Endocrine Week Flashcards
Patient presents with hirsutism.
Give androgen-dependent and androgen independent differentials for this?
Androgen-dependent= *PCOS, congenital adrenal hyperplasia, androgen-secreting tumours
Androgen-independent= hypothyroidism, anorexia nervosa
What is the deficiency related to congenital adrenal hyperplasia?
21-hydroxylase deficiency
At what BP should we begin HTN management for patients with DM?
> 140/80
130/80 if evidence of end-organ damage
Give 3 secondary causes of increased triglycerides?
Alcoholic liver disease
Hypothyroidism
Failure to control hyperglycaemia
What is the target cholesterol level for patients on statins?
<4mmol/L
True or false, sluphonyluria and metformin can cause weight gain
True
Lactic acidosis is a rare SE of which DM medication?
metformin
How do you calculate serum osmolality?
2(Na + K) + glucose + urea
Give a typical pH and HCO3 level for DKA
pH<7.3
HCO3 < 15mmolL
Acarbose can be used in the mangement of DM, how?
Delays digestion of starch + sucrose by inhibiting alpha glucosidases in intestines
lowers glucose levels
Give an example of a thiazolideniadone?
Proglitazone / Rosiglitazone
Give an example of a sulphonylurea?
Glicazide
What are the features which indicate monogenic diabetes?
What is the treatment?
DM age <25
Strong FHx
Assoic w/HNF 1-alpha (decreased amount of insulin produced)
Tx= sulphonylurea
Which diabetes medication stimulates an increased release of insulin?
Sulphonylureas e.g glicliazide
“sulphs stimulate”
Water deprivation test is used as an investigation for which condition?
DI
Give 2 main causes of hypothyroidism
iodine-deficiency
AI e.g hashimoto’s thyroiditis
Patient presents with polyuria, polydipsia and lethargy… likely diagnosis?
T2DM
Patient presents with tiredness, depression, weight gain, constipation… likely diagnosis?
Hypothyroidism
Patients with diabetes are more vulnerable to opportunistic infections. Candida can cause what presentation in females / males?
Female= pruritis vulvae Male= penile inflammation (balanitis)
What is balanitits?
Inflammation of the glans penis / foreskin
Patient presents with symptoms representing a cushingoid clinical picture. What are the 4 potential causes of their symptoms?
high-dose steroid intake
cushing’s disease (pituitary tumour)
cushing’s syndrome (ectopic ACTH tumour)
adrenal tumour
A high-dose dexamethasone suppression test is used in patients which present with what symptoms?
What differentials does it distinguish between?
Patients with cushingoid symptoms
A high dose of dexamethasone is enough to suppress ACTH in cushing’s disease (pituitary tumour) but not ACTH released in ectopic tumour producing ACTH.
What is the first line investigation for patients supsected of cushing’s disease?
24 hr urinary cortisol
Grave’s disease is the commonest cause of hyperthyroidism, true/false?
True
What is the pathophysiology of graves’ disease?
Antibodies which stimulate TSH receptors therefore causing increased T3/T3
Antibodies in graves’ disease bind to TSH receptors stimulating increased thyroid hormones. Give 3 other sites they act on to produce characteristic signs seen in graves?
Shin- pre-tibiial myxoedema
Eyes (extraocular muscles)- gaze abnormality
Fingers- clubbing
What differential diagnosis is explored by ordering a 24hr urinary catecholamine?
phaeochromocytoma
What is pre-diabetes?
Condition characterised by increased risk of future development of type 2 diabetes
What is De Querevain’s thyroiditis?
Transient thyroid state due to viral infection
Fever, painful neck, signs of hyperthyroidism then hypothyroidism then euthyroid
Only cause of thyroid disease to swing from hyper to hypo
Where can thyroid cancer metastasise to?
Brain, bone, lung, liver
Patient presents with….
Postural hypotension, hyperpigmentation, wt loss, malaise, vitiligo
What is appropriate investigation?
What is the likely diagnosis?
short synthacthen test
addison’s disease
On examination:
Single, compressible, fluid-filled thyroid swelling.
Likely diagnosis?
Investigation?
Thyroid cyst/nodule (usually harmless)m
US, fine-needle biopsy
On examination
Woody/stony thyroid caused by fibrosis
Diagnosis?
Riedel’s thyroiditis
A patient has a high serum osmolality and a low urine oslolality, what is the likely diagnosis?
Diabetes Insipidus
You suspect a patient has diabetes insipidus due to their history of polyuria and polydipsia. What investigation could you do?
serum and urine osmolality (DI= serum high, urine low)
Fluid deprivation and desmopressin test
(Test urine osmolality on fluid deprivation and desmopressin to distinguish cranial and nephrogenic)
Explain how fluid deprivation and demopressin tests help to distinguish nephrogenic and cranial DI?
Nephrogenic= UO fluid dep <300, UO after desmompressin <300 (kidneys insensitive to ADH so regardless of giving desmopressin the UO is unchanged)
Cranial= UO fluid dep <300, UO after desmopressin >800 (pituitary produces insufficient ADH so when provided with desmopressin the UO increases)
UO= urine osmolality
Investigations reveal the patient has a high serum osmolality, what is a typical cause of this?
Dehydration
Describe the serum/urine osmolality and serum sodium levels for a patient with SIADH?
Serum osmolality= low (lots of water)
Urine osmolality= high (lack of water)
Hyponatraemia (euvolaemic)
Patient has euvolaemic hyponatraema, potential cause?
SIADH
What is diabetic amyotrophy?
Asymmetrical painful wasting of quadriceps
Control of glucose normally resolvs it
On examination:
Mobile, painless mass which is soft. Just under skin, can occur anywhere on body
Lipoma (benign mass)
Diabetic injections (or any injection) under poor sanitary conditions can result in an infection abscess. What does this look like?
Red, puss-filled cavity, painful
On examination:
Smooth, firm lumps on the lower abdomen of a diabetic patient who injects insulin are also known as….
Lipohypertrophy
Give 2 examples of diabetes education programmes?
DAFNE
Dose adjusted for normal eating (all ptx T1DM)
DESMOND
Diabetes education + self-managment for ongoing newly diagnosed (T2DM)
All patients diagnosed with T1DM should be advised to attend which education programme?
DAFNE
Dose adjusted for normal eating
A T2DM has struggled to maintain blood glucose control despite adhering to diabetic medications. The GP checks their HbA1c level and after seeing the result suggests it is time to start insulin.
What result would indicate this?
HbA1c > 75
What is the target HbA1c for most patients? For patients at risk of hypos?
Normal <48
Risk of hypos <58
Explain the effect of conn’s syndrome on patients BP?
High BP
Conn’s = primary aldosteronism
Excess aldosterone = excess sodium retention = excess water retention = high BP
Low TSH, low T3/T3
Diangosis?
Secondary hypothyroidism
Raised TSH, raised T3/T4
Diagnosis
Secondary hyperthyroidism
Raised TSH, low T3/T4
Diagnosis?
Primary hypothyroidism
Low TSH, raised T3/T4
Diagnsosi?
Primary hyperthyroidism
Which medication is given first line for a thyroid crisis and why?
Propylthiouracil
Prevents peripheral T4-T3 conversion
Patient presents to A+E tachycardic, febrile, confused, irritable. Bilateral peripheral oedema, irregularly irregular pulse. 2 wk hx of excessive sweating, palpitations, breathlessness and difficulty sleeping.
Diagnosis?
Management?
Thyroid crisis
Mx= proplythiouracil / carbimazole (if prop not available)
Chloestryamine (aids clearance by blocking enterohepatic circulation), Potassium iodide (1hr post prop)
What is a rare but life-threatening side effect of carbimazole?
Agranulocytosis
