Endocrinology Flashcards
NICE recommendation 1st line treatment for DM
Biguanides - Metformin
Which OHA should not be given in a patient with a significant smoking history and frequently exposed to occupational chemotherapeutic agents?
Pioglitazone - High risk of bladder cancer
What to do in a CKD patient taking Metformin whose eGFR < 45?
Reduce dose
What to do in a CKD patient taking Metformin whose eGFR < 30?
Discontinue
Metformin OHA Class Risk of Hypoglycemia Weight Change Safety Issues
Biguanides
None
Weight Loss
- Cardiovascular benefits
- In renal impairment:
eGFR < 45: Reduce dose
eGFR < 30: Discontinue
Gliclazide OHA Class Risk of Hypoglycemia Weight Change Safety Issues
Sulphonylureas
With hypoglycemia
Neutral in terms of weight change
In renal impairment, increased risk of hypoglycemia
SITAGLIPTIN
OHA Class
Risk of Hypoglycemia
Weight Change
Safety Issues
DPP4 inhibitors
Rare
Neutral
- Risk of pancreatitis
- Heart Failure
PIOGLITAZONE
OHA Class
Risk of Hypoglycemia
Weight Change
Safety Issues
-
Rare
Weight gain
- Bladder Cancer
- CI in Heart Failure
Renal-safe oral diabetic medications (can be given even if eGFR is less than 30)?
Repaglinide
Linagliptin
Pioglitazone
Low TSH, High FT4, Increased RAI uptake test
Graves’ Disease
Low TSH, High FT4, Decreased RAI uptake test
Subacute thyroiditis (De Quervain’s Thyroiditis) - usually following URTI
High TSH, Low FT4
Primary Hypothyroidism
Low TSH, Low FT4
- Secondary Hypothyroidism
2. Sick euthyroid syndrome
High TSH, Normal FT4
- Subclinical hypothyroidism
2. Poor compliance to thyroxine medications
Osteoporosis
Levels of serum Ca, Phosphate, ALP
Normal, Normal, Normal
Paget’s Disease
Ca, PO4, ALP
Normal, Normal, High
Osteomalacia
Ca, PO4, ALP
Low, Low, High
Main cause of hypercalcemia
Primary Hyperparathyroidism
Initial Management of severe hypercalcemia
Rehydration with normal saline 3-4L/day
What action should be done when you encounter a patient with elevated TSH but normal FT4?
Repeat TSH after 3 months
On initial consult, patient presents with elevated TSH and normal FT4. On repeat testing three months after, patient still had elevated TSH. What to do?
Elevated TSH but <10
a. Asymptomatic - NO TREATMENT
b. 65 yrs and above - NO TREATMENT (oversuppression of TSH may cause AF)
c. Below 65 and symptomatic - LEVOTHYROXINE
Elevated TSH but > 10
LEVOTHYROXINE
What are the three main differences between Addison and Conn?
ADDISON
Hyponatremia
Hypotension
Hyperkalemia
CONN
Hypernatremia
Hypertension
Hypokalemia
Most appropriate management of MODY?
Refer to secondary care (endo)
Medication of choice for MODY
Sulphonylureas
Test to request for LADA
GAD Antibody
When will you start Levothyroxine in a patient with subclinical hypothyroidism?
First, let’s define subclinical hypothyroidism. Subclinical hypothyroidism is diagnosed when a patient presents with elevated TSH and normal T4 on two occasions, 3 months apart.
If patient presents with TSH less than 10 but patient is asymptomatic, no need for treatment.
If patient presents with TSH less than 10 but patient is over the age of 65, no need for treatment as oversuppression of TSH may result in atrial fibrillation.
THerefore, there are two scenarios where you should consider treatment in a patient with subclinical hypothyroidism
- If patient presents with TSH less than 10 but the patient is SYMPTOMATIC and age less than 65.
- If the patient presents with TSH more than 10.
Calcimimetic agent used for patients who are not suitable for parathyroidectomy
Cinacalcet
***tells the PTH gland to stop secreting PTH
Laboratory findings expected on a patient with primary hyperparathyroidism
Elevated PTH (may be normal in 10% of the population)
Elevated Ca
Decreased phosphate
***usually asymptomatic especially with Ca level less than 3
