Endocrinology Flashcards
Causes of osteoporosis
Primary:
- idiopathic
- post menopausal
Secondary: (ME DR G)
- malignancy = myeloma, metastatic cancer
- endocrine = cushing’s disease, thyrotoxicosis, primary hyperPTH, hypogonadism
- drugs = steroids, heparin
- rheum = RA, AS
- gastro = malabsorption (e.g. coeliac, partial gastrectomy), liver disease (e.g. PBC), anorexia
Osteoporosis risk factors (SHATTERED)
Steroid use of >5m/g prednisolone
Hyperthyroidism
Hyperparathyroidism
Hypercalciuria
Alcohol and tobacco use
Thin (<BMI<22)
Testosterone low
Early menopause/late menarche
Renal or liver failure
Erosive/inflammatory bone disease, e.g. RA
Dietary calcium low/malabsorption/DMT1
Management of post-menopausal woman with hip fracture and normal Ca and no diagnosis of osteoporosis
Bisphosphonates (e.g. ALENDRONATE, Risedronate) and calcium supplements
Osteoporosis guidelines state if a postmenopausal woman has a fracture she should be put on bisphosphonates (there is no need for a DEXA scan)
What is the FRAX tool?
An online tool that combines risk factors and femoral neck T-score to estimate 10-year fracture risk
Conservative measures for osteoporosis
o Smoking cessation
o Reduce alcohol intake
o Weight-bearing and muscle-strengthening exercise: 20 mins 3x per week
o Diet with optimal calcium and vit D: 1g calcium and 800-1000 units vit D daily
o Maintain BMI > 19
o Falls prevention - elderly care fall clinics, fall physiotherapy
What monoclonal antibody can be used in osteoporosis to inhibit bone resorption?
Denosumab
SC 6 monthly
What agents can increase bone formation in osteoporosis?
Teriparatide
* Recombinant human PTH inc activation of osteoblasts
* Daily SC injection
* Prescribed by specialists in severe cases
Abaloparatide
* Stimulates PTH type 1 receptor
What surgery can be done in vertebral osteoporotic fractures?
Kyphoplasty
Triad of thyroid acropachy
Digital clubbing
Soft tissue swelling of hands/feet
Periosteal new bone formation
What familial syndromes put patients at risk of phaeochromocytoma?
Men 2a and 2b
Von Hippel Lindau Syndrome
Neurofibromatosis type 1
What do you use in hypertensive crisis for phaeochromocytoma?
Short-acting IV alpha blocker phentolamine
What are some complications of phaeochromocytoma?
Malignant hypertension
Hypertensive encephalopathy
Post-operative complications (hypoglycaemia, hypotension, arrhythmia)
What is pioglitazone shown to increase the risk of?
Risk of bladder cancer
What can cause lower than expected Hb1Ac levels?
Sickle-cell anaemia
G6PD deficiency
Haemodialysis
Hereditary spherocytosis
What can cause higher than expected Hb1Ac levels?
IDA
Vit B12/folic acid deficiency
Splenectomy
What anti-diabetic drug is contraindicated in heart failure?
Pioglitazone (thiazolidinediones)
Sulphonylurea side effects?
Hypoglycaemia
Weight gain
Example - gliclazide
What is the therapy for toxic multinodular goitre?
Radioiodine therapy
Three signs of disease activity in Grave’s disease
Tremor
Tachycardia
Lid lag
What is Lofgren’s syndrome?
Specific type of sarcoidosis
Triad of:
- erythema nodosum
- bilateral hilar lymphadenopathy
- polyarthralgia
What are differentials for sarcoidosis?
TB
Lymphoma
HIV
Hypersensitivity pneumonitis
Toxoplasmosis
Histoplasmosis
Management of sarcoidosis
- Usually no treatment (no/mild symptoms) - majority resolve themselves
- Oral steroids for 6-24 months (given with bisphosphonates to protect bones)
- Immunosuppressants (e.g. methotrexate, azathioprine)
Severe pulmonary disease –> lung transplant
Management of sarcoidosis
- Usually no treatment (no/mild symptoms) - majority resolve themselves
- Oral steroids for 6-24 months (given with bisphosphonates to protect bones)
- Immunosuppressants (e.g. methotrexate, azathioprine)
Severe pulmonary disease –> lung transplant
Best indicator of hypovolaemia in hyponatraemia?
Low Urine Na+
