Endocrinology Flashcards
What is sick euthyroid syndrome?
The sick euthyroid syndrome often occurs in individuals suffering from a systemic illness such as a myocardial infarction. The condition usually resolves upon treatment and resolution of the underlying condition. TSH, thyroxine and T3 are low; in most cases, the TSH level is often within the normal range.
What are expected renin and aldosterone levels in Conns syndrome?
High plasma aldosterone with suppressed renin
What is the mechanism of sitagliptin?
It inhibits DDP-4 (dipeptidyl peptidase-4).
DDP-4 is an enzyme that breakdowns incretins such as GLP-1.
By increasing incretin levels, there is an enhanced insulin release, reduced glucagon secretion and improved blood glucose control
What is pseudohypoparathyroidism?
Rare and genetic condition that occurs when there is a failure of cell response to PTH. PTH is hence elevated but calcium is low and phosphate is raised.
There are also other physical signs shortened metacarpals (especially fourth and fifth), a round face, short stature, calcified basal ganglia, and a low IQ
What is the difference between pseudohypoparathyroidism and pseudopseudohypoparathyroidism?
Pseudohypoparathyroidism will present with raised PTH, low calcium and raised phosphate + other physical features
Pseudopseudohypoparathyroidism has the same physical features as above but a normal biochemistry
What test has replaced the oral glucose tolerance test for acromegaly?
Insulin-like growth factor 1 (IGF-1) measurement
How do the following diabetes drugs work?
SGLT-2 inhibitors
Biguanides
Sulfonylureas
GLP-1 mimetics
DPP-4 inhibitors
SGLT-2 inhibitors (e.g. canagliflozin, dapagliflozin and empagliflozin) - reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.
Biguanides (e.g. metformin) - decrease gluconeogenesis in the liver and increase insulin sensitivity
Sulfonylureas (e.g. gliclazide) - increase insulin release from beta-cells in the pancreas
GLP-1 mimetics (e.g. exenatide) - mimic incretin which is usually released in the gastrointestinal tract, and has the effect of increasing insulin production
DPP-4 inhibitors (e.g. sitagliptin) - block the action of DPP-4, an enzyme which breaks down incretin
Which diabetes drugs is recommended for patients with CVD and heart failure?
SGLT-2 inhibitors
What is a common cause of impaired hypoglycaemia awareness in T1DM?
Neuropathy of autonomic nervous system
*Certain drugs like beta blockers also blunt awareness.
What is the preferred first-line imaging when presenting with a thyroid nodule?
USS
It can detect lesions as small as 2 mm and provides information on their dimensions, shape, and parenchymal changes. Sonographic criteria are used to classify thyroid nodules, ranging from U1 (benign) to U5 (malignant), which helps to determine the need for further investigations.
If you suspect malignacny, you can then perform other tests such as fine needle aspiration
What is the usual presentation of maturity onset diabetes of the young (MODY)?
They present with persistent, asymptomatic hyperglycaemia without the typical features of T1DM or T2DM
Unlike Type 1 diabetes, patients with MODY usually do not present with diabetic ketoacidosis except under severe stress conditions, and unlike Type 2 diabetes, they are often of normal weight and do not exhibit signs of insulin resistance.
Why is insulin not given in hyperosmolar hyperglycaemic states?
Usually fluid replacement is sufficient to normalise serum glucose and improve patient symptoms.
Giving insulin in hyperosmolar hyperglycaemic state may provoke sudden and dramatic fluid shift between compartments, which may result in central pontine myelinolysis.
What class of diabetes medication has proven cardiovascular benefits?
SGLT-2 inhibitor (e.g. dapagliflozin)
What would the tests results (ACTH and Cortisol) suggest if you performed a high dose dexamethasone suppression test?
- ACTH suppressed, Cortisol not suppressed
- ACTH suppressed, Cortisol suppressed
- ACTH not suppressed, Cortisol not suppressed
- Cushing’s syndrome due to other causes (e.g. adrenal adenomas) *
- Cushing’s disease (i.e. pituitary adenoma –> ACTH secretion)
- Ectopic ACTH secretion
*ACTH is suppressed in high dose dexamethasone test in Cushing’s syndrome because cortisol release is ACTH-independent.
How would you differentiate an adrenal adenoma from bilateral adrenal hyperplasia where both present with Cushing’s syndrome?
Adrenal vein sampling, where you can compare the aldosterone secretion
What are contraindications for prescribing metformin?
Patients at risk of lactic acidosis, including those with:
* diabetic ketoacidosis
* Estimated glomerular filtration rate (eGFR) less than 30 mL/minute/1.73 m2
* Risk of acute kidney injury, such as dehydration, prolonged fasting, severe infection, or shock
* Conditions that may cause tissue hypoxia, such as cardiac or respiratory failure, recent myocardial infarction, or shock
* Hepatic insufficiency, acute alcohol intoxication
What is the initial test to diagnose Cushing’s syndrome?
Low-dose (overnight) dexamethasone suppression test
Patients with Cushing’s syndrome do not have their morning cortisol spike suppressed
*You can also confirm Cushing’s with a 24 hr urinary free cortisol (two measurements are required) or bedtime salivary cortisol (two measurements are required)
What are the different thyroid cancers?
- Papillary (70%) - excellent prognosis
- Follicular (20%)
- Medullary (5%) - Cancer of parafollicular (C) cells, secrete calcitonin, part of MEN-2
- Anaplastic (1%) - Not responsive to treatment, can cause pressure symptoms
- Lymphoma (Rare) - Associated with Hashimoto’s thyroiditis
What is the distribution of diabetic neuropathy?
Sensory loss in a symmetrical ‘glove and stocking’ distribution, with the lower legs affected first
What are some causes of gynaecomastia?
- physiological: normal in puberty
- syndromes with androgen deficiency: Kallman’s, Klinefelter’s
- testicular failure: e.g. mumps
- liver disease
- testicular cancer e.g. seminoma secreting hCG
- ectopic tumour secretion
- hyperthyroidism
- haemodialysis
- drugs: see below
What drugs cause gynaecomastia?
- spironolactone (most common drug cause)
- cimetidine
- digoxin
- cannabis
- finasteride
- GnRH agonists e.g. goserelin, buserelin
- oestrogens, anabolic steroids
What are some side effects of thiazolidinediones (e.g. pioglitazone)?
- weight gain
- liver impairment
- fluid retention - heart failure + peripheral oedema
- bladder cancer
What is the ideal management of Grave’s disease?
- Symptomatic control - propanolol
- Anti-thyroid drugs (e.g. carbimazole, propylthiouracil)
- Radioiodine therapy
How is growth hormone administered and for what conditions?
It is given subcutaneously to:
* proven growth hormone deficiency
* Turner’s syndrome
* Prader-Willi syndrome
* chronic renal insufficiency before puberty
What are side effects of sulfonylureas?
Common:
* Hypoglycaemic events
* Weight gain - the glucose is stored as fat
Rare:
* Hyponatraemia secondary to SIADH
* Bone marrow suppression
* Hepatotoxicity (typically cholestatic)
* Peripheral neuropathy
What is liraglutide?
GLP-1 mimetic that can be given in obese patients (BMI >35) that are also pre-diabetic. It is given subcutaneously.
What electrolyte imbalance is seen in Cushing’s?
Hypokalaemic metabolic alkalosis
High cortisol –> sodium and water retention –> increased potassium excretion + increased hydrogen excretion
What is the treatment of phaeochromocytoma?
Surgery is the definitive management. The patient must first however be stabilized with medical management: alpha-blocker (e.g. phenoxybenzamine), given before abeta-blocker (e.g. propranolol)
What is Kallman’s syndrome?
X-linked recessive condition, causing failure of GnRH (gonadotropin-releasing hormone) secreting neurons migrating to the hypothalamus –> hypogonadotropic hypogonadism
It presents with delayed puberty and anosmia in a male, who are often average/ above average height. A hormone profile would show low testosterone with low (or inappropriately normal) luteinising hormone (LH) and follicle-stimulating hormone (FSH).
What is pseudo-Cushing’s?
Condition that mimics Cushing’s
Due to alcohol excess or severe depression
False positive dexamethasone suppression test or 24 hr urinary free cortisol
Insulin stress test may be used to differentiate
Would the following levels be raised or reduced in De Quervain’s thyroiditis?
T4
ESR
Uptake of iodine-131
T4: raised
ESR: raised
Uptake of iodine-13: reduced
What are precipitating factors for thyroid storms?
- Thyroid or non-thyroidal surgery
- Trauma
- Infection
- Acute iodine load e.g. CT contrast media
What is the management of thyroid storm?
- Symptomatic treatment e.g. paracetamol
- Treatment of underlying precipitating event
- Beta-blockers: typically IV propranolol
- Anti-thyroid drugs: e.g. methimazole or propylthiouracil
- Lugol’s iodine
- Dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
What is the medical treatment for patients with a parathyroid adenoma?
Calcimimetics such as cinacalcet. These mimic the action of calcium on tissues by allosteric activation of the calcium-sensing receptor –> increases the sensitivity of calcium receptors on parathyroid cells, reducing PTH levels and resulting in a decrease in serum calcium levels.
What are the mechanism of actions of:
* Metformin
* Sulfonylurea
* SGLT-2 Inhibitors (e.g. empagliflozin)
* Thiazolidinedione (e.g. pioglitazone)
* DPP-4 Inhibitors (gliptins)
* GLP-1 Mimetics (e.g. exenatide)
- Metformin - increase insulin sensitivity and decrease glucose production
- Sulfonylurea - stimulates insulin release from pancreas
- SGLT-2 Inhibitors - reduces reabsorption of glucose in proximal tubules
- Thiazolidinedione - increase insulin sensitivity and decrease glucose production
- DPP-4 Inhibitors & GLP-1 Mimetics - increase incretin activity (increase insulin secretion + inhibit glucagon production + slow absorption by the gastrointestinal tract)
Each one of the following is a feature of subacute thyroiditis, except:
- Good prognosis
- Increased iodine uptake on scan
- Painful goitre
- Hyperthyroidism
- Elevated ESR
Increased iodine uptake on scan
*In De Quervain’s thyroiditis there is globally reduced uptake of iodine-131 during thyroid scintigraphy
What is the clinical picture of subacute (De Quervain’s) thyroiditis?
Thyrotoxicosis with tender goitre
*Grave’s would usually not present with tender goitre
What should every person being treated with insuline have?
A glucagon kit for emergencies where the patient is not able to orally ingest a short-acting carbohydrate
What should you do when someone is experiencing gastrointestinal side effects of metformin (immediate release)?
Change them to modified release (which is taken once a day)
What is subclinical hypothyroidism?
TSH raised but T3, T4 normal + no obvious symptoms
Significance:
* risk of progressing to overt hypothyroidism is 2-5% per year (higher in men)
* risk increased by the presence of thyroid autoantibodies
What is the management of subclinical hypothyroidism?
If TSH is > 10mU/L and the free thyroxine level is within the normal range, consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart.
If TSH is between 5.5 - 10mU/L and the free thyroxine level is within the normal range:
* if < 65 years consider offering a 6-month trial of levothyroxine if: the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart, and there are symptoms of hypothyroidism
* in older people >80, offer “watch and waiting”
* if asymptomatic, observe and repeat thyroid function in 6 months
What investigation is used to confirm Addison’s disease?
Short ACTH test
Plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM
In which conditions can you see lower-than-expected levels of HbA1c?
*Due to reduced red blood cell lifespan
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
In which conditions can you see higher-than-expected levels of HbA1c?
*Due to increased red blood cell lifespan
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
What are the criteria for diagnosis of diabetes using plasma glucose?
If symptomatic:
* fasting glucose greater than or equal to 7.0 mmol/l
* random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
If asymptomatic:
* Same as above but must be demonstrated on two separate occasions
What are the criteria for diagnosis of diabetes using HbA1c?
Greater than or equal to 48 mmol/mol (6.5%)
In which conditions can HbA1c not be used for diabetes diagnosis?
- Haemoglobinopathies
- Haemolytic anaemia
- Untreated iron deficiency anaemia
- Suspected gestational diabetes
- Children
- HIV
- Chronic kidney disease
- People taking medication that may cause Hyperglycaemia (for example corticosteroids)
What should you do if a hypoglycaemic patient is unable to tolerate oral glucose?
Give IM glucagon
If this is not effective within 10 minutes, give IV glucose
What are the phases of de Quervain’s thyroiditis?
Phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
Phase 2 (1-3 weeks): euthyroid
Phase 3 (weeks - months): hypothyroidism
Phase 4: thyroid structure and function goes back to normal
What is the treatment for de Quervain’s thyroiditis?
None needed
Can give NSAIDs for thyroid pain
What are the symptoms of T1DM-associated gastroperesis?
What is the management for this?
Erratic blood glucose control, bloating and vomiting
Give prokinetic agents such as metoclopramide, domperidone or erythromycin
What is the recommendation for monitoring blood glucose in T1DM?
Recommend testing at least 4 times a day, including before each meal and before bed
More frequent monitoring is recommended if frequency of hypoglycaemic episodes increases; during periods of illness; before, during and after sport; when planning pregnancy, during pregnancy and while breastfeeding
Which drugs can cause gynaecomastia?
- Spironolactone (most common drug cause)
- Cimetidine
- Digoxin
- Cannabis
- Finasteride
- GnRH agonists e.g. goserelin, buserelin
- Oestrogens, anabolic steroids
Which isthe most common type of thyroid cancer?
Papillary carcinomas - likely to spread lymphatically
Often in young females
Excellent prognosis
Which thyroid cancer is associated with MEN2?
Medullary carcinomas - made out of parafollicular cells which secrete calcitonin
What is the difference between hot and cold thyroid nodules?
Hot nodules are hormonally active and produce hormones. Cold nodules do not.
On an isotope scan, hot nodules are shown with increased uptake (black dot, with rest of thyroid white). Cold nodules are shown with reduced uptake (white dot, with rest of thyroid black).
What steroid (and route) is given in addisonian crisis?
IV hydrocortisone - this has primarily glucocorticoid effect, with some weak mineralocorticoid action. Since this is given at high doses, there is enough mineralocorticoid activity (so fludrocortisone is not necessary here unlike in Addison’s disease)
What are complications of diabetic foot disease?
Calluses
Ulceration
Charcot’s arthropathy
Cellulitis
Osteomyelitis
Gangrene
What are the associations of MEN1?
3Ps
Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumours
What are the associations of MEN2a?
2Ps 1M
Parathyroid hyperplasia
Phaeochromocytoma
Medullary thyroid carcinoma
What are the associations of MEN2b?
1P 2M
Phaeochromocytoma
Mucosal Neuromas
Medullary thyroid carcinoma
What is a myxoedema coma?
Typically presents with confusion, hypothermia, bradycardia and profound hypothyroidism
The patient will require:
* IV thyroid replacement
* IV fluid
* IV corticosteroids (until the possibility of coexisting adrenal insufficiency has been excluded)
* electrolyte imbalance correction
* sometimes rewarming
What are the causes of primary hyperparathyroidism?
- 85%: solitary adenoma
- 10%: hyperplasia
- 4%: multiple adenoma
- 1%: carcinoma
What is the 1st line test for acromegaly?
Serum IGF-1 levels - this has overtaken OGTTs
The OGTT test is recommended to confirm the diagnosis if IGF-1 levels are raised
*Pituitary MRI may be useful to visualise a pituitary tumour
What is the first-line treatment of acromegaly?
Trans-sphenoidal surgery
What management can be done if transphenoidal surgery is not successful in acromegaly?
Somatostatin analogue (e.g. octreotide) - directly inhibits the release of growth hormone
Dopamine agonists (e.g. bromocriptine) can be used as an adjunct to somatostatin analogues
Which drugs can induce gynaecomastia?
- Spironolactone (most common drug cause)
- Cimetidine
- Digoxin
- Cannabis
- Finasteride
- GnRH agonists e.g. goserelin, buserelin
- Oestrogens, anabolic steroids
What should patients on long-term steroids do when they are ill?
Advised to increase their steroid dosage when they are unwell, as illness may precipitate adrenal crises. These are known as ‘sick day rules’.
What is Waterhouse- Friderichsen syndrome?
Rare and potentially life-threatening condition characterized by adrenal gland failure due to bleeding into the adrenal glands.
It is associated with severe bacterial infections, particularly those caused by Neisseria meningitidis.
Features:
* Rapid onset
* Fever
* Shock
* Adrenal insufficiency
* Skin rash
* Multi-organ failure
What is the main test to diagnose phaeochromocytoma?
24 hr urinary collection of metanephrines (sensitivity 97%)
What test can be used to differentiate Cushing’s syndrome from Pseudo-Cushing’s?
Insulin stress test
*Pseudo-Cushing’s presents similarly to Cushing’s syndrome, however, rather than being caused by excessive corticosteroid levels, it is due to alcohol excess or severe depression.
How would LH/FSH levels differ in Kallman’s syndrome and Klinefelter’s syndrome?
FSH/LH Fall in Kallman’s (HYPOgonadotrophic hypogonadism)
FSH/LH Climb in Klinefelter’s (HYPERgonadotrophic hypogonadism)
What is Kallman’s syndrome?
Failure of GnRH-secreting neurons to migrate to the hypothalamus –> delayed puberty secondary to hypogonadotropic hypogonadism (X-linked recessive trait)
Features:
* ‘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
What is Klinefelter’s syndrome?
karyotype 47XXY
Features:
* often taller than average
* lack of secondary sexual characteristics
* small, firm testes
* infertile
* gynaecomastia - increased incidence of breast cancer
* elevated gonadotrophin levels but low testosterone
Diagnosis is by karyotype (chromosomal analysis).
How do you manage illness in an Addison’s patient?
Glucocorticoid dose should be doubled, with the fludrocortisone dose staying the same
What backup do patients with Addison’s require?
Patients should be provided with hydrocortisone for injection with needles and syringes to treat an adrenal crisis
What is Nelson’s 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. Removal of both adrenal glands eliminates the production of cortisol, and the lack of cortisol’s negative feedback can allow any pre-existing pituitary adenoma to grow unchecked.
Continued growth can cause mass effects due to physical compression of brain tissue. Increased production of adrenocorticotrophic hormone (ACTH) can result in increased melanocyte stimulating hormone (MSH) which can result in hyperpigmentation
What are the sick day rules for diabetic patients?
Type 1:
* Maintain normal insulin regimen
* Drink at least 3 L of fluid (5 pints) a day to prevent dehydration
* Check blood glucose more frequently, at least once every 4 hours
* Consider checking blood or urine ketone levels regularly
Type 2:
* Stop some oral hypoglycaemics during an acute illness
* Medication may be restarted once the person is feeling better and eating and drinking for 24-48 hours
* For insulin, same as T1DM
* Monitor blood glucose more frequently
What electrolyte abnormalities are seen in refeeding syndrome?
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
What electrolyte abnormalities are seen in tumour lysis syndrome?
Hyperkalaemia
Hyperphosphataemia
Hypocalcemia
What electrolyte abnormalities are seen in vitamin D excess?
Hypercalcaemia and hypomagnesaemia
What is the most common endogenous cause of Cushing’s syndrome?
Pituitary adenoma aka Cushing’s Disease
What is the management of hypercalcaemia?
- Aggressive rehydration with normal saline (typically 3-4L/day)
Consider: IV bisphosphonates, calcitonin and steroids (for sarcoidosis)
*Loop diuretics such as furosemide are sometimes used in hypercalcaemia, particularly in patients who cannot tolerate aggressive fluid rehydration
What is the most common cause of primary hyperaldosteronism?
Bilateral adrenal hyperplasia (60-70%)
What are the preferences for giving propylthiouracil or carbimazole in pregnancy?
In the 1st trimester, propylthiouracil is preferred as carbimazole is associated with an increased risk of congenital abnormalities.
In the 2nd trimester, carbimazole is preferred as propylthiouracil has an increased risk of severe hepatic injury.
How does nuclear scintigraphy of toxic multinodular goitre present?
Patchy uptake
What are causes of subclinical hyperthyroidism?
Multinodular goitre, particularly in elderly females
Excessive thyroxine may give a similar biochemical picture
What are risks of subclinical hyperthyroidism?
- Atrial fibrillation
- Osteoporosis
- Dementia
What is the management of subclinical hyperthyroidism?
- TSH levels often revert to normal - therefore levels must be persistently low to warrant intervention
- Can consider therapeutic trial of low-dose antithyroid agents for approximately 6 months in an effort to induce a remission
What class of drug does MODY with HNF1A association respond well to?
Low-dose sulfonylureas
In hyperkalaemia, what can be given/done to remove potassium from the body?
- Calcium resonium (orally or enema) - enemas are more effective than oral as potassium is secreted by the rectum
- Loop diuretics
- Dialysis
This is done after stabilisation of the cardiac membrane and shift of potassium from ECF to ICF (using insulin/dextrose + salbutamol)
What are the different types of impaired glucose regulation?
- Impaired fasting glucose (IFG) - due to hepatic insulin resistance
- Impaired glucose tolerance (IGT) - due to muscle insulin resistance
*Patients with IGT are more likely to develop T2DM and cardiovascular disease than patients with IFG
What are the definitions of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)?
- a fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)
- impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
- people with IFG should then be offered an oral glucose tolerance test to rule out a diagnosis of diabetes. A result below 11.1 mmol/l but above 7.8 mmol/l indicates that the person doesn’t have diabetes but does have IGT
Where should you inject your Epipen?
Anterolateral aspect of the middle third of the thigh
How should metformin be taken during Ramadan?
One-third of the normal metformin dose should be taken before sunrise and two-thirds should be taken after sunset
What should you do in a patient presenting with hypomagnesemia and hypokalaemia?
Replace magnesium before correcting hypokalaemia. Hypomagnesemia prevents potassium absorption
What is the diagnostic marker for carcinoid syndrome?
24 hour urinary 5 HIAA measurements
or
plasma chromogranin A
What is the management of carcinoid tumours?
- Somatostatin analogues e.g. octreotide
- Surgery
What is the maximum rate of IV potassium chloride that can be delivered without a cardiac monitor?
IV potassium chloride at 10mmol/hour
What is an important side effect of SGLT2 inhibitors to know about?
Urinary and genital infection (secondary to glycosuria) + Fournier’s gangrene
Fournier’s gangrene: fulminant form of infective necrotising fasciitis affecting the genitalia and/or perineum - can lead to sepsis
What would nuclear scintigraphy show in thyroid cancer?
Abnormally non-functioning ‘cold’ areas within the thyroid gland, which would appear as small paler regions.
What is a consequence of failure to rotate insulin injection sites?
Lipodystrophy
Which gene is mutated in familial hypercholesterolaemia?
Gene encoding the LDL-receptor protein
Causes of acalculous cholecystitis
- Critical Illness: such as those in intensive care units, especially those with severe trauma, burns, or systemic infections.
- Prolonged Fasting or Total Parenteral Nutrition: stasis of bile in the gallbladder causing inflammation.
- Vascular Insufficiency
- Immunosuppression
What change to insulin regime should be done in a DKA?
Start fixed-rate insulin
Continue long-acting insulin
Stop short-acting insulin
What cardiac symptoms/signs is thyrotoxicosis associated with?
Palpitations
Tachycardia
High-output cardiac failure
Reversible cardiomyopathy can rarely develop
What electrolyte disturbances are seen in Cushing’s syndrome?
Hypokalaemic metabolic alkalosis
What is the management of nephrogenic diabetes insupidus?
- Thiazides - causes more sodium to be released into the urine, which lowers plasma osmolarity, breaking the polyuria-polydipsia cycle
- Low salt/protein diet
When do you add metformin in T1DM?
If BMI is equal to or over 25
How do non-functioning pituitary tumours present?
Hypopituitarism
Pressure effects
Which patients will require variable rate insulin infusion in surgery?
Surgery requiring a long fasting period of more than one missed meal
Patients whose diabetes is poorly controlled
*patients treated with insulin who have good glycaemic control (HbA1c < 69 mmol/mol) and are undergoing minor procedures, can be managed during the operative period by adjustment of their usual insulin regimen
What is a typical fearture of thyroid papillary carcinomas?
Excellent prognosis despite having a tendency to spread to cervical lymph nodes early
What are complications of thyroid surgery?
- Anatomical: recurrent laryngeal nerve damage.
- Bleeding: owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema.
- Calcium: damage to the parathyroid glands resulting in hypocalcaemia.
