGLT2 inhibitors?

A

Inhibit main glucose transporter in renal tube

18
Q

What is the treatment for HHS?

A
  • Fluids
  • Monitor urine output and CVP if required
  • Insulin
  • K+
  • Prophylactic heparin
  • Look for cause
19
Q

What is the treatment of a prolactinoma?

A
  • Dopamine agonists

- Transphenoidal hypophysectomy

20
Q

What tests are be used for diagnosis of acromegaly?

A
  • Increased GH or IGF-1
  • Failure to suppress OGTT
  • DM or IGT
  • MRI/CT pituitary
21
Q

What is the treatment of acromegaly?

A
  • Transphenoidal hypophysectomy (first line)
  • Radiotherapy
  • Ocreotide, bromocriptine
22
Q

What tests are required to diagnose Cushing’s syndrome?

A
  • Urinary 24 hour free cortisol
  • Overnight dexamethasone suppression test
  • Establish ACTH levels ± imaging for cause
  • If ACTH excess, inferior petrosal sinus sampling required
23
Q

What tests are required to diagnose Addison’s disease?

A
  • Serum cortisol (low)
  • Serum ACTH (high)
  • Synacthen test
24
Q

How do you manage an Addisonian crisis?

A
  • Hydrocortisone 100mg IV 6hrly
  • Fluid replacement (IV normal saline)
  • Glucose if hypoglycaemic
25
Q

How do you manage Addison’s disease (not crisis)?

A

Glucocorticoid and mineralocorticoid replacement

26
Q

What are the symptoms of Addison’s disease?

A
  • Fatigue, lethargy
  • Hypotension
  • Anorexia, weight loss
  • N+V
27
Q

What is clinical triad in Conn’s syndrome?

A

Hypertension, hypokalaemia, metabolic alkalosis

28
Q

What tumours occur in MEN1?

A

Pituitary, pancreas and parathyroid

29
Q

When do you check thyroid function in thyroid disease?

A

6 weeks post-therapy commencement

30
Q

What TFT results are expected in subclinical hypothyroidism?

A

TSH elevated by FT4 and FT3 normal

31
Q

What are some symptoms of androgen deficiency?

A
  • Decreased sense of well being, poor concentration
  • Tiredness, poor stamina
  • Depression, irritability
  • Reduced libido
  • Erectile failure (rare)
  • Reduced muscle mass and strength
  • OP and fracture
  • Increased fat mass
  • Gynaecomastia
32
Q

What are contraindications to testosterone replacement therapy?

A
  • Prostate cancer
  • Breast cancer
  • Erythrocytosis or hyperviscosity
  • Untreated OSA
  • Severe LUTS
  • Class III or IV HF
  • Desire to have a child
33
Q

What needs to be monitored in patients on testosterone replacement therapy?

A
  • History and examination
  • TT
  • LFTs
  • PSA and DRE
  • Lipids
  • Haematocrit
  • BMD

MD2 lectures (13 decks)

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