Endocrinology Flashcards
What is Chvostek’s sign and when is it seen?
Twitch of the facial muscles that occurs when gently tapping the parotid
Hypocalcaemia
What is Trousseau’s sign and when is it seen?
Carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure for 2 to 3 minutes
Hypocalcaemia
How is hypocalcaemia treated?
Calcium gluconate
What lab results are seen in Cushing’s syndrome?
Hypokalaemic metabolic alkalosis Hyperglycaemia Hypertension Hypernatraemia Hypokalaemia
What are the different types of results you can get for 8mg Dexamethasone suppression test and what do they mean?
ACTH + Cortisol suppressed = Cushing’s disease
ACTH suppressed, cortisol not suppressed = ACTH independent e.g. adrenal adenoma
ACTH and cortisol not suppressed = Ectopic ACTH production (e.g. small cell lung cancer)
What are features of adrenal insufficiency?
Lethargy
Weakness
Weight loss
Salt craving
in Addison’s - palmar crease hyperpigmentation
What lab results are seen in adrenal insufficiency?
Hyperkalaemia
Hyponatraemia
Hypotension
Hypoglycaemia
How does an Addisonian crisis present?
Reduced consciousness + Same labs you see in Addison’s
How is an Addisonian crisis managed?
IV Hydrocortisone
Treatment of hypoglycaemia
What autoantibodies are seen in T1DM?
Insulin antibodies
Islet cell antibodies
Anti-GAD antibodies
Also low C-peptide levels
What are symptoms and signs of a DKA?
Symptoms:
Abdominal pain
Nausea/vomiting
Polyuria+polydipsia
Signs:
Fruity ketone smelling breath
Kussmaul breathing
Dehydration
What are side effects and CIs to Metformin
Side effects=
Diarrhoea
Lactic acidosis
CI=
Recent MI
CKD
What are side effects and CIs to a DPP4 Inhibitor?
Side effects=
URTI
GI system upset
Pancreatitis
Not that effective
-gliptin
What are side effects and CIs to Pioglitazone?
Side effects= Weight gain Fluid retention Anaemia Heart failure Increased risk of bladder cancer Increased risk of fractures
CI=
Heart failure
History of bladder cancer
What are side effects and CIs to Gliclazide?
Side effects=
Weight gain
Hypoglycaemia
CI=
People who drive for their job
What are side effects and CIs to SGLT2 inhibitors?
Side effects= Euglycaemic DKA Fouriers gangrene Increased risk of UTIs Weight LOSS
Which autoantibodies are seen in Hashimoto’s?
Anti-TPO
Anti-thyroglobulin
Which autoantibodies are seen in Graves’ disease?
TSH receptor stimulating antibodies
Anti-TPO
How does a thyroid storm present?
Thyroid storm Tachycardia Reduced consciousness Fever Confusion Nausea+vomiting
How is a thyroid storm managed?
Hydrocortisone/Dexamethasone + Propranolol + Propylthiouracil
Which diabetes drugs cause weight gain?
Gliclazide
Pioglitazone
Which diabetes drugs cause weight loss?
SGLT2 inhibitors
GLP1 memetic
Metformin
How is a prolactinoma managed?
- Cabergoline/Bromocriptine
2. Trans-sphenoidal surgery if medical management has not been successful
How does acromegaly present?
Large tongue Large hands and feet Protruding jaw Large forehead Increased sweating Symptoms of the tumour
How is acromegaly investigated? How is it managed?
- Insulin like growth factor
- Oral glucose tolerance test + serial growth hormone levels
- MRI Pituitary
Management
- Trans-sphenoidal surgery
- Octreotide if surgery not suitable
How is SIADH treated?
Tolvaptan
How does carcinoid syndrome present?
Abdominal pain Flushing Bronchospasm Diarrhoea Hypotension
How is carcinoid syndrome diagnosed?
Raised urinary 5HIAA
How is carcinoid syndrome managed?
Octreotide
What is a pheochromocytoma and how does it present?
Adrenal adenoma secreting catecholamines (adrenaline and noradrelinane)
Hypertension Headaches Palpitations Sweating Anxiety
How is pheochromocytoma diagnosed?
24 hour urinary collection of metanephrines
How is phaechromocytoma managed?
First stabilise with Alpha blocker (Phenoxybenzamine)
then beta blocker (propranolol/labetalol)
How does a myxoedema coma present?
Bradycardia
Hypothermia
Hyporeflexia
Confusion
What is MEN I?
3 P’s
Parathyroid (hyper)
Pituitary
Pancreas
Hypercalaemia
What is MEN IIa?
2 P’s
Parathyroid
Phaechromocytoma
Associated with medullary thyroid cancer
What is MEN IIb?
1 P
Phaechromocytoma
What is seen on XR in hyperparathyroidism?
x
Is kallman’s or Klinefelter’s associated with anosmia?
Kallmann’s
How is Graves disease seen on thyroid scintigraphy?
Diffuse, homogenous increased uptake
How is toxic multi nodular goitre seen on thyroid scintigraphy?
Patchy uptake
How is subacute thyroiditis seen on thyroid scintigraphy?
Globally reduced uptake
What is the first line imaging for thyroid nodules?
Ultrasonography
How to manage a new change in vision in someone with a history of hyperthyroidism?
Urgent ophthalmology referral
How often should T1DM patients check glucose whilst driving?
Every 2 hrs
What is the first line insulin regime in a newly diagnosed T1 diabetic?
Basal bolus + twice daily insulin detemir
What can cause a lower than expected HbA1c?
Sickle cell anaemia
G6PD
Hereditary spherocytosis
What can cause a higher than expected HbA1c?
Splenomegaly
Vitamin B12/folate deficiency
Iron deficiency anaemia
What should capillary glucose targets be for a T1 diabetic?
On waking = 5-7
Before meals = 4-7
How is T2DM diagnosed?
Fasting glucose >7
Random glucose >11
HbA1c >48
If patient is asymptomatic - this must be demonstrated on two occasions
If patient is symptomatic - one reading is sufficient
What is impaired fasting glucose and impaired glucose tolerance?
Impaired glucose tolerance = 2 hour oral glucose tolerance is between 7.8 and 11.1
Impaired fasting glucose = fasting glucose is between 6.1 and 7
Which autoantibodies are most common in Graves disease?
TSH receptor stimulating autoantibodies
What are side effects of corticosteroids?
Endocrine = impaired glucose regulation in diabetics, increased appetite and weight gain, hirsutism
Cushing’s = moon face, buffalo hump, striae
Musculoskeletal = osteoporosis + proximal myopathy
Psychiatric = insomnia, mania, psychosis, depression
Immunosuppression
Peptic ulcers
Growth suppression in children
Neutrophilia
IIH
How does Kallman’s present?
Hypogonadotropic hypogonadism Delayed puberty Hypogonadism (small testes) Anosmia Low FSH and low LH
How does Klinefelter’s present?
Tall Lack of secondary sexual characteristics Infertile Gynaeocmastia Low testosterone High FSH and LH
What is androgen insensitivity syndrome?
X-linked recessive condition
End organ resistance to testosterone - genotypical male child which presents with a female phenotype
Primary amenorrhoea
Groin swellings due to undescended testes
How can you grade the severity of Graves eye disease?
NOSPECS No signs/symptoms Only signs (upper lid retraction) Signs and symptoms Proptosis Extra-ocular muscle involvement Corneal involvement Sight loss
What signs are specific to Graves disease and not other types of hyperthyroidism?
Exophthalmos
Ophthalmoplegia
Pretibial myxoedema
Digital clubbing
DKA guidelines- fluids
If systolic BP <90 - fluid bolus
If systolic BP >90 - can just give 1L over 1 hour
What is the most common cause of primary hyperparathyroidism?
Solitary parathyroid adenoma
