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RW FY1 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

HbA1c 86 mmol/mol (10.0%). What is the average glucose?

A

Average glucose = (HbA1c, % x 2) - 4.5 Average glucose = 15.5

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2
Q

45F, Lethargy, Na 129, K 5.1, Total T4 66 (RR 70-140). Next Ix?

A

Short synacthen test Addison’s: Fatigue, Low Na, High K May be associated with hypothyroidism Hypothyroidism would not cause high K

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3
Q

Abdo pain, vomiting, Hypotensive, Hypoglycaemia, PMHx Hypothyroidism. Tx?

A

Dx: Addison’s Tx: Hydrocortisone Addison’s is associated with Hypothyroidism

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4
Q

Causes of hypokalaemia with hypertension (4)

Causes of hypokalaemia with normal BP (5)

A

Hypokalaemia with hypertension

  • Cushing’s syndrome
  • Conn’s syndrome (primary hyperaldosteronism)
  • Liddle’s syndrome
  • 11-beta hydroxylase deficiency

Hypokalaemia without hypertension

  • Diuretics
  • GI loss (e.g. Diarrhoea, vomiting)
  • renal tubular acidosis (type 1 and 2)
  • Bartter’s syndrome
  • Gitelman syndrome
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5
Q

Heavy periods + Polycythaemia. Dx?

A

Uterine fibroids

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6
Q

Osmolality formula

A

Estimated osmolality = 2 (Na + K) + Urea + Glucose

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7
Q

Ix for GH deficiency

A

Insulin

Hypoglycaemia is a potent stimulus for GH release

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8
Q

Ix for Acromegaly

Initial Ix?

Definitive Ix?

A

Serum IGF-1: ↑ [initial Ix]

OGTT [confirm diagnosis]

  • If Normal: Glucose load –> ↓ GH levels
  • If Acromegaly: Glucose load –> Paradoxical ↑ GH levels
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9
Q

Tx for Acromegaly

A

(1st line) Trans-sphenoidal surgery

(2) Somatostatin analogue (Octreotide)
(2) Dopamine agonist (Cabergoline, Bromocriptine)
(3) GH receptor antagonist (Pegvisomant)

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10
Q

Causes of hyperprolactinaemia

A

Pregnancy

Prolactinoma

Pituitary adenoma (stalk compression)

Acromegaly (high GH has prolactin like effects)

Primary hypothyroidism (high TRH)

Dopamine receptor antagonists

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11
Q

Tx for prolactinoma

A

(1) Dopamine agonist (Cabergoline, Bromocriptine)
(2) Trans-sphenoidal surgery

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12
Q

Raised serum osmolality, Low urine osmolality

Diagnosis?

Ix?

Treatment?

A

Diabetes insipidus

Ix: Fluid deprivation + DDAVP test

If cranial DI –> Desmopressin

If nephrogenic DI –> Thiazide diuretic (Bendoflumethiazide)

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13
Q

Low plasma osmolality, Raised urine osmolality

Diagnosis? Treatment?

A

SIADH

Treat underlying cause

Fluid restriction

+/- Lithium +/- Demeclocycline +/- Tolvaptan

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14
Q

Known pituitary tumour

Acute onset headache

N&V

Xanthochromia

Diagnosis? Tx?

A

Pituitary apoplexy (haemorrhage of pitutiary tumour)

Tx:

(1) IV Hydrocortisone (given first)
(2) Levothyroxine

+ Surgical intervention

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15
Q

Tx of acute thyroid storm

A
  • High-dose anti-thyroid drug (Carbimazole, Propylthiouracil, Methimazole)
  • + Corticosteroids
    • β-blockers (IV Propanolol)
    • Iodine (Lugol solution)
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16
Q

Hashimoto’s thyroiditis

Associated with

A

Hashimoto’s thyroiditis

Associated with

  • Other autoimmune diseases
  • MALT Lymphoma
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17
Q

Pendred’s syndrome

Clinical features? Cause?

A

Pendred’s syndrome

Autosomal recessive –> defect in organification of iodine

  • Progressive hearing loss
  • Hypothyroidism
  • Goitre
  • MRI: one ond a half turns of cochlea
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18
Q

Middle-aged woman

Hypothyroidism

“woody” goitre

Diagnosis?

A

Riedel’s thyroiditis = thyroid is replaced by fibrotic tissue

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19
Q

Adrenal zones

A
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20
Q

Ix for Cushin’s syndrome

A

Low dose dexamethasone suppression test:

diagnostic [GOLD STANDARD] [1st line]

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21
Q

Tx for Cushing’s syndrome

A

Medical

  • Metyrapone (S/E: Hyperaldosteronism, Hirsuitism)
  • Ketoconazole (S/E: Hepatotoxic)

Surgical

  • If Cushing’s disease –> Pituitary surgery (Transsphenoidal hypophysectomy)
  • If Ectopic ACTH production –> removal of tumour
  • If Adrenal adenoma –> Unilateral (or Bilateral) adrenalectomy
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22
Q

Hypertension + Hypokalaemia

Diagnosis? Ix? Tx?

A

Hyperaldosteronism

  • Bilateral adrenocortical hyperplasia (2/3) –> most common
  • Conn’s syndrome (1/3) = aldosterone-producing adenoma

Ix: Plasma Aldosterone : Renin ratio

Tx:

  • Short term –> MR antagonists (Spironolactone / Epleronone)
  • Long term –> Laparoscopic adrenalectomy (both NOT both!)
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23
Q

Ix for Phaeochromocytoma

A

24 hour urinary metanephrines: raised

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24
Q

Hyponatraemia + Hyperkalaemia

Diagnosis? Ix?

A

Addison’s disease

SynACTHen test

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25
Q

Congenital adrenal hyperplasia

Types / Presentations

A

21-hydroxylase deficiency (most common)

  • Ambiguous genitalia
  • Virilisation of females
  • Complete –> Addisonian crisis (Hypotension)
  • Partial –> Precocious puberty

11-hydroxylase deficiency

  • Conn’s syndrome (Hypertension + Hypokalaemia)
  • Ambiguous genitalia
  • Precocious puberty

17-hydroxylase deficiency

  • Conn’s syndrome (Hypertension + Hypokalaemia)
  • Failure to enter puberty
26
Q

MALE Hypogonadism

Klinefelter’s syndrome vs Kallmann’s syndrome

A

Klinefelter’s syndrome (XXY) –> primary hypogonadism

Kallmann’s syndrome (failure of GnRH neurones) –> secondary hypogonadism

27
Q

Causes of FEMALE hypogondism

A

Pregnancy [most common]

Primary hypogonadism

  • Turner’s syndrome (45 XO)
  • Premature ovarian insufficiency

Secondary hypogonadism

  • Hypopituitarism
    • Sheehan syndrome
    • Low BMI
    • Kallmann syndrome
  • Hyperprolactinaemia
28
Q

Tx for PCOS

Hirsuitism/Acne

Subfertility

A

PCOS

Hirsuitism/Acne –> COCP

Subfertility –> Clomifene or Metformin

29
Q

Hypocalcaemia

Low Ca, High PTH

Abnormal 4th metacarpal

Diagnosis? Definition

A

Pseudohypoparathyroidism = PTH resistance

30
Q

Osteitis fibrosa cystica

Features

Associated with

A

Osteitis fibrosa cystica = replacement of bone with fibrosis (–> brown tumours)

Associated with Primary hyperparathyroidism

31
Q

Skull X ray shows

Pepper pot skull

Rugger jersey spine

Diagnosis?

A

Primary hyperparathyroidism

32
Q

Cause of Tx of primary hyperparathyroidism

A

Parathyroid adenoma (most commonly) –> Primary HyperPTH

(1) Parathyroidectomy

(2) Medical –> Cinacalcet

Treat hypercalcaemia

33
Q

Hungry bone syndrome

Associated with?

Definition? Ix?

A

Primary hyperparathyroidism

Due to sudden drop in previously high levels of PTH

Previously, ↑ PTH stimulates osteoclasts to resorb bone –> ↑ Ca

Sudden ↓ PTH (due to short half life)

–> ↓ osteoclast activity and ↑↑osteoblast activity

–> bones rapidly re-mineralise –> ↓ Ca, ↓ PO4

Ix: ↓ Ca2+, PTH, ↓↓ PO4

34
Q

Tx of Osteoporosis + S/E

A
  • (1) Bisphosphonates (Alendronate, Risedronate)
    • S/E: Oesophagitis, Osteonecrosis of jaw, Atypical fractures
  • + Calcium
  • + Vitamin D
  • (2) Strontium ranelate
    • MOA: dual action bone agent
      • –> promotes osteoblasts and inhibits osteoclasts
    • S/E: multiple! (VTE)
  • (2) SERMs (Tamoxifen)
    • S/E: DVT/PE
  • (2) Denosumab
    • RANKL inhibitor
    • S/E: Hypocalcaemia
  • (3) Teriparatide (recombinant PTH)

If post-menopausal –> HRT

35
Q

Fracture

Marble bone on X ray

Ca , PO4 , ALP

Diagnosis? Cause?

A

Osteopetrosis = Marble bone disease

Autosomal recessive

Defect in osteoclast function –> unable to resorb bone –> dense + brittle bones

36
Q

Bone pain

Sensorineural deafness

Fracture

Age > 50 years old

ALP: ↑↑↑

Ca2+, PO4, PTH: normal

Diagnosis? Tx? Complications?

A

Paget’s disease of bone

(1) Bisphosphonates

Complications: Osteosarcoma (1%)

37
Q

Latent autoimmune diabetes in adults (LADA)

Features?

Epidemiology?

A

LADA

Anti-islet cell +ve

Very slow progression of autoimmune cell failure

Young + obese

38
Q

Maturity onset Diabetes of the Young (MODY)

Features? Cause? Tx?

A

MODY

T2DM in patients < 25 years old

Autosomal dominant (HNF-1-a mutation)

Tx: Gliclazide (very sensitive to sulfonylureas)

39
Q

Definition of Diabetes

A
40
Q

Definition of DKA

A
41
Q

Diabetic

Shiny, yellow/red skin

Not painful

Diagnosis?

A

Necrobiosis lipoidica diabeticorum

42
Q

Sulphonylurea

Example

MOA

S/E

A

Sulphonylurea

Example: Gliclazide + Glibenclamide

MOA: increase insulin secretion

S/E: Hypoglycaemia, Weight gain, SIADH

43
Q

a-glucosidase inhibitor

Example

MOA

S/E

A

a-glucosidase inhibitor

e.g. Acarbose

MOA: delays absorption of carbohydrates

S/E: Flatus

44
Q

Thiazolidinediones

Example

MOA

S/E

C/I

A

Thiazolidinediones

e.g. Pioglitazone

MOA: Acts on PPAR-y receptor on adiopcytes –> peripheral insulin sensitiser

S/E: Fluid retention, Weight gain, Bladder cancer

C/I: Heart failure, Bladder cancer

45
Q

SGLT2 inhibitor

Example

MOA

S/E

A

SGLT2 inhibitor

Examples: Empagliflozin | Dapagafloxin | Canagliflozin

MOA: inhibits Na-glucose co-transporter in early DCT –> inc renal glucose excretion

S/E: Weight loss, UTIs, Euglycaemic DKA

46
Q

GLP-1 agonists

Example

MOA

S/E

A

GLP-1 agonists

e.g. Liraglutide S/C, Exenatide S/C

MOA: GLP-1 agonist –> increase insulin

S/E: Weight loss, GI side effects

47
Q

DPP4 inhibitors (Gliptins)

Example

MOA

S/E

A

DPP4 inhibitors (Gliptins)

e.g. Linagliptin

MOA: DPP4 inhibitor –> inhibit breakdown of endogenous GLP-1

S/E: Weight loss

48
Q

Diabetic medications which cause hypoglycaemia

A
  • Insulin
  • Sulphonylurea (Gliclazide)
49
Q

Diabetic medications which cause weight gain

Diabetic medications which cause weight loss

A

Weight gain (SIT)

  • Sulphonylurea (Gliclazide)
  • Insulin
  • Thiazolidinedione (Pioglitazone)

Weight loss (renal excretion of glucose + GLP)

  • SGLT2 inhibitors (Empagliflozin)
  • GLP-1 agonists (Liraglutide, Exenatide)
  • DPP4 inhibitors (Linagliptin)
50
Q

Diabetic medications step wise

A
51
Q

Gestational diabetes

Targets

Tx

A
52
Q

Diabetic retinopathy - stages

A
53
Q

Diabetic retinopathy

Screening Ix

Ideal Ix

A

Screening Ix –> Fundoscopy

Ideal Ix –> Fluorescein angiography

54
Q

Diabetic neuropathy + neuropathic pain

Tx?

A

Duloxetine or Amitriptyline or Pregabalin or Gabapentin

55
Q

Diabetic

Bloating

Vomiting

Erratic blood glucose control

Cause?

A

Diabetic neuropathy (Gastroparesis)

Tx: Metoclopramide

56
Q

Diarrhoea

Flushing

Wheeze

Telagniectasia

Diagnosis? Ix? Tx?

A

Carcinoid syndrome

24hr urine collection of 5-hydroxyindoleacetic acid: ↑

Serum Chromogranin A/B: ↑

Tx: Surgical resection +/- Octreotide

57
Q

Schmidt’s syndrome

Definition

A

APS-2 (= Schmidt’s syndrome)

Need 2/3 features below:

  • Addison’s disease
  • Autoimmune thyroid disease
  • T1DM
58
Q

MEN syndromes

A
59
Q

Causes of hypertriglyceridaemia

Causes of hyperholesterolaemia

A
60
Q

How to uptitrate statins

A

Repeat Lipid profile @ 3 months

If non-HDL cholesterol ↓ < 40% –> ↑ Atorvastatin to 80mg ON

RW FY1 (15 decks)

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