Endocrinology

Question 1

What are the stimuli for GH release?

Answer 1

Stress/exercise
Hypoglycaemia
Amino acids
Sex steroids

Question 2

What inhibits GH release?

Answer 2

Somatostatin 
Other inhibitory factors;
- IGF1
- FFAs
- glucose
- obesity

Question 3

How does growth hormone act?

Answer 3

Causes gluconeogenesis, stimulates lipolysis and fat oxidation
Acts on the kidneys to retain Na+
Acts on the liver to produce IGF1. IGF1 stimulates tissue growth.

Question 4

How do you test for acromegaly?

Answer 4

Screeni for it with IGF1. If this is elevated, do an oral glucose tolerance test. If normal GH should be suppressed due to increased somatostatin production

Question 5

What causes acromegaly?

Answer 5

GH producing pituitary tumour

Question 6

What are the clinical features of acromegaly?

Answer 6

Increased mortality
Diabetes
Cardiomyopathy
Arrhythmias 
HTN
OSA
Hypertriglyceridaemia 
Colorectal Ca

Question 7

What is the treatment for acromegaly?

Answer 7

Surgery (transphenoidal)
Somatostatin analogue e.g. octreotide
Growth hormone antagonists e.g. pegvisoment
Dopamine agonists

Question 8

How do you diagnose diabetes?

Answer 8

HBA1C >48
Random glucose > 11.1 on two occasions
Fasting glucose >7
OGTT (gold standard): > 11.

Question 9

How do you dx impaired glucose tolerance?

Answer 9

OGTT @2hours; >7.8-<11.1

Fasting glucose >6.1 and <7

Question 10

How does HBA1C define prediabetes?

Answer 10

39_47

Question 11

What are the specific types of diabetes?

Answer 11

Type 1
Type 2
MODY
LADA
Secondary causes of diabetes:
- exocrine disease of the pancreas e.g. chronic pancreatitis, CF
- Cushing’s syndrome 
- acromegaly
- gestational diabetes

Question 12

What clinical features are suggestive of MODY?

Answer 12

FHx of <25 with DM, 2 consecutive gens
GAD -
C-peptide present

Question 13

What are the criteria for metabolic syndrome?

Answer 13

HTN: >130/85
Central adiposity
- M > 102, F > 89
Hypertriglyceridaemia > 1.69
Fasting glucose > 6.1

Question 14

What are the mx goals of type 2 diabetes?

Answer 14

Prevention (diabetes and exercise, metformin)
Weight
BP
Smoking
Lipids
Glucose

Question 15

What are the pharmacological options for type 2 DM?

Answer 15

• metformin
• sulphonylureas
• SGLT2 inhibitors
• GLP1 agonists/DDP-4 inhibitors
• thiozolidinidiones
• acabose
• insulin