Endocrine Gap

Question 1

Acromegaly diagnostic test

Answer 1

Initial Test: Serum IGF-1 levels

Confirmatory: OGTT suppression of GH is used for confirmation

Question 2

Inv for Subacute Thyroiditis

Answer 2

Investigations
thyroid scintigraphy: globally reduced uptake of iodine-131

Question 3

Acromegaly Rx

Answer 3

• Trans-sphenoidal surgery is the first-line treatment for acromegaly in the majority of patients.
• If a pituitary tumour is inoperable or surgery unsuccessful then medication may be indicated:
  First line:
  somatostatin analogue
  directly inhibits the release of growth hormone
  for example octreotide
  effective in 50-70% of patients

Question 4

Negative Acute phase proteins

Answer 4

albumin
transthyretin (formerly known as prealbumin)
transferrin
retinol binding protein
cortisol binding protein

Question 5

Patient with features of addissons diseaase but normal short synacthen test. what to do next?

Answer 5

Performing an insulin tolerance test is the most appropriate next investigation. The insulin tolerance test is considered the gold standard for assessing secondary adrenal insufficiency and is the most appropriate next step.

Question 6

—– is the most important modifiable risk factor for the development of thyroid eye disease

Answer 6

smoking is the most important modifiable risk factor for the development of thyroid eye disease

Question 7

——- is the most common complication of thyroid eye disease

Answer 7

Exposure keratopathy
this is the most common complication of thyroid eye disease

Question 8

Which drug can cause hypothyroidism/Hyperthyroidism

Answer 8

Amiodarone

Question 9

Toxic Multinodular Goitre Investigations

Answer 9

• Nuclear scintigraphy reveals patchy uptake
• The treatment of choice is radioiodine therapy

Question 10

Lab findings in sick euthyroid

Answer 10

T3, T4 low
TSH low or more than normal

Question 11

Thyroid scintigraphy finding of Subacute (De Quervain’s) thyroiditis

Answer 11

thyroid scintigraphy: globally reduced uptake of iodine-131

Question 12

Name of Thyroid Cancers

Answer 12

PFEMALE
Papillary: most common. young woman
Follicular
Medullary: associated with MEN2
Anaplastic: can cause pressure symptoms
Lymphoma: associated with Hashimotos

Question 13

Which drugs have interaction with Thyroxine

Answer 13

iron, calcium carbonate
absorption of levothyroxine reduced, give at least 4 hours apart

Question 14

Choice of antithyroid drugs during pregnancy

Answer 14

Propylthiouracil has traditionally been the antithyroid drug of choice

Question 15

What happens during pregnancy in terms of thyroid physiology

Answer 15

In pregnancy, there is an increase in the levels of thyroxine-binding globulin (TBG). This causes an increase in the levels of total thyroxine but does not affect the free thyroxine level.

Question 16

DPP4 inhibitors

Answer 16

Sitagliptin
Saxagliptin
Linagliptin
Alogliptin
Vildagliptin

Question 17

Sulfonylureas

Answer 17

Glibenclamide (also known as Glyburide)
Glipizide
Gliclazide
Glimepiride

Question 18

How to adjust Metformin in Ramadan

Answer 18

for patients taking metformin the expert consensus is that the dose should be split one-third before sunrise (Suhoor) and two-thirds after sunset (Iftar)

Question 19

Higher-than-expected levels of HbA1c seen in

Answer 19

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

Question 20

Lower-than-expected levels of HbA1c are seen in

Answer 20

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis

Question 21

Antibodies seen in Graves

Answer 21

Autoantibodies
TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)

Graves’ disease is an autoimmune thyroid disease in which the body produces IgG antibodies to the thyroid-stimulating hormone (TSH) receptor.

Question 22

Major complication of Carbimazole

Answer 22

the major complication of carbimazole therapy is agranulocytosis

Question 23

—– is a known feature of chronic hypocalcaemia.

Answer 23

Cataract formation is a known feature of chronic hypocalcaemia.

Question 24

if the cause of hypoglycaemia is not clear then a combination of —— and —- levels can be measured

Answer 24

if the cause of hypoglycaemia is not clear then a combination of serum insulin and c-peptide levels can be measured

Question 25

Inv for Insulinoma

Answer 25

supervised, prolonged fasting (up to 72 hours)

Question 26

Bartter’s syndrome results from —-, and results in —-?

Answer 26

defective chloride absorption at the Na+ K+ 2Cl- cotransporter (NKCC2) in the ascending loop of Henle. It should be noted that it is associated with normotension (unlike other endocrine causes of

Question 27

impaired fasting glucose (IFG) - due to —— resistance
impaired glucose tolerance (IGT) - due to ——- resistance

Answer 27

impaired fasting glucose (IFG) - due to hepatic insulin resistance
impaired glucose tolerance (IGT) - due to muscle insulin resistance

Question 28

—– is the most common causes of primary amenorrhoea

Answer 28

gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes

Question 29

Cause of Bartter’s Syndrome

Answer 29

Bartter’s syndrome is an inherited cause (usually autosomal recessive) of severe hypokalaemia due to defective chloride absorption at the Na+ K+ 2Cl- cotransporter (NKCC2) in the ascending loop of Henle.

Loop diuretics work by inhibiting NKCC2 - think of Bartter’s syndrome as like taking large doses of furosemide

Question 30

Lab inv for Conn, Liddle and RAS

Answer 30

Renin and Aldosterone;
Both High= Bilateral Renal Artery Stenosis
Both Low=Liddle Sydrone (L for Low)
Renin Low,Aldo High=Conn’s

Question 31

Rx of Liddle

Answer 31

Treatment is with either amiloride or triamterene.

Liddle’s syndrome results from a gain-of-function mutation leading to persistent activation of epithelial sodium channels (ENaC) in the distal convoluted tubule

Question 32

Liddle pathophysiology

Answer 32

Mutation in the epithelial Sodium channels

Question 33

Bartter presents as

Answer 33

usually presents in childhood, e.g. Failure to thrive
polyuria, polydipsia
hypokalaemia
normotension
weakness

Question 34

Congenital Adrenal Hyperplasia is diagnosed as

Answer 34

ACTH stimulation testing is used to confirm the diagnosis
evaluates the adrenal gland’s response to ACTH, with abnormal increases in 17OHP indicating CAH

Question 35

M/A of Dpp4

Answer 35

Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that increases incretin levels by inhibiting their breakdown

Question 36

Familial hypercholesterolaemia (FH) genetics

Answer 36

• autosomal dominant
• results in high levels of LDL-cholesterol which, if untreated, may cause early cardiovascular disease (CVD). - FH is caused by mutations in the gene which encodes the LDL-receptor

Question 37

Low K, Hypertension

Answer 37

The differential for hypertension with low potassium includes Conn’s, Cushing’s, renal artery stenosis and Liddle’s. The first step in this case should be further simple investigations. Quantifying the renin and angiotensin levels will help to distinguish the cause here, before going on to more specialised tests.

Cushing’s and Conn’s would be associated with a high aldosterone and a low renin, renal artery stenosis would be associated with a high renin and aldosterone, Liddle’s is associated with a low renin and aldosterone.