Endocrinology Flashcards
Ix & Mx Acromegaly
Ix: 1st Serum IGF-1 levels + serial GH levels... if IGF is + --> OGTT to confirm Mx: 1st line--> Trans-sphenoidal sx somatostatin analogue: octeride dopamine agonist: bromocriptine
Ix & Mx addisons
Ix & Mx cushings
Ix & Mx conn’s
ADDISON
Ix: synacthen test
Mx: hydrocortisone, fludracortisone
CUSHINGS
Ix: dexamethasone suppression test, 24 hr free urinary cortisol
Mx: transphenoidal resection
CONNS
Ix: 1st line: aldosterone/renin ratio ( high aldosterone + low renin (negative feedback due to sodium retention from aldosterone)
2nd: high-resolution CT abdomen
if normal…
Adrenal venous sampling (AVS) : to distinguish btw unilateral adenoma & bilateral hyperplasia
Mx: Spironolactone
SE of steroids
Cataracts Osteoporosis Retarded growth Thinning skin Immunosupression Cushings features Oedema Suppresion oh HPA axis Teratogenic Emotional disturbance: depression, anx Raised BP Obesitry Increased body hair growth Diabetes STRIAE
steroid rules
Don’t STOP
-Dont stop abruptly—> addisonian crisis
Sick day rules (double the dose)
Treatment card steroid
Osteoporosis prevention bisphos +Ca, vit D
PPI
Carbimazole SE
Agranulocytosis
crosses the placenta, but may be used in low doses during pregnancy
Levothyroxine SE (4)
Levi maskeen he was underground so no sun (osteoporosis) and his friends all died so he heart hurts :(
Hyperthyroidism: due to over tx
OSTEOPOROSIS
worsening of angina
AF
CAH Cx presenting? Ix Mx
21-hydroxylase deficiency
responsible for converting progesterone into aldosterone & cortisol-> so instead the progesterone is converted to TESTOSTERONE
they get: low aldosterone, low cortisol and abnormally high testosterone.
features: AMBIGUOUS genitalia” and an LARGE clitoris due to the high testosterone levels.
most common cause of ambiguous genitalia?
CAH
DKA diagnosis
causes
PH <7.3 or HCO3 <15
glucose more than 11 mmol
ketones more than 3
Cx:
infection, missed insulin doses, myocardial infarction, pump failure
initial AIMS of DKA
–> Commence IV 0.9% sodium chloride
–> Give 10U soluble insulin (e.g. Actrapid®) stat either i/m or s/c if likely to be
delay of longer than 15 mins from diagnosis, in starting iv insulin
–> Commence IV fixed rate insulin
–> Establish appropriate monitoring (hrly capillary blood glucose and blood ketones plus 2 hrly K+ by VBG
–> Clinical and biochemical assessment of patient
–> Review IV fluid regimen based on patient’s clinical and biochemical assessment and blood glucose levels
Mx?
when do u give dextrose and how much?
Give 10 U (e.g. Actrapid®) stat either i/m or s/c
0.1/kg/hr
1) FLUIDS--> 6L 1L--> over 1 hr 1L--> over 2 hrs 1L--> over 2hrs 1L--> over 4hrs 1L--> over 4hrs 1L--> over 6hrs
2) if K+ 3.5-5.5
ADD K to the second bag
20 mmol per 500ml fluid
once blood G is < 14 mmol/l an infusion of 5% dextrose should be started
DKA resolution is defined a
pH >7.3
blood ketones < 0.6 mmol/L
bicarbonate > 15.0mmol/L
DKA complic
DEATH cerebral edema--> bc of fluids VTE--> dehydration Hypoglycemia Aryhtmmia--> K Sepsis AKI-> dehydration
HHS pathophysiology
SO DEHYDRATEDDDDDDD
Hyperglycaemia results in osmotic diuresis with associated loss of Na and K
Severe volume depletion results in a significant raised serum osmolarity (typically > than 320 mosmol/kg), resulting in hyperviscosity of blood.
Despite these severe electrolyte losses and total body volume depletion, the typical patient with HHS, may not look as dehydrated as they are, because hypertonicity leads to preservation of intravascular volume.
Hypogylcemia Mx
Oral glucose tablets 10-20g
awake can’t swallow–> glucogel, IM glucagon 1mg
unconscious–> 75ml of 20% Glucose or 150ml of 10%
be careful in giving glucagon in malnourished, bc they have no glycogen stores.
