Endocrine Flashcards
What’s the mechanism and SE of SGLT2 inhibitors?
Inhibit SGLT2 channels in PCT, so less glucose is reabsorbed, more is excreted. End in -ozin.
SE: UTIs, necrotising fasciitis of penis, increased risk of lower limb amputation.
Indication and SE of carbimazole
Mx of thyrotoxicosis. SE: agranulocytosis- FBC.
Administer in high doses for 6 weeks till euthyroid, then reduce.
Primary hyperparathyroidism sx and cause
Thirst, bones (pain/#), stones, abdominal groans, psychiatric moans (depression). Polydipsia and uria. Associated with hypertension. Often old thirsty ladies. Most caused by solitary adenoma.
Investigations for primary hyperparathyroidism
Raised or inappropriately normal PTH,
Raised Ca,
Low phosphate
Technetium scan (MIBI)
Mx for primary hyperparathyroidism
Parathyroidectomy
How many units of insulin in 1ml?
1 ml = 100 units
How does hypothyroidism affect periods?
Causes menorrhagia. Whilst hyperthyroid causes amenorhoea or oligo.
TFTs for primary hypothyroidism
High TSH
Low free T4
Poor compliance with meds = high TSH, normal free T4
TFTs for secondary hypothyroidism
V rare
Low TSH, low free T4
4 phases of de quervain’s thyroiditis (subacute)
1) painful goitre, raised esr, hyperthyroid
2) euthyroid
3) hypothyroid
4) structure and function return to normal
Cause of subacute thyroiditis
Usually follows viral infection. Usually self limiting.
Investigation for subacute thyroiditis
Decreased iodine uptake on scan.
Most common drug cause of gynaecomastia
Spiranolactone
Which signs on examination are specific to Grave’s?
Exophthalmos
Symptoms of acromegaly
Glossitis and enlarged gum spaces
Prognathism (jaw extends/bulges out)
Features of pituitary tumour: headache, bitemporal hemianopia (tumour on chiasm)
Increase in hand/shoe size
Potentially galactorrhea (increased prolactin)
What type of hemianopia would you expect in a stroke, and in acromegaly?
Stroke or other lesion distal to optic chiasm: homonymous
Acromegaly: bitemporal hemianopia
Features of raised prolactin in women
Amenorrhoea
Galactorrhea
Features of raised prolactin in men
Impotence
Reduced libido
Galactorrohea
Causes of raised prolactin
Obs/gynae: PCOS, pregnancy, oestrogens
Endocrine: prolactinoma, acromegaly, primary hypothyroidism- TRH stimulates prolactin release
Physiological: stress, exercise, sleep
Drug causes of raised prolactin
Anti-psychotics: haloperidol and phenothiazines
Anti-sickness: domperidone, metoclopramide
Tx of raised prolactin and mechanism
Bromocriptine
Dopamine inhibits prolactin release, so use a dopamine agonist.
Carcinoid syndrome: what is it and how does it present
Neuroendocrine tumour, can be GI, resp, other places. Usually occurs from mets in liver.
Secretes serotonin so causes flushing, diarrhoea, bronchospasm, abdo pain
Cardiac associations of carcinoid syndrome
TIPS
Tricuspid insufficiency
Pulmonary stenosis
Inv for carcinoid
Urinary 5-HIAA
Mx for carcinoid
Somatostatin analogues like ocreotide. (Somatostatin inhibits release of somatotropins which are growth factors)
How does alcoholic ketoacidosis present clinically and in investigations?
Management?
Alcoholics who have an episode of reduced food intake. Start to metabolite fats. Nausea, vom, abdo pain.
Ketones, normal or low glucose, acidotic.
Saline with thiamine for wernickes.
Presentation of Wilsons
Neuro: psychiatric and speech problems
Liver: hepatitis, cirrhosis
Investigating and tx Wilson’s
Total Serum copper is reduced as serum caeroloplasmin carries 95% and is reduced, free copper is increased, increased urinary copper excretion
Penicillamine
How do you mx hypercalcaemia?
IV 0.9% saline 3/4 litres then bisphosphonates later
Causes of hypercalcaemia
Primary hyperparathyroidism
Malignancy like Squamous cell LC
Antibodies in Grave’s
TSH-receptor stimulating autoantibodies
Anti-thyroid peroxidase autoantibodies (lower %)
Investigations for Grave’s
Low TSH
Raised free T4
Effects of mineralocorticoids vs glucocorticoids
Fluid-retention vs. anti-inflammatory
Which mineralocorticoid exerts the highest mineralo effect but lowest gluco effect?
Fludrocortisone
Which glucocorticoid exerts the highest glucocorticoid effect but lowest mineralo?
Dexamethasone
What’s the most important modifiable RF for thyroid eye disease?
Stop smoking
How does myxoedema coma present?
Confusion, hypotension, bradycardia, hypothermia, profoundly hypothyroid
Mx of myxoedema coma
IV thyroid hormone replacement + IV hydrocortisone (may have co-existing adrenal insufficency so must avoid precipitating a crisis)
Sick euthyroid syndrome: cause, investigations and mx
Severe systemic illness causes low everything.
Low or normal TSH, low thyroxine, T3.
Reverses naturally upon recovery.
Which haematological disease can produce falsely low HbA1cs?
Sickle cell- decreased RBC lifespan
2 aspects of diabetic foot disease
1) Neuropathy- 10g filament test
2) Ischaemia- Doppler DP pulse, ABPI is reduced
5 types of hormones released by adrenal glands (stimulated by ACTH)
- Androgens
- Oestrogen
- Mineralocorticoid
- Glucocorticoids
- Catecholamines (adrenaline, noradrenaline, dopamine)
