Endocrine

Question 1

What are the features of SIADH?

Answer 1

• Hyponatraemia

- Concentrated urine

Question 2

What are the investigations for SIADH?

Answer 2

Plasma Na+ low (< 125)
Plasma osmolality (<260)
Urine Na+ high (>20)
Urine osmolality high (>100)

Question 3

What are the causes of SIADH?

Answer 3

Malignancy (small cell lung ca., pancreas, prostate)

Neurological disorders (stroke, encephalitis, head injury etc.)

Chest (TB, pneumonia)

Drugs (SSRIs, anti-psychotics, opiates, cytotoxics)

Question 4

What is the management of SIADH?

Answer 4

Treat cause
Fluid restrict
Salt +/- loop diuretics
Vaptans

Question 5

What is the management of hyperthyroidism?

Answer 5

• Symptomatic tx: propranolol
• Carbimazole: 4-8 weeks until euthyroid. Then either titrate or block and replace for 6-18 months
• If relapse, radioiodine or thyroidectomy

Question 6

What would be the features of toxic multinodular goitre?

Answer 6

Hyperthyroid, with an irregular goitre. Isotope scan will show hot and cold areas. Usually elder patients.

Question 7

What would be the features of toxic adenoma?

Answer 7

Hyperthyroid, with single nodule. Isotope scan shows single hot nodule. Usually younger patients.

Question 8

What are the features of subacute (de Quervain’s) thyroiditis?

Answer 8

Post-viral URTI, shows 3 phases: hyperthyroid, hypothyroid, euthyroid.

Treat with NSAIDs and propranolol at first. Thyroxine if progression to hypothyroid.

Question 9

What are the features of thyroid storm?

Answer 9

Extreme hyperthyroidism secondary to thyroid surgery, radioiodine, infection or MI.

Hyperthermia, agitation, confusion, AF and coma.

Give IV fluids, sedation, propranolol, carbimazole and Lugol’s solution.

Question 10

What are the features of Hashimoto’s thyroiditis?

Answer 10

Goitre due to lymphocyte infiltration. Transient hyperthyroidism, followed by hypothyroid phase.

Requires levothyroxine.

Question 11

What is criteria for DKA?

Answer 11

• Acidosis (<7.3)
• Hyperglycaemia
• Ketonaemia

Question 12

What is management of DKA?

Answer 12

If hypotensive, give 500 mL 0.9% saline bolus.

Otherwise, 1L 0.9% saline over 1 hr, 1L/2hr, 1L/2hr, 1L/4hr, 1L/4hr, 1L/6hr.

Start insulin infusion based on weight. 0.1 units/kg/hr. Aim for fall in ketones of 0.5 per hour.

Take regular VBG for pH, bicarb, glucose and K+.

Watch for K+ depletion, replace as necessary by adding to bag of 0.9% saline.

Avoid hypoglycaemia by adding 10% glucose once BM <14.