Endocrinology

Question 1

Management of prolactinoma?

Answer 1

Management
in the majority of cases, symptomatic patients are treated medically with dopamine agonists (e.g. cabergoline, bromocriptine) which inhibit the release of prolactin from the pituitary gland
surgery is performed for patients who cannot tolerate or fail to respond to medical therapy. A trans-sphenoidal approach is generally preferred unless there is a significant extra-pituitary extension

Question 2

T2DM management?

Answer 2

First off offer lifestyle - review in 6 months and if Hba1c >48 start treatment :

Metformin tolerated:

1. start metformin

If Hba1c >58 add second

2. Metformin and gliptin OR sulphonylurea OR poiglitazone OR SGLT2 antagonists

If Hab1c above 58 still

3. Metformin + gliptin + sulphonylurea OR Metformin andPioglitazone + sulphonylurea OR Metformin and sulphylurea and SGLT2 OR metformin + pioglitazone +SGLT2. (basically add any drug to metformin and sulphylurea OR SGLT2 and pioglitazone) OR INSULIN

If still not working/not tolerated and BMI >35 then metformin sulphonylurea and GLP-1 mimetic

Metformin not tolerated: (Same without GLT2, metformin and GLP1)

1. Gliptin, sulphonylurea or pioglitazone

HBa1c Above 58

2. Gliptin and pioflitazone OR Gliptin and sulphonylurea OR Sulphylurea

If still above 58 then Insulin

Question 3

Causes of raised prolactin?

Answer 3

Causes of raised prolactin - the p's
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

Question 4

What drugs can cause hypothyroidism?

Answer 4

lithium, amiodarone or anti-thyroid drugs such as carbimazole

Question 5

What should be given 4hrs apart from levothyroxine?

Answer 5

Iron tablets

Question 6

TATT and hyperpigmentation of palmar creases/mucosa?

Answer 6

Addisons

Question 7

How do you manage primary hyperaldosteronism?

Answer 7

Sprionolactone (which makes sense)

Question 8

What is bromocriptine?

Answer 8

Ergoline derivative and dopamine agonist that is used in the treatment of pituitary tumors, Parkinson’s disease, hyperprolactinaemia, neuroleptic malignant syndrome, and, as an adjunct, type 2 diabetes

Question 9

What drugs commonly cause hypercalcaemia?

Answer 9

thiazides, calcium containing antacids

Question 10

What type of diabetes has high c-peptide levels?

Answer 10

Type 2 (is a product of insulin and so people with no insulin will not have any).

Question 11

What causes secondary hypothyroidism and therefore what is the diagnostic investigation?

Answer 11

Pituitary dysfunction.

MRI brain and pituitary.

Question 12

Symptoms of thyroid storm/hyperthyroid crisis ?

treatment?

Answer 12

hyperthermia, tachycardia, jaundice, and altered mental status

IV propanolol

Question 13

What antidiabetic drug can you not give in HF?

Answer 13

Pioglitazone

Question 14

Side effect to council people who start carbimazole?

Answer 14

Agronulocytosis - so need to monitor FBC and attend as an emergency if sore throat etc.

Question 15

Hba1c targets on T2DM?

Answer 15

NICE guidelines suggest a standard target of 48mmol/mol for patients managed by lifestyle and/or a single antidiabetic drug.

The target may change to 53 mmol/mol if the patient is started on a second agent, or if they are receiving a medication that carries the risk of hypoglycaemia (e.g. sulphonylurea).

Question 16

Most common cause of hypothyroidism?

Answer 16

Hashimotos (autoimmune)

Question 17

Drug causes of gynaecomastia?

Answer 17

spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

Question 18

If someone is pre-diabetic what other investigation should you arrange?

Answer 18

Fasting blood glucose

Question 19

In primary hyperparathyroidism what level is the PTH?

Answer 19

Inappropriately normal or high

Question 20

Starting dose of levothyroxine - what does this depend on?

Answer 20

Initially 1.6 micrograms/kg once daily, adjusted according to response, round dose to the nearest 25 micrograms

25mcg in cardiac disease or elderly

Question 21

When treating thyroid disease what is the most important blood test to monitor?

Answer 21

TSH

Question 22

What is Fourniers gangrene?

Answer 22

Fournier’s gangrene is a fulminant form of infective necrotising fasciitis affecting the genitalia and/or perineum.

Question 23

Impaired Fasting glucose OGTT results?

Answer 23

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

Question 24

Risks of thyroxine replacement therapy?

Answer 24

hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation

Question 25

Would you treat asymptomatic bacteriuria in pregnancy?

Answer 25

Yes

Question 26

If PTH normal in raised calcium this likely means?

Answer 26

Primary Hyperparathyroid.