Endocrine Flashcards
Does Hashimoto’s cause hyper or hypothyroidism?
What type of goitre?
Autoimmune. Hypothyroidism (although RARELY may be 6-12 months of thyrotoxicosis in acute phase)
Firm, non-tender goitre.
What antibodies would you expect in Hashimoto’s?
Anti-thyroid peroxidase and anti-Tg antibodies.
What would a viral infection followed by hyperthyroidism suggest>?
Subacute (De Quervain’s) thyroiditis.
What are the 4 typical phases of De Quervain’s thyroiditis?
1: (3-6 weeks): Hyperthyroidism, painful goitre, raised ESR
2: (1-3 weeks) Euthyroid
3: (weeks-months) Hypothyroidism
4: Structure and function -> normal.
What is the Mx of De Quervain’s thyroiditis?
Usually self-limiting. Most patients do not require treatment.
Thyroid pain may respond to NSAIDs
Steroids used in more severe cases.
What glucose results are needed to diagnose T2 DM?
If symptomatic:
- Fasting 7+
- Random/after OGTT: 11.1 +
If asymptomatic: same criteria, on two occasions.
What is impaired fasting glucose?
Fasting glucose: 6.1-6.9
Offer OGTT
What is impaired glucose tolerance?
Fasting plasma glucose: <7 and OGTT 2-hour value 7.8-11
What HbA1c value would be diagnostic of diabetes?
48+mmol/mol (6.5%)
NB. Value below this doesnt exclude, its not as sensitive as fasting samples.
When would you not be able to use HbA1c in diabetes diagnosis?
Increased RBC turnover:
- Haemoglobinopathies
- Haemolytic anaemia
- Untreated iron deficiency anaemia
- Suspected gestational diabetes
- Children
- HIV
- CKD
- Meds that may cause hyperglycaemia, ie. steroids.
How do you adjust steroid dosage in Addison’s patient with acute illness?
Double hydrocortisone dose, same fludrocortisone dose
What is the typical drug mx of Addison’s disease?
Hydrocortisone (= glucocorticoid) (in 2/3 doses, majority in morning dose)
Fludrocortisone (=mineralocorticoid)
In the context of acute illness, what would low T3/4 and normal TSH suggest?
Sick euthyroid syndrome.
May also get rise in cortisol as normal stress response to infection
What important advice would you give a patient statin carbimazole?
Attend for medical review if develop any infection symptoms - check neutrophil count on FBC.
- Rare SE of drug is agranulocytosis.
What are the ‘sick day rules’ in DM?
- Increase frequency of glucose and ketones readings to at least 4 hourly
- Increase fluid intake, aim for >3L in 24hrs
- If unable to eat, may need sugary drinks to maintain carb intake
- Take medications as normal, except metformin if becoming dehydrated (renal function)
Which DM drug is CI if hx of bladder ca?
Pioglitazone
What are the criteria for starting a GLP1 mimetic (e.g. exenatide)?
BMI >35 and specific health problems associated with obesity
BMI <35 if insulin therapy would have significant occupational implications/ weight loss would benefit other obesity related comorb.
Give 4 drugs that can lead to raised (P)rolactin?
Phenothiazines (-azine)
MetocloPramide
DomPeridone
HaloPeridol
What is the first-line mx of cerebral metastases?
High-dose dex
Release of which 3 hormones is reduced in the stress response?
- Insulin
- Testosterone
- Oestrogen
What are the features of MEN 2B?
- Mucosal neuroma
- Medullary thyroid carcinoma
- Phaeochromocytoma
- Marfanoid appearance
What are the features of primary hyperaldosteronism?
- HTN (refractory)
- Hypokalaemia
- Alkalosis
What is the mx of prolactinomas?
1: Medical - dopamine agonists e.g. bromocriptine
2: Surgery - trans-sphenoidal
What DM drugs would you use in end-stage renal failure?
Metformin is CI
Use a Glicazide
What is Paget’s disease?
Features?
Increased, uncontrolled bone turnover.
Only 1 in 20 patients are symptomatic
- Bone pain
- Bowing of tibia, skull bossing
- Raised ALP, with normal Ca and Ph.
- Old, male.
What are the indications for treatment in Paget’s?
Mx?
Ind: Bone pain, skull or long bone deformity, fracture, periarticular Paget’s.
- Bisphosphonate (Oral Risedronate or IV Zoledronate)
What are the causes of Addisonian crisis?
- Sepsis or surgery exacerbating chronic insufficiency
- Adrenal haemorrhage
- Steroid withdrawal
What blood results would you expect in an Addisonian crisis?
Low Na
High K
Low glucose
What is the Mx of an Addisonian crisis?
- Hydrocortisone 100mg IM/IV
- 1L normal saline over 30-60 mins, with dextrose if hypo
- Continue hydrocortisone 6 hourly until stable
How do thaizolidinediones work? (-glitazones)
SE?
Reduce peripheral insulin resistance.
- Weight gain
- Liver impairment
- Fluid retention (esp if taking insulin): CI in HF
- Pioglitazone - Bladder ca
What marker can you use to monitor medullary thyroid ca?
Serum calcitonin levels
What is the Ix for suspected phaeochromocytoma?
24hr urinary metanephrines
What are the features of phaeochromocytoma?
- HTN
- Headaches
- Palpitations
- Sweating
- Anxiety
What is the Mx of pheochromocytoma?
Surgery is definitive, however stabilise first:
- Alpha blocker (Phenoxybenzamine) THEN
- BB
What insulin regime is used in DKA?
A fixed rate intravenous insulin infusion of 0.1 units/kg/hour
In what circumstance would you not need to inform the DVLA when you are taking insulin?
Temporary treatment for 3 months or less
Or because of gestational diabetes up to 3 months post-partum as long as under medical supervision.
What is the first-line mx of diabetic neuropathy?
One of: (1) Amitriptyline (Avoid in BPH) Duloxetine Gabapentin Pregabalin
What is the first-line insulin regime in newly diagnosed T1 DM?
Basal-bolus with twice-daily insulin detemir
What is the diagnostic test in suspected acromegaly?
OGTT and serial GH measurements
Serum IGF-1 also used as screening/monitoring
What are the two autoantibodies seen in Graves’? Which is most common?
TSH receptor stimulating antibodies (90%)
Anti-thyroid peroxidase antibodies (75%)
What drug interaction must you be mindful of when prescribing ferrous sulphate for iron-deficiency anaemia?
Reduces the absorption of levothyroxine, must give at least 2 hours apart
