Endocrinology Flashcards
1
Q
Diabetes T1 family history
A
HLA DR3-DQ2 or HLADR4-DQ8
2
Q
Diabetes T1 presentation
A
Classic triad - polydipsia, polyuria, weight loss (BMI<25)
3
Q
Diabetes T2 management
A
- Lifestyle
- Medications
1. METFORMIN (side effect lactic acidosis) - increase insulin sensitivity, first choice in obese patients
2. If HbA1c remains high then dual therapy with metformin: - DPP4 inhibitor
- Gliclazide (sulphonylurea) - increase insulin secretion
- Pioglitazone
3. If still high - triple therapy
4. Insulin
4
Q
Diabetes ketoacidosis presentation
A
- Complication of T1DM
- Extreme diabetes symptoms plus N+V, weight loss, confusion, lethargy, abdo pain
- KUSSMAUL’S BREATHING (deep, rapid breath)
- PEAR DROP BREATH
5
Q
Diabetes ketoacidosis investigations/treatment
A
- Plasma ketones >3mmol/L
- Blood pH <7.35
- Urine dipstick: glycosuria, ketonuria
- Serum U+E - raised urea and creatinine, low total K+, high serum K+
- ABC management
- Replace fluid - 0.9% salive IV
- IV insulin
- Restore electrolytes - e.g. K+
6
Q
Hyperosmolar hyperglycaemic state (HHS) def
A
- High glucose levels
- Hyper osmolality
- MILD/NO KETOSIS
- Complication of T2DM
7
Q
Hyperosmolar hyperglycaemic state investigations/treatment
A
- Urine dipstick - glucosuria
- Plasma osmolality - high
- U+E - low total K+, high serum K+
- Replace fluid - 0.9% salineIV
- Insulin - at low rate because may result in shock
- Restore electrolytes - e.g. K+
- LMWH
8
Q
Graves disease (Hyperthyroidism) def/presentation
A
- Autoimmune form of hyperthyroidism
- F 9x>M
- Hyperthyroidism symptoms plus thyroid eye disease - eyelid retraction, periorbital swelling, proptosis
9
Q
Hyperthyroidism pres/investigation/treatment
A
- HLA-DR3
- Everything goes fast - hot and sweaty, diarrhoea, hyperphagia, weight loss, palpitation, tremor
- TFTs - increased T4/T3, primary: decreased TSH, secondary: increased TSH
- 1st line - CARBIMAZOLE - blocks synthesis of T4
- Beta blockers - rapid symptom relief
10
Q
Hypothyroidism pres/investigation/management
A
- F 6x>M
- Everything goes slow - fatigue, weight gain, loss of appetite, cold, constipation, lethargy, depression
- TFTs - decreased T4/T3, primary: increased TSH, secondary: decreased TSH
- LEVOTHYROXINE (T4) - thyroid hormone replacement
11
Q
Hypothyroidism causes
A
- Autoimmune causes - Hashimotos and primary atrophic hypothyroidism
12
Q
Cushing’s syndrome (pituitary adenoma) def
A
- Long term exposure to excessive cortisol hormone released by adrenal glands
13
Q
Cushing’s syndrome (pituitary adenoma) investigation/treatment
A
- Random plasma cortisol raised
- Overnight dexamethasone suppression test - cortisol will not be suppressed in Cushing’s disease
- Plasma ACTH
- Iatrogenic - stop medication if possible
- Removal of pituitary adenoma - TRANSSPHENOIDAL SURGERY
- Adrenalectomy
14
Q
Acromegaly (pituitary adenoma) def/investigations/treatment
A
- Release of excess growth hormone causing overgrowth of all systems
- 1st line - insulin like growth factor 1 test - raised
- Gold standard - oral glucose tolerance test
- 1st line - transsphenoidal resection surgery (if adenoma)
- 2nd line - somatostatin analogue e.g. octreotide
15
Q
Prolactinoma (pituitary adenoma) def/pres/treatment
A
- Benign adenoma of pituitary gland producing excess prolactin
- Visual field defect
- Menstrual irregularity
- Galactorrhoea
- Infertility
- Gold standard - transsphenoidal resection surgery of pituitary gland
- 1st line - dopamine agonists as dopamine has inhibitory effect on prolactin
