Endocrinology Flashcards
28F on Lithium
weight gain, oligomenorrhoea, primary infertility
High TSH
Low T4
High Prolactin
Dx?
Mx?
Primary hypothyroidism due to Lithium
Mx
- Thyroxine
- Don’t stop lithium (psych relapse)
NB. high prolactin as hypothyroid -> high TRH -> high prolactin
Advantage insulin analogue e.g. aspart
Rapid onset action
45F weight gain and sweating for 1 yr
Dx?
Insulinoma
Best intervention for reducing micro/ macro- vascular events in T2DM?
anti-HTN medication
1st and 2nd line Rx for Cushing’s Disease
surgery (remove ACTH tumour)
2nd line = Ketoconazole
Retrosternal goitre and stridor
Ix for airway obstruction?
Flow volume loop (detects tracheal obstruction)
Amyloid polypeptide on pancreas histology
Dx?
T2DM
Best intervention for reducing diabetic retinopathy progression
anti - hypertensives
Soft exudates
in pre-proliferative or proliferative retinopathy?
pre-proliferative retinopathy
48M post colectomy
L1 fracture and wt loss w normal diet
Low Ca
Low Phos
Cause for fracture?
Vit D deficiency
get low Ca, and increased PTH -> low Phos
51M HTN obesity T2DM
pituitary-dependent Cushing’s.
preoperative BP is elevated at 175/100 mmHg, BMI is 32 and fasting glucose is 11.2
Rx to improve his metabolic parameters prior to surgery?
Metyrapone
inhibits 11-beta hydroxylase inhibits cortisol production
rapid onset of action
without associated weight gain of e.g. insulin
Criteria for metabolic syndrome
Central obesity
(≥94 cm for men, ≥80 cm for women) plus any two of:
Hypertriglyceridaemia >1.7 mmol/L
Low HDL concentration <1.03 mmol/L male, <1.29 mmol/L female
BP ≥ 130/85 mmHg, or on treatment for hypertension
Fasting glucose ≥5.6 mmol/L, or known to have type 2 diabetes.
45F chronic diarrhoea. opening her bowels 8x/day watery motions Low K abdo US - pancreatic mass
Dx?
Rx?
VIPoma
Somatostatin analogues
weight loss
hypokalaemia
chronic diarrhoea
metabolic acidosis
Dx
VIPoma
Bromocriptine
MOA
Indication
is a dopamine agonist which can be used in the treatment of prolactinoma
Cholestyramine
MOA
Indication
is a bile acid sequestrant that can be used in the management of diarrhoea related to small bowel malabsorption or pancreatitis.
Urge incontinence
1st line
2nd line
1) bladder training
2) oxybutinin
52M
HGV driver
morbidly obese
On Metformin 1g BD
HbA1c 73
Rx?
Exanatide
(as morbidly obese (or risk hypos) give exanatide)
Otherwise give metformin or sulphonylurea
HRT risks
HRT increases CVD and stroke
frequently produces a rise in triglyceride concentrations.
Most likely complication anaplastic thyroid cancer
upper airway obstruction
When to monitor bgl in diabetes
On insulin, sulphonylureas or glinides (repaglinide or netaglinide)
fasting and pre-prandial glucose levels
Thyroidectomy commonest complication
transient hypoparathyroidism
low Ca
TB drug interrupts thyroxine absorption
Rifampicin
Drugs for PCOS
hirsutism
conception
hirsutism - COCP
conception - metformin
Artery close to recurrent laryngeal nerve
inferior thyroid artery
Rx to reduce risk renal failure in diabetic nephropathy (proteinuria)
ACEi e.g. lisinopril
Headache
Vomiting
Visual disturbance
Hormonal dysfunction
Pituitary apoplexy
(acute haemorrhage/infarct to pituitary)
- initially worried about no ACTH -> Addisonian crisis -> give hydrocortisone
- then can get low TSH and low LH/FSH
Low BP
Low Na
High K
Low glucose
Addisonian crisis
Galactorrhoea and amenorrhoea for 1 year
Visual fields normal
Prolactin 10500
Dx?
Rx?
Dx = macroprolactinoma
Rx = DA carbergoline or bromocriptine
lowers prolactin and normalises oestrogen
Changes to TFTs during pregnancy
High total T4 (as higher thyroid binding globulin)
Low TSH
Low Ca
High Phos
High PTH
Short stature
Short 4th/5th metatarsals
Intellectual impairment
Pseudohypoparathyroidism
PTH resistance
Low Ca
High Phos
Low PTH
Hypoparathyroidism
Thigh pain
Progresses to proximal muscle wasting
loss knee reflexes
Dx?
Ix?
Diabetic amyotrophy
(as vasa nervorum occlusion for lumabr plexus +- femoral nerve
Ix = (test for DM), so OGTT or BGL
Flu-like illness
hyperthyroid -> hypothyroid
then recovert
Gland diffusely tender
Dx?
Rx?
Dx = de Quervains thyroiditis
Rx = NSAIDs (no need to give thyroid meds)
32F amenorrhoea 4m
FSH low
LH low
raised prolactin 800
MRI mpituitary
Hypogonadotrophic hypogonadism
in the presence of raised prolactin is likely secondary to microprolactinoma
23F
T1DM
Weight loss, no other Sx
microcytic anaemia
Ix?
anti - TTG Ab
?coeliac in bg of T1DM as well
can have Fe and B12 deficiency and have few Sx with coeliac
Leptin function
satiety
made by adipocytes
acts on hypothalamus
31F
T1DM
Pain R shoulder
Reduced passive and active movements R side
Adhesive capsulitis
associated w diabetes
diffuse tender goitre
hyperthyroidism
very low uptake on radioactive iodine uptake scan
de Quervain’s thyroiditis
get hyperthyroidism due to rapid release preformed thyroid hormones
de Quervain’s thyroiditis
Rx?
symptomatic control
BB for tremor/anxiety
Pred or NSAIDs for thyroiditis
Lipaemia retinalis
associated with
hypertriglyceridaemia
Xanthelasma and corneal arcus
associated with
hypercholesterolaemia
Dx for gestational diabetes
75 g oral glucose tolerance test
at 16-18 weeks
rpt at 28wks if normal
Rx gestational diabetes
diet and exercise
if fails after 1-2 weeks give meds
(METFORMIN, GLEBENCLAMIDE, INSULIN)
if evidence fetal macrosomia start meds immediately
Cause osteoporosis in young men
Hypogonadism
do testosterone level first (before prolactin)
Drug causing nephrogenic DI
Lithium
K and Na
in primary hyperaldosteronism
other Ix?
K low
Na high
K CAN BE NORMAL IN 12% PATIENTS
do aldosterone: renin ration (stop BB before doing this)
amenorrhoea
raised LH:FSH ratio
insulin resistance
hyperandrogenism -raised androstenedione + slightly raised testosterone
PCOS
important predictor of potential ulceration in diabetic foot
callus formation
Prolactin levels
<1000
1000 - 3000
> 3000
<1000 = drug induced high prolactin/ hypothyroid
1000-3000 = microprolactinoma
> 3000 = macroprolactinoma
h ypoaldoseteronism
-> reduction in PCT ammonium excretion
mild (normal anion gap) metabolic acidosis
type 4 RTA
exanatide MOA
GLP 1 analogue
suppresses appetite
inhibits glucose production in the liver
slows gastric emptying
stimulates insulin release
Alpha subunit G protein mutation
pseudohypoparathyroidism
(pth resistance)
hypothyroidism
neuroendocrine tumour
xs SEROTONIN
flushing, diarrhea and wheezing
carcinoid SYNDROME
- commonly in SI, appendix tumours
- but NOT commonly w/ carcinoid tumours
Lung carcinoid TUMOUR a/w Cushings (as produces ectopic ACTH)
Carinoid tumour Rx
Octreotide
somatostatin analogue
(also used in acromegaly)
exanatide rare SE
pancreatitis
Rare renal disorder (AR)
defect in Loop of Henle
Low K
high renin + aldosterone
Normal BP
Barrters syndrome
Hasimotos’s thyroiditis increased risk of which cancer
thyroid lymphoma
amenorrhea
hypergonadotropinism - high fsh
low oestrogen
primary ovarian failure
