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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
Congenital adrenal hyperplasia Types / Presentations
**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
MALE Hypogonadism Klinefelter's syndrome vs Kallmann's syndrome
**Klinefelter's syndrome** (XXY) --\> primary hypogonadism **Kallmann's syndrome** (failure of GnRH neurones) --\> secondary hypogonadism
27
Causes of FEMALE hypogondism
**Pregnancy** [most common] **Primary hypogonadism** * **Turner's syndrome** (45 XO) * **Premature ovarian insufficiency** **Secondary hypogonadism** * **Hypopituitarism** * Sheehan syndrome * Low BMI * Kallmann syndrome * **Hyperprolactinaemia**
28
**Tx for PCOS** Hirsuitism/Acne Subfertility
PCOS ## Footnote Hirsuitism/Acne --\> **COCP** Subfertility --\> **Clomifene** or **Metformin**
29
**Hypocalcaemia** Low Ca, High PTH **Abnormal 4th metacarpal** Diagnosis? Definition
**Pseudohypoparathyroidism** = PTH resistance
30
**Osteitis fibrosa cystica** Features Associated with
**Osteitis fibrosa cystica** = replacement of bone with fibrosis (--\> brown tumours) Associated with **Primary hyperparathyroidism**
31
Skull X ray shows **Pepper pot skull** **Rugger jersey spine** Diagnosis?
**Primary hyperparathyroidism**
32
Cause of Tx of primary hyperparathyroidism
**Parathyroid adenoma** (most commonly) --\> Primary HyperPTH ## Footnote **(1) Parathyroidectomy** **(2)** Medical --\> **Cinacalcet** Treat hypercalcaemia
33
**Hungry bone syndrome** Associated with? Definition? Ix?
**Primary hyperparathyroidism** ## Footnote 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
Tx of Osteoporosis + S/E
* (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
**Fracture** **Marble bone on X ray** **Ca , PO4 , ALP** Diagnosis? Cause?
**Osteopetrosis** = **Marble bone disease** Autosomal recessive Defect in osteoclast function --\> unable to resorb bone --\> dense + brittle bones
36
**Bone pain** **Sensorineural deafness** Fracture Age \> 50 years old **ALP: ↑↑↑** Ca2+, PO4, PTH: normal Diagnosis? Tx? Complications?
**Paget's disease of bone** (1) **Bisphosphonates** Complications: **Osteosarcoma** (1%)
37
**Latent autoimmune diabetes in adults (LADA)** Features? Epidemiology?
_LADA_ ## Footnote **Anti-islet cell +ve** **Very slow progression of autoimmune cell failure** **Young + obese**
38
**Maturity onset Diabetes of the Young (MODY)** Features? Cause? Tx?
**MODY** **T2DM in patients \< 25 years old** Autosomal dominant (**HNF-1-a mutation**) *_Tx_*: **Gliclazide** (very sensitive to sulfonylureas)
39
Definition of Diabetes
40
Definition of DKA
41
**Diabetic** **Shiny, yellow/red skin** **Not painful** Diagnosis?
**Necrobiosis lipoidica diabeticorum**
42
**Sulphonylurea** Example MOA S/E
Sulphonylurea ## Footnote *_Example_*: **Gliclazide** + **Glibenclamide** *_MOA_*: increase insulin secretion *_S/E_*: **Hypoglycaemia, Weight gain**, SIADH
43
**a-glucosidase inhibitor** Example MOA S/E
a-glucosidase inhibitor ## Footnote e.g. **Acarbose** MOA: delays absorption of carbohydrates S/E: Flatus
44
**Thiazolidinediones** Example MOA S/E C/I
**Thiazolidinediones** ## Footnote 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
**SGLT2 inhibitor** Example MOA S/E
**SGLT2 inhibitor** ## Footnote *_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
**GLP-1 agonists** Example MOA S/E
**GLP-1 agonists** ## Footnote e.g. Liraglutide S/C, Exenatide S/C *_MOA_*: GLP-1 agonist --\> increase insulin *_S/E_*: **Weight loss**, GI side effects
47
**DPP4 inhibitors (Gliptins)** Example MOA S/E
DPP4 inhibitors (Gliptins) ## Footnote e.g. **Linagliptin** *_MOA_*: **DPP4 inhibitor** --\> inhibit breakdown of endogenous GLP-1 *_S/E_*: **Weight loss**
48
Diabetic medications which cause hypoglycaemia
* Insulin * Sulphonylurea (Gliclazide)
49
Diabetic medications which cause **weight gain** Diabetic medications which cause **weight loss**
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
Diabetic medications step wise
51
Gestational diabetes Targets Tx
52
Diabetic retinopathy - stages
53
**Diabetic retinopathy** Screening Ix Ideal Ix
Screening Ix --\> **Fundoscopy** Ideal Ix --\> **Fluorescein angiography**
54
Diabetic neuropathy + neuropathic pain Tx?
**Duloxetine** or Amitriptyline or Pregabalin or Gabapentin
55
**Diabetic** **Bloating** **Vomiting** **Erratic blood glucose control** Cause?
**Diabetic neuropathy** (**Gastroparesis**) *_Tx_*: **Metoclopramide**
56
**Diarrhoea** **Flushing** **Wheeze** **Telagniectasia** Diagnosis? Ix? Tx?
**Carcinoid syndrome** ## Footnote **24hr urine collection of 5-hydroxyindoleacetic acid**: ↑ **Serum Chromogranin A/B**: ↑ *_Tx_*: **Surgical resection +/- Octreotide**
57
**Schmidt's syndrome** Definition
**APS-2 (= Schmidt's syndrome)** Need 2/3 features below: * **Addison's disease** * **Autoimmune thyroid disease** * **T1DM**
58
MEN syndromes
59
Causes of hypertriglyceridaemia Causes of hyperholesterolaemia
60
How to uptitrate statins
Repeat Lipid profile @ 3 months If **non-HDL cholesterol ↓ \< 40% --\> ↑ Atorvastatin to 80mg ON**

RW FY1 (15 decks)

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