Endocrinology Flashcards
Rules over information DVLA in type 1 diabetics
Do not…
Must inform DVLA andFor group 1 vehicles, diabetic patients on insulin may drive if they have hypoglycaemic awareness
Do not switch meds!
Why in long term type 1 diabetics may they have recent and many admissions due to hypoglycaemia?
Autonomic nervous system affected which delays patient detecting they will have a hypo- will be too late and have admission
Talk through high dose dexamethasone suppression test results and where to locate
Pituitary adenoma- Low ACTH and low Cortisol. The dex has suppressed it from the source.
Adrenal hyperplasia- Low ACTH but Still High Cortisol. Dec cannot surprise the adrenal gland which is out of control
Ectopic ACTH High ACTH and High Cortisol. Dex cannot surprise crazy Small Cell lung cancer pumping ACTH
What is myoxedema coma?
a potentially fatal complication of longstanding undertreated hypothyroidism. It may be precipitated by illness, stress, and certain drugs.
Presents with confusion and hypothermia, patients may have non-pitting periorbital and leg oedema, reduced respiratory drive, pericardial effusions, anaemia, seizures, and other symptoms of hypothyroidism.
Management of cancer met seizure
First line-
Then give…
High dose Dexamethasone to decrease cerebral oedema
Anticonvulsants to prevent further- phenytoin etc.
Pheochromotcyoma
Presentation: typical triad
Initial investigations
1.
2.
10% Assoc with… (3)
definitive management
but first must be medically stable by using (2)
Presentation: typical triad
sweating, headaches, and palpitations
newly hyoertensive
Initial investigations
1. 24 hr Urinary metanephrines rise!
2. CT chest, abdomen and pelvis if metanephrines come back raised.
MEN 2, neurofibromatosis and von Hippel-Lindau syndrome
Surgery to excise the adrenal…
Medical:
1. alpha-blocker (e.g. phenoxybenzamine), given before a
2. beta-blocker (e.g. propranolol)
Subclinical hyperthyroidism presentations (3)
definition
atrial fibrillation, osteoporosis and fractures, and possibly dementia
Def (3) defined as low or undetectable serum thyroid-stimulating hormone levels in the presence of normal free thyroxine levels.
Subclinical hyperthyroidism presentations (3)
definition
atrial fibrillation, osteoporosis and fractures, and possibly dementia
Def (3) defined as low or undetectable serum thyroid-stimulating hormone levels in the presence of normal free thyroxine levels.
Addison’s disease bloods (3)
- Hyponatraemia
- Hyperkalaemia
- HYPOglycaemia
Addison’s means low aldosterone, this means less water reab DUE TO LESS Na+ REAB. K=+ is just the opposite. Low BM because you release glucose into blood when under stress, due to corticosteroids, this is inhibited so become hypo.
What can give a FLASE LOW BM reading, will see if low when they take it manually but they have normal continuous blood glucose levels from machine (4) and why
Recent haemodialysis
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
This is generally caused by factors that shorten the average lifespan of an erythrocyte in circulation.
What can give a FLASE HIGH BM reading, will see if high when they take it manually but they have normal continuous blood glucose levels from machine (3) and why
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
(due to increased red blood cell lifespan)
Any changes in vision (including colour vision) in a Grave’s patient requires…
Urgent referral to eye
In fact, the loss of the colour vision (particularly red) has been associated with upcoming sudden vision loss
Hashitomtos thryoiditis triad
diff to De Quervain’s thyroiditis
hypothyroidism + goitre (painless but firm) + anti-TPO
De Quervain’s - typically causes a painful goitre
Endocrine parameters REDUCED in stress response: (3)
Insulin
Testosterone
Oestrogen
Hashimoto’s thyroiditis is a risk factor for what cancer?
mucosa-associated lymphoid tissue (MALT) lymphoma
guidance recommended growth hormone therapy for the following indications (4)
administered via…
Discontinue if…
Adverse effects (3)
proven growth hormone deficiency
Turner’s syndrome
Prader-Willi syndrome
chronic renal insufficiency before puberty
given by subcutaneous injection
treatment should be discontinued if there is a poor response in the first year of therapy
Adverse effects
headache
benign intracranial hypertension
fluid retention
What type of pituitary adenoma causes generalised hypopituitarism?
Order in which the hormones decrease? (5)
non-functioning tumours
GL TAP (‘Girl tap’)
1st :GH
LH/ FSH
TSH
ACTH
Last: Prolactin
Big risk factor for Graves disease, specifically Grave’s eye disease too
Smoking
Most common cause of Addisons disease in UK and world wide?
UK- autoimmune
World- TB
What is sick euthyroid?
Sick euthyroid syndrome = low T3/T4 and normal TSH with acute illness
What drug is given in gastroperesis linked to diabetic neuropathy?
Metoclopramide is the most appropriate treatment as it is a pro-kinetic antiemetic, although erythromycin and domperidone can also be used as alternatives.
Not your classic cyclizine because isn’t prokinetic whereas dopamine antagonist antiemetics are (metoclopramide/domperidone), their bowel isn’t moving/doing peristalsis as it should
Side effects of thyroxine therapy in hypothyroidism especially if they are self medicating (4)
- hyperthyroidism: due to over treatment
- reduced bone mineral density
- worsening of angina
4 atrial fibrillation
Addisons disease sick day rules
double the glucocorticoids, keep fludrocortisone dose the same
Important for meLess import
Causes of raised prolactin - 6 Ps (also 1 A_
- Pregnancy
- Prolactinoma
- Physiological stress- Stres, exercise , sleep
- polycystic ovarian syndrome
- primary hypothyroidism (TRH stimulates pituitary to release prolactin)
- Anti- Psychotics! + phenothiazines, metoclopramide, domperidone
Acromegaly in 1/3
What is the most common cause of primary hyperaldosteronism?
Bilateral idiopathic adrenal hyperplasia
Pheochromocytoma- the definitive mx. is surgery but they must be stable first, what is given?
- FIRST GIVE…alpha-blocker (e.g. phenoxybenzamine),
PHeochromocytome = PHenoxybenzamine) - beta-blocker (e.g. propranolol
Hypothyroids and pregnancy management
A woman’s need for levothyroxine will increase in pregnancy, by as much as 50% as early as 4 - 6 weeks of pregnancy.This is due to an increase in the levels of thyroxine-binding globulin (TBG). This causes an increase in the levels of total thyroxine but does not affect the free thyroxine level.
Increase the dose of levothyroxine by 25-50mcg immediately on conception.
Hashimoto’s thyroiditis is associated with what cancer?
MALT lymphoma
A marginal zone lymphoma which is a type of low-grade B-cell non-Hodgkin’s lymphoma. MALT lymphoma is also associated with H. pylori infection.
Secondary hypothyroidism is very rare
results:
Imaging?
a low TSH and low T4 (problem in pituitary)
pituitary insufficiency is most likely and therefore an MRI head of the gland
Features of Kallman syndrome
- Delayed puberty
2.
3.
4.
5.
- Delayed puberty
- hypogonadism, cryptorchidism
- anosmia
- sex hormone levels are low
- LH, FSH levels are inappropriately low/normal
- patients are typically of normal or above-average height
3 ways RBC life might increase giving an a inappropriately high HbA1c?
- Vitamin B12/folic acid deficiency
- Iron-deficiency anaemia
- Splenectomy
ALWAYS GET WRONG!!!!
What do you see on ABG in Cushings?
Metabolic Alkalosis and hypokalaemia
metabolic alkalosis is due to excess aldosterone which increases acid and potassium excretion in the kidney.
Management of Addisons crisis?
1.
- How much and what?
2.
Oral replacement is started when?
- Aggressive fluid management
1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
- IV Hydrocortisons (acts as both a mineral and glucocorticoid)
No fludrocortisone is required because high cortisol exerts weak mineralocorticoid action
oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
