Endocrinology Flashcards by Viet Nguyen

Cushing’s syndrome Ix (3)

-Dexamethasone suppression test (If +ve –> refer Endo, not diagnostic)
-Midnight salivary cortisol (2x readings)
-24-hour urine free cortisol (2x readings)

How well did you know this?

Not at all

Perfectly

Phaeochromoctyoma triad + Ix

Episodic headache + sweating + tachycardia

Ix - 24 urinary metanephrines, or plasma metanephrines

How well did you know this?

Not at all

Perfectly

Addison’s clinical features

Fatigue, LOW, nausea, LOA, depression

Postural hypotension
Skin hyperpigmentation
Salt craving

Hyperkalaemia, hyponatraemia

How well did you know this?

Not at all

Perfectly

Addison’s Ix - findings

Low cortisol, elevated ACTH
Hyponat, hyperkalaemia
Hypoglycaemia
Hypercalcaemia

Confirm w/ short synacthen test

How well did you know this?

Not at all

Perfectly

Indications for thyroid USS

-Structural abnormality (e.g nodule or goitre, assesses extent)
-Determine malignancy risk in known thyroid nodules
-Before neck surgery for thyroid Ca + after

–Hot nodules = low risk Ca, don’t USS
–Cold nodules = needs USS

How well did you know this?

Not at all

Perfectly

Thyroxine starting dose (units per kg)

vs. Insulin starting dose (units per kg)

Thyroxine - 1.6mcg/kg

Insulin - 0.2 units /kg)

How well did you know this?

Not at all

Perfectly

Prolactinoma causes (4)

Clinical manifestations

-Stress
-Nipple stimulation/lactation
-Pregnancy
-Medications (antipsychotics/anti-emetics)

Clin features:
Women - (microprolactinoma more likely) –> menstrual disturbance, galactorrhoea, infertility
Men - macroprolactinoma more likely –> visual field defects, hypopit

How well did you know this?

Not at all

Perfectly

SGLT2 inhibitor RISKS (4)

-Euglycaemic ketoacidosis
-Mycotic genital infection - e.g Fourniere’s gangrene
-Increased UTIs
-Polyuria –> volume loss –> hypotension

(less risk of hypos)

How well did you know this?

Not at all

Perfectly

Dumping syndrome - pathophys and key element of PHx

Pathophys - postprandial hypoglycaemia, due to rapid gastric emptying after a meal

History of gastric bypass/sleeve gastrectomy

How well did you know this?

Not at all

Perfectly

Dumping syndrome clinical features

Dizziness/light-headedness, sweating, palpitations, hypotension, nausea, fatigue, diarrhoea

How well did you know this?

Not at all

Perfectly

Screening bloods for (biocehmical) hyperandrogenism

-Free/total testosterone
-Free androgen index
-DHEA-S
-Androstenedione?
-LH/FSH
-Oestrogen, progesterone
-SHBG

Could also consider TSH, fasting insulin

Best done on day 3-5 of mesntrucal cycle, between 8-10am

How well did you know this?

Not at all

Perfectly

Addison’s self-care action plan - aspects (4)

○ ↑glucocortcoid dose during illness
○ Recognise signs of adrenal crisis (N/V/hypotension/dehydration)
○ Carry injectable hydrocort when travelling
○ Wear alert necklace/bracelet/wallet card

How well did you know this?

Not at all

Perfectly

Painful neck swelling DDx (7)

-De Quervain’s thyroiditis
-Infectious/suppurative thyroiditis
-Skin infection (cellulitis)
-Infected sebaceous cyst/thryoglossal cyst
-Traumatic thyroiditis
-Grave’s disease
-Thyroid node harbouring Cancer

How well did you know this?

Not at all

Perfectly

Peripheral Neuropathy DDx (8)

-Diabetes
-Idiopathic
-B12 deficiency/other vit deficiencies
-Peripheral vascular disease
-Multiple myeloma
-Restless leg syndorme/periodic limb movement disorder
-Hypothyroidism
-Raynaud’s phenomenon

How well did you know this?

Not at all

Perfectly

Diabetes management goals:
-how much LOW?
-Exercise?
-Fasting/post-prandial BGLs?
-Chol levels?
-BP?

-5-10% LOW
-150 mins + 2-3 resistance exercise sessions per week
-fasting 4-7, post-prandial 5-10
-TChol <4, HDl >1, LDL <2, TG, <2
BP <140/90 (<130/80 if a/w albuminuria)

How well did you know this?

Not at all

Perfectly

AUSDRISK - how often?
What to test if high risk?
Other high risk groups?
ATSI population?

-Every 3 years after age .40 y.o
-fasting BGL/HbA1c every 3 years (anyone w/ impaired glucose tolerance - test annually)
-Obese people, previous CV event, gestational diabetes/PCOS, antipsychotic drugs
-Skip straight to annual bloods from age 18

Gestational Diabetes Mellitus definition

Glucose intolerance beginning in pregnancy
Dx: fasting BGL >5.5 OR 2hr post-prandial >8.0

Don’t do OGTT if prev. weight loss surgery - risk of dumping syndrome

F/u w/ OGTT 6-12 weeks post-partum

SGLT2 how long to withhold prior to surgery?

Withhold 3 days prior if >1 day stain in hospital, or bowel prep involved

Withhold day of if just a day procedure

Diabaetes Cycle of care
6 monthly
12 monthly
2 yearly

6 mthly - BP, BMI, foot exam
12 mthly - HbA1c, lipids, urine ACR, SNAP/complication prevention
2 yearly - eye exam

Other causes of low HbA1c (5)
Other causes of high HbA1c (3)

Low
-Anaemia
-Haemoglobinopathies
-Blood/iron transfusions
-Recovery from acute blood loss
-Chronic blood loss/renal failure

High
-Iron deficiency anaemia
-Splenectomy
-Alcoholism

Which medication reduces progression of diabetic retinopathy?

Fenofibrate

Driving conditions:
-T2DM on OHGs
-T2DM on insulin
-T2DM (any) & commercial licence

-Private licence, medical review every 5 years (unless severe hypos, end-organ complications)
-Conditional licence w/ 2 yearly review
-Conditional licence w/ specialist review

No driving after severe hypo for 6 weeks

Hypoglycaemia “Rule of 15”
+severe management

15g quick-acting carb (adults)
Wait 15 mins - repeat
Long-acting carb if next meal more than 15 mins away
BSL every 1-2 hours for next 4 hours

Severe: IM/subcut glucagon 1mg

Don;t use 50% IV dextrose in kids!

Klinefelter syndrome clin. features (7)

-Small testicular size
-Gynaecomastia
-Tall stature
-Reduced body hair
-Varicose veins
-Abdominal obseity
-Infertility

Other DDx small testes - mumps orchitis, vascular impairment, chemoTx

Klinefelter syndrome Ix & findings (4)

-Low serum total testosterone --Morning, fasting sample - if abnormal, repeat -Elevated LH/FSH -Karyotype 47XXY -Aszoospermia on semen analysis ?TFTs ## Footnote Testing not useful until post-pubertal - normal hormone levels until mid-puberty

Klinefelter complications (8)

Thyroid dysfunction T2DM CVS - Venous thromboembolism/ischaemic heart disease/PE Autoimmune - SLE Lupus/Hashimoto's Breast Ca Osteoporosis Tremor/Parkinson-like syndrome Psych disorder - depression

Indications for bariatric surgery (3)

BMI >40 BMI >35 + poor glycaemic control BMI >30 + poor glycaemic control + elevated CV risk

Puberty first signs & when they occur - girls, boys

Girls -First sign = breast development, ~age 10 (normal range (8-13) -Then growth spurt --> menarche Boys -First sign = testicular enlargement, ~age 11 (normal range 9-14) -Then pubic hair, penile enlargment --> growth spurt

Precocious puberty Ix (4)

-LH, FSH -Oestradiol/testosterone -Bone age XR -TFTs (rare cause of central PP) ## Footnote Central = high LH/FSH due to GnRH stimulation

Medications a/w hyponatraemia | CARDISH

CARDISH -ChemoTx -Antidepressants/Antipsychotics/Anticonvulsants -Recreational drugs (ecstasy) -Diuretics -Inhibitors- ACE inhibitors, SSR inhibitors -Sulfonylureas -Hormones/hypnotics (desmopressin, temazepam)

Underlying causes of SIADH (5 categories)

-Neuro (GBS, subarach haemorrhage) -Infective - sarcoidosis, meningitis -Resp - pneumonia/tuberculosis/asthma -Meds - CARDISH -Malignancy - mesothelioma, lymphoma, sacroma,

Hyponatraemia general DDx (conditions) (8)

-Hyperglycaemia -Hypercholesterolaemia -SIADH -Heart failure -Cirrhosis -CKD -Nephrotic syndorme -Hypothyrpidism

Obesity pharmacotherapy options (3)

Phentermine (duromine) 15mg --C/i if b/g CVS disease, hypoerthyroidism, anxiety, eTOH/drug use, pregnancy Orlistat 120mg TDS --A/e's - steatorrhoea, flatulence, faecal incontinence Liraglutide (Saxenda) 0.6mg daily injection --C/I severe CKD, PHx pancreatitis --A/e's - N/V, diarrhoea, constipation

HHS triggers (5) + clinical sign (1)

-Infection -AMI -Stroke -Pancreatitis -Insulin non-compliance **Dehydration** most clin. obvious sign

HHS management aspects (4)

-Rehydration - Saline 0.9%, 3 -6L in first 12 hours (will fix BSL) -Potassium - add to 2nd bag of IV fluids -Insulin - only if ketones >1 -Treat underlying infection

Diabetic foot ulcer management aspects (6) +antibiotic choices

○ Antibiotics -Mild fluclox/ceflex/clinda/augment DF, 1-2 weeks -Mod - IV augmentin 1.2g. Severe - PipTaz ○ Debridement ○ Pressure offloading ○ Optimise glycaemic control ○ Wear shoes - protect from incidental trauma ○ Nightly-self foot check

Androgen deficiency Ix (4)

○ Serum total testosterone - AM, fasting test § Food intake decreases testosterone § Always re-test an abnormal low result ○ Prolactin ○ Iron studies ○ ?Pituitary imaging if testosterone level <5.2 and low-normal gonadotrophins ## Footnote Functional hypogyonadism - older men w/ chronic diseases - borderline low levels - ???modest benefit in replacement (but guidelines say don't treat)

Diabetic foot examination aspects (4)

* Proprioception * Monofilament sesnation at plantar surface MTPJ * Ankle jerk reflexes * Peripheral pulses