Endocrinology Flashcards
Outline how would you make Dx of diabetes
Fasting plasma glucose >/=7mmol/L (fasting is no colorise intake for atleast 8hours)
Or
Random glucose >/= 11.1
Or
HbA1C >/=6.5%
Or
2h PG in a 75g OGTT >/= 11.1mmol/L
In absence of any sx, test should be repeated on a diff day to confirm diagnosis
What tests confirms pre-diabetes states
Impaired fasting glucose: fasting plasma glucose 6.1-6.9
Impaired glucose tolerance: 2h post OGTT glucose 7.8-11.0 mmol/L
Other HbA1C 5.7-6.4%
List the macro vascular complications of diabetes
Ischemic Heart disease-heart attacks
CVA
Peripheral vascular disease -Poor wound healing
List the micro vascular complications of diabetes
Nephropathy
Neuropathy
Retinopathy
What are the 3 main diabetic emergencies
Diabetic ketoacidosis
Hyperosmolar non ketotic coma
Hypoglycaemia
What are the 7 main sx of diabetes
Excessive thrust
Frequent urination
Excessive hunger
Loss of weight
Fatigue
Pins and needles feeling
Blurry vision
What would you find in ophthalmoscope of a person with diabetic retinopathy (5)
Haemorrhages
Abnormal growth of vessels (Angiogenesis)
Cotton wool spots
Aneurisms
Hard exudates
What are people with atherosclerosis at risk of (3)
Heart attack
Stroke
Gangrene
What is the mechanism for the development of type 1 diabetes and type 2
Type 2: Genetic predisposition
HLA DR3/4 and DR4/4
Multiple subtypes
Then Triggers : Virus
Early Cow’s milk
Early cereals
Low vitamins (D, E)
Hygiene
Psychosocial factors
other
Type1 is Autoimmune
Anti GAD
Anti IA2
ICA
Insulin
I
What is the function of in region hormone in the body
Gut hormone released after nutrient intake and stimulate insulin secretion together with hyperglycaemia.
What are the prevention measures for diabetes
Exercise
Healthy diet
What causes hypoglycaemia in diabetic patients
Too much medication-overdosing
Too little food
Food and meds timing mismatch
Exercise
Illness
What are the common causes of hyperthyroidism (5)
- Graves’ disease
- Toxic multinodular goitre
- Toxic nodule
- Thyroiditis
- Iodine induced
- Thyrotoxicosis factitia
- TSH secreting pirtuitary tumour
- Trophoblastic disease
- Strums Ovarii
What is the commonest cause of thyroidism
Graves’ disease
Women 10:1 men
What are the clinical features of Graves’ disease 4
Common
Diffuse goitre with a bruit
Opthalmopathy
Uncommon
Pretibial myxodema
Thyroid acrobatic-clubbing due to thyroid disease
Describe the physiology of T3 and T4 (how is it made/produced)
Hypothalamus stimulates TRH
TRH stimulates Pituitary to release TSH
TSH stimulates thyroid gland to release T3 and T4
Only 15% T3 is from Pituitary, 85%comes from conversion of T4 to T3
Which test do you do for someone if you suspect hyperthyroidism
TSH and T4, rarely T3
Which tests would you do in someone with hyperthyroidism inorder to confirm the cause of the hyperthyroidism
TSH receptor antibodies - if positive it’s Graves
Thyroid reuptake scan, using radioactive isotopes if the prev test is negative
What are the treatment options for hyperthyroidism I’m SA
Thionamides - Carbimazole
What is the mechanism of action of theonamide (carbimazole)
Inhibits thyroid peroxidase
Latent period before therapeutic response because inhibits hormone synthesis not release
List 4 adverse effects of Neomercazole
Agranulocytosis
Hepatotoxicity
Thrombocytopenia
Lupus like syndrome
What do you do if adverse effects occur due to neomercazole therapy in hyperthyroidism
Stop it, treat with radioactive iodine or surgery
How would a pt with agranulocytosis due to neomercazole present
Fever and sore throat
Which other anti thyroid drugs can be used in hyperthyroidism that have a quicker onset or mechanism of action (5)
Logo’s iodine
Beta blockers
Lithium
Cholestyramine
Dexamethazone
Causes of primary hypothyroidism (3)
Post surgery / iodine deficiency
Hashimotos disease
Anti thyroid drugs
What is the treatment of choice of hypothyroidism
Levothyroxine (T4- eltroxin, euthyrox)
Which drugs can affect absorption of thyroid hormone
Cholestyramine
Calcium carbonate
PPIs (Omeprazole, landoprazole)
Ciprofloxacin
Sucralfate, ferrous sukfate, aluminium hydroxide
Chromium
What is Is osteoporosis
Disease of bone mineral deficiency and reduced density
Define osteomalacia
Adult form of rickets in which mineral component is deficient in bone
Outline function of osteocytes
Maintain nutrition of other cells
List some of the non endocrine causes of Osteoporosis
Smoking! Tobacco use
Alcohol
Haematological malignancies eg multiple myeloma and breast carcinoma
Define osteopetrosis
Bone is dense but brittle
Not have necessary collagen bone, posciline bone
Outline the functions of the different cells of bone tissue
Osteocytes- maintains bone
Osteoblasts - forms bone matrix
Osteopenia cell- stem cell
Osteoblast - resorts bone
What is a low impact fall
Forced external rotation of the lower extremity which impinges on posterior lip of the acetabulum
Which bones fracture in osteoporosis
Wrist fracture
Spinal fracture
Hip fracture
List the Causes of osteoporosis
Endocrine - hypogonadism, high ACH, Thyrotoxicosis, Anorexia nervousa, hyperprolactinaemia, porphyria, DM1, hyperparathyroidism, Acromegaly
Nutrition- malabsorption syndromes, malnutrition, vit D deficiency, calcium deficiency, alcoholism, gastric operations, hypercalciuria, chronic liver disease
Drugs- glucocorticoid, excess thyroid hormone, heparin, phenytoin
Disorders of collagen metabolism- osteogenesis imperfecta
Other- rheumatoid arthritis, thalassemia
Which drug is the main cause of secondary osteoporosis
Glucocorticoid
What other presentations can be similar to Cushings
Alcohol
Depressions
Alcohol-red checks, bruising
HBAc abnormal
How to test for Cushings
1m overnight Dexamethasone suppression test
24h urinary cortisol
Midnight cortisol (salivary)
