Endocrinology Flashcards
How do you diagnose diabetes?
symptoms + one test result
OR no symptoms + 2 test results
what are some complications of diabetes?
NEUROPATHY
Gastroparesis - feeling full quickly, ERRATIC BMS bloating, N+V
- use metoclopramide
Neuropathic pain
- amitryptiline (not in BPH) duloxetine
NEPHROPATHY
- yearly albumin creatinine ration -ACEi
DIABETIC FOOT
- PAD - absent foot impulses
- Neuropathy
what can cause a falsely high HbA1c
low?
alcohol, vit b12 def, splenomegaly, IDA
Sickle cell
what is the long term management of T1DM
measure BM 4 times a day
1 - basal bolus regimine
- rapid + long acting
if sick - continue insulin, if glucose goes up then increase insulin
- BD mixed regimen
intermediate + short OR rapid acting
rapid acting - before meal
short acting - 15-30 mins before meal
what is the long term management plan for T2DM?
HbA1c 42-48 = lifestyle changes and diabetes prevention programme
> 48 diabetes
LIFESTYLE
1. Metformin
(suppresses appetite, lactic acidosis, b12 reduced absorption, GI upset )
IF CV RISK FACTORS ADD SGLT2 INHIB (FLOZINS)
DKA, infections, angioedema, gangrene
> 53
1. Metformin
+ sulphonylurea (gliclazide/glibencamide)
weight gain + hypoglycaemia)
+ DDP4 inhib GLIPTINS
good for overweight - weight loss
+SGLT2 inhib
DKA, infections, angioedema, gangrene
+pioglitazone
weight gain, LFT, bladder cancer, oestoporosis
how do you treat MODY?
sulphonylurea - flozins
autosomal dominant
early onset T2DM
no ketosis
investigation - C peptide
what is the diagnostic criteria for hyperosmolar hyperglycaemic syndrome?
osmolality >330
BM >30
pH >7.35
how do you manage HHS?
- fluids 3-6L over 12 hrs
- fixed rate insulin infusion 0.5/kg/hr
what do the following show?
- low TSH, low T4
- high TSH, normal T4
- low TSH, normal T4
- low TSH, low T4
secondary hypo
sick euthyroid - high TSH, normal T4
subclinical hypo
poor compliance - low TSH, normal T4
steroid use
what investigations do you do for a thyroid lump?
<1mm - nothing
>1mm USS and FNA
what are some causes of high and low uptake on technicium scan?
HYPERTHYROID
high uptake
- graves
- toxic multinodular goitre
- single toxic adenoma
low
- viral thyroiditis/de quervain
- post partum thyroiditis
how do you manage graves disease?
1- propranolol
2. carbimazole
propylthoiuracil (pregnant, 6m before conceiving, pancreatitis)
titrate up and then reduce once euthyroid
- if meds dont work then radioiodine (not in preg)
- surgery - HAVE TO BE EUTHYROID
how do you manage myxodema coma?
IV thyroxine, IV hydrocortisone, Iv fluids
what are the sypmtoms and investigations for addisons?
REDUCED ALDOSTERONE AND CORISOL
hypotension
hyperkal
hyponat
9am plasma cortisol if <500
short synACTHen test
plasma cortisol 30 mins later
how is addisons managed?
IM hydrocortisone
IV fluids + glucose
what investigations are done for suspected acromegaly?
serum IGF-1
use OGTT to monitor
how do you manage a prolactinoma?
cabergoline/bromocriptine
transsphenoidal hypophysectomy (THIS IS FIRST LINE FOR ACROMEGALY - followed by octreotide)
how do you test for cushings?
- 11pm salivary cortisol (if low then NOT cushings)
- low dose dexa suppression test - NOT SUPPRESSED = CUSHING
- inferior petrosal sinus sampling - to determine cause
how do you differentiate between primary hyperadosteronism and renal artery stenosis from A:R?
primary hyperadosteronism
HIGH A:R, HIGH ALDOSTERONE, LOW RENIN
RAS
NORMAL A:R, HIGH aldosterone and HIGH renin
what are some causes of hypernatraemia?
increase intake - NaCl
Renal loss - diabetes insipidus
GI loss
Sweat loss
Conns
Renal artery stenosis
what investigations should you do for hypernatraemia?
glucose - diabetes mellitus
serum potassium - nephrogenic DI (hypokalaemia)
serum calcium - NDI (hypercal)
plasma and urine osmolality
water deprivation test
what are some causes of hyponatraemia?
hypervol
- cardiac failure, cirrhosis, renal failure
euvol
- hypothyroid, addisons, SIADH
what are some complications of correcting hypo and hypernatraemia?
hypo - central pontine myelinosis
hyper - cerebral oedema
what are some causes of hyperkalaemia?
addisons
low GFR/renin
ACEi/ARB
heparin
tacrolimus
aldoesterone antag
acidosis, rhabdomyolysis
how do you treat hyperkalaemia?
10ml 10% CA gluconate
100ml 20% dextrose
10U insulin
nebulised salbutamol
what are some causes of hypkalaemia?
GRRR
GI losses
Renal loses
- thiazide and loop diuretics
- conns, cushings
Redistribution
- insulin
- alkalosis
- beta agonist
Renal tubular acidosis
what are the precursors for multiple myeloma?
MGUS
<30g/L protein
<10% plasma cells in bone marrow
Smoldering myeloma
>30g/L protein
>10% plasma cells
MM
CRAB symptoms
B cell leukaemia
Do serum and urine electropheresis
