Endocrinology Flashcards
What is MODY
Maturity onset diabetes in the young
Cause and treatment of mody
HNF alpha
Glicazide
2 positives to DPP4
No weight gain
No hypoglycaemia
2 hormone changes in klinefelters
Increased LH
Reduced testosterone
2 hormone changes in Kallman syndrome
Reduced FSH/LH
Hyperglycaemia and dehydration
Give IV fluids
What is prolactin inhibited by
Dopamine (carbergoline)
Insulin during sick days
Never stop
Check sugar regularly
You may need to increase
3 changes stress can cause to hormones (e.g. surgery)
Reduced insulin
Reduced testosterone
Reduced oestrogen
Treatment of diabetic neuropahty
1st: Duloxetine, Amitriptyline, Gabapentin, Pregabalin
Tramadol - rescue
Capsacin - topical
Pain management clinic
Risk factor for graves
Smoking
Where is a papillary carcinoma found and what is its prognosis
Thyroid
Good prognosis
3 SGLT-2 inhibitor side effects
Increased urinary excretion
Weight loss
Can cause UTI
Diagnosis of pheochromocytoma
24hr metanephrins (HTN)
Thyrotoxicosis with tender goitre
Subacute thyroiditis
Diagnosis of acromegaly
1st: Increased IGF-1
2nd: OGTT and serial GH
What is trosseaus sign
Carpal spasm on bp cuff inflation
Side effect of spironolactone and goserelin
Enlarged breasts
What is goserelin used for
Prostate
Side effect of metoclopramide
Galactorrhoea
3 features of multiple endocrine neoplasia T1
Peptic ulceration
Galactorrhoea
Hypercalcaemia
Treatment of bladder cancer
Thiazolindinediones (Pioglitazone)
Addisons and illness
Double glucocorticoids
Keep fludrocortisone the same
What is myxoedema
In hypothyroid
Confusion and hypothermia
What is acropachy
Clubbing
What thyroid condition is clubbing found in
Graves
Side effect of pioglitazine
Fluid retention
What should you monitor in hyperosmolar hyperglycaemia state
Serum osmolarity
2 electrolyte disturbances in malabsorption
Reduced calcium
Reduced magnesium
Increased phosphate
When should you withdraw corticosteroids
Increased 40mg for 1+ week
3+ w treatment
Repeated courses
Treatment of hypoglycaemia and impaired GCS
IV glucose if access
Insulin dependent diabetic and driving
Check glucose every 2 hours when driving
Inform the DVLA
Commercial = stop
Most common exogenous and endogenous cause of cushings syndrome
Exogenous steroids
Endogenous pituitary adenoma
What is the name for subacute thyroiditis What is it caused by Presenting feature 2 findings Prognosis
DeQuervain’s
Reduced iodine uptake
Painful goitre
Increased ESR
Hyperthyroid
Good prognosis
T1DM
C-peptide
Treatment of hypothyroidism
Increased thyroxine 50%
Treatment of galactorrhoea
Bromocriptine
Class and MOA of gliptins
DDP4 inhibitors
Reduce peripheral breakdown of incretins
Diabetic targets
48: diet/lifestyle/1 drug
53: single hypoglycaemic drug/ 2 diabetic drugs
Hyperosmolar hyperglycaemic state
Hypovolaemia and hyperglycaemia
Side effect of SGLT2 inhibitors
UTI
Most common cause of primary hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
Hypertension with hypokalaemia and mild alkalosis
Primary hyperaldosteronism
What does whipple’s triad diagnose
Insulinoma
Hypoglycaemia
Glucose below 2.5
Reversibility of sx on administration of glucose
C-peptide on exogenous insulin stress test in pts with insulinoma
Will not fall
Multiple endocrine neoplasia (MEN) type 1
parathyroid
pituitary
pancreas e.g. insulinoma
MEN type 2a
medullary thyroid cancer
parathyroid
pheochromocytoma
MEN type 2b
Medullary thyroid cancer
Phaeochronocytoma
Neurones
Marfanoid
viral illness, raised ESR, reduced uptake of iodine, tender goitre and initial hyperthyroid phase
De Quervains subacute thyroiditis
Treatment for Dequav
naproxen
Sick euthyroid syndrome
low T3/T4
normal TSH
acute illness
Which diabetic drug causes weight gain
Gliclazide
Sulfonylureas
Risk of LT steroids
Avascular necrosis, osteopaenia and osteoporosis
What metabolic disturbance does cushings cause
Hypokalaemic metabolic alkalosis
DIABETES BLOOD PRESSURE IS DIFFERENT TO NORMAL
TARGET BELOW 140/80
MOA of DPP-4 inhibitors
Increase levels of incretins
e.g. sitagliptin
Treatment of hypoglycaemia if the patient is conscious and able to swallow
Fast acting carbohydrate by mouth e.g. glucose liquids, tablets or gels
Assessing diabetic neuropathy in the feet
10G monofilament
Elevated T4 and low TSH
thyrotoxicosis
AB in hashimotos
Antithyroid peroxidase AB
Fasting glucose not quite DM then diagnosed with
Impaired fasting glycaemia
Diagnostic criteria for T2DM with Sx
Fasting glucose higher than 7
Random glucose higher than 11.1
Presentation of myxoedema coma
Confusion and hypothermia
Adrenal venous sampling (AVS) can be used to distinguish between unilateral adenoma and bilateral hyperplasia in primary hyperaldosteronism
How is iodine taken up in graves disease
Homegenous uptake
BMI ranges
Under 18.5 - underweight
18.5-25 normal
25-30 overweight
(then obese in 5’s)
Primary hypoaldosteronism
Addisons
test for addisons
Short synacthen test
Hyponatraemia and hyperkalaemia in a patient with lethargy
Addisons
DKA IV insulin
0.1 unit/kg/hour
PTH in primary hyperparathyroidism
Can be normal as the hypercalcaemia supresses it
Medication to control Sx in graves
Propanolol
Diagnosis of cushings
Low dose dexamethasone supression test
What does a high serum parathyroid hormone do to calcium and phosphate
High calcium and low phosphate (causes phosphate excretion)
Action of steroids
Fludrocortisone: high mineralocorticoid
Hydrocortisone: glucocorticoid and mineralocorticoid
Prednisolone, Dexamethasone and Betamethasone: high glucocorticoid
Ectopic source of ACTH with high dose dexamethasone
Neither cortisol or ACTH suppressed
What medication can worsen diabetes control
Corticosteroids
rules for taking levothyroxine
empty stomach 30-60 mins before food
take calcium/iron supplements 4 horus llater
medication for acromegaly
octreotide
Definite management of hyperparathyroidism
Total parathyroidectomy
First line treatment for most patients with a pituitary tumour causing acromegaly
Trans sphenoidal surgery
Common cause of primary hyperparathyroidism
Solitary parathyroid adenoma
Patchy uptake of iodine
Toxic multinodular goitre
The standard HbA1c target in type 2 diabetes mellitus
48 mmol/mol
What does over replacement of thyroxine increase the risk of
Osteoporosis
Water deprivation test: nephrogenic DI
urine osmolality after fluid deprivation: low
urine osmolality after desmopressin: low
Erratic blood glucose control, bloating and vomiting
Gastroparesis
Klinefelter’s syndrome
Kallmann syndrome
Kartagener’s syndrome
Klinefelter’s Above average height and infertility
Kallmann: failure of GnRH, anosmia and infertility
Kartagener’s dextrocardia, recurrent sinusitis, bronchiectasis and infertility
Levothyroxine is not associated with inducing diabetes
LADA
Latent autoimmune diabetes of adulthood
Orlistat MOA
Pancreatic lipase inhibitor
What is cinacalecet
Drug that mimics calcium
Used in parathyroid adenoma that can’t have surgery
LH and FSH in kallmann
LH and FSH low-normal
Thyrotoxicosis with tender goitre
De quervains
Does graves or hashimotos cause a tender goitre
No
Treatment of myxoedema coma
IV thyroid hormone replacement and IV hydrocortisone
What haem disorder can give falsely low HbA1c
Sickle cell
What is nelsons syndrome
Rapid enlargement of a pituitary corticotroph adenoma (ACTH producing adenoma) that occurs after the removal of both adrenal glands (bilateral adrenalectomy) which is an operation used for Cushing’s syndrome
Hypoglycaemia with impaired GCS
Give IV GLUCOSE
How to distinguish between T2DM and T1DM
C-peptide levels and diabetes autoantibodies e.g. Anti-GAD
Presentation of phaeochromocytoma
Sweating
headaches
palpitations
First line investigation for phaeochromocytoma
Plasma and urinary metanephrines
First line antihypertensive for black T2DM patients with HTN
ARB blocker (sartan)
thyroids and periods
Hyperthyroidism is associated with oligomennorhoea, or amennorhoea, whereas hypothyroidism is associated with menorrhagia
Headaches, amenorrhoea, visual field defects
Prolactinoma
