Endocrinology Flashcards

1
Q

Diagnosis of T1DM

A

Requires 2 lab tests, or one and symptomatic.
FBG >/ 7
Non fasting >/11.1
2h 75g GTT >/ 11.1
HbA1c >/ 6.5

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2
Q

HbA1c goals per group

A

<7: most adults, most children
<7.5: children and adolescents <18
7.1-8: functionally dependent
7.1-8.5: recurrent severe hypoglycemias, decreased life expectancy, frail, elderly

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3
Q

Annal investigations for diabetics

A

Fasting lipid q1-3 years (1 year in kids)
Optometry
ACR
Foot exam
EKG

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4
Q

What BMs must be reported to the licensing body?

A

Any severe hypo while driving in past 12 months
>1 severe hypo while awake but not driving in past 6 months

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5
Q

When to refer for T1DM

A

ACR >60mg/mmol
eGFR <30
Pets with albumineria
>30% Cr in 3 month of starting ACEi/ARB
Retinopathy/vitreous hemp/macular edema

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6
Q

What to start if symptomatic hyperglycemia +/- metabolic decompensation in T2DM

A

Insulin +/- Metformin

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7
Q

Second line for T2DM if ASCVD, HF or >60 with 2 CV risk factors

A

SGLT2i - Empagliglozin, Dapagliflozin
GLP-RA - Semaglutide, Liraglutide

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8
Q

Second line for T2DM if no cardiac hx or risk factors but wanting cardiorenal benefit and weight loss

A

SGLT2i - Empagliglozin, Dapagliflozin
GLP-RA - Semaglutide, Liraglutide

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9
Q

Second line for T2DM if no cardiac hx or risk factors but wanting weight neutral and CV neutral

A

DPP4i - sitagliptin

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10
Q

Second line for T2DM if no cardiac hx or risk factors but increased hypoglycemias

A

Sulfonylureas - glicazide

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11
Q

What T2DM meds should be held in acute illness

A

Metformin, insulin secretagogues and SGLT2i

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12
Q

Diagnosis of DKA in peds

A

BG >11, venous ph < 7.3 or bicard <15, ketonemia or mod-large ketonuria

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13
Q

What to monitor in DKA

A

q1-2h glucose, lytes, urea, calcium, magnesium, phosphate, hematocrit, blood glasses, ECG (t-waves), fluid input/output, neuro

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14
Q

DKA rehydration in peds

A
  1. 0.9% NS 10ml/kg over 60 min, may repeat
  2. Replace remaining fluid deficit over 24-48 hours with 0.9% NS at 4-6.5mL/kg/hr with 40mmol/L of KCl
  3. When glucose < 16 or down by 5 then change to 0.45 or 0.9 % NS and add glucose to fluids

1-2h after IV fluid start IV insulin at rate of 0.05-0.1 units/kg/hr

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15
Q

DKA rehydration in adults

A
  1. Rehydrate
  2. Once euvolemic check correct sodium (Na + (3/10 x glucose) - 5). If corrected sodium low or low osmolality > 3mmol/kg/hr then continue NS. If normal or high and osmolality < 3mmol/kg/hr then switch to 0.45% NS.
  3. when glucose <14 do D5W or D10W to maintain glucose 12-14
  4. When K <5.5 and patient urinating, add KCl.W
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16
Q

What is the normal function of parathyroid

A

Decrease serum ionised calcium
Secrete PTH
Increase calcium reabsorption in disral renal tubular cells
Osteoclastic bone resorption
Conversion to D3
Increase calcium reabsorption from the gut

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17
Q

What is hyperparathyroidism associated with

A

Multiple endocrine neoplasia type 1 and 2a
Familial hypocalciuric hypercalcemia
Familial hyperparathyroidism

18
Q

What are the signs of symptoms of hyperparathyroidism

A

bones, groans, stones, and psychiatric understones

19
Q

What are the investigations for hyperparathyroidism

A
  • Likely increased calcium +/- PTH
  • If normal PTH that is abnormal in setting on high calcium - repeat 3 times to confirm
  • Low phosphate and high ALP
  • Decreased BMD
  • Albumin (corrected ca)
  • R/o vitamin d deficiency
  • R/o chronic renal insufficiency
  • R/o TSSH, malignancy, adrenal insufficiency
20
Q

How can you differentiate between FHH and HPT

A

Replace vitamin D
- In HPT this increases urinary calcium
- In FHH this does not

21
Q

What is the management of hyperparathyroidism

A

Primary:
Parathyroidectomy
Hypercalcaemia - hydration, loop diuretics, pamidronate or zolendronate

FHH - no parathyroidectomy
Screen family members

22
Q

What medications can cause hyperthyroidism

A

Lithium
Amiodarone
Iodide

23
Q

What is the etiology of Graves

A

Hyperthyroidism
Autoimmune
Antibodies against TSH receptor

24
Q

What is the etiology of toxic multinodular goiter

A

Hyperthyroidism
Higher risk in iodine deficit area
Insidious onset

25
What is the etiology of toxic adenoma
Hyperthyroidism Younger patients in iodine deficit area
26
What is the etiology of thyroiditis
Hyperthyroidism Subacute - hormones leak from inflamed gland, usually resolves in 8 months, can be recurrent Lymphocytic + postpartum
27
Which tumours can cause hyperthyroidism
Metastatic thyroid ca Ovarian ca Secrete TSH
28
Signs and symptoms of hyperthyroidism
General: weight loss, heat intolerance HEENT: lid lag, proptosis, periorbital edema, hair loss, goiter, thyroid tenderness, nodularity, bruit CVS: palpitations, tachycardia, afib, widened pulse pressure, HTN MSK: tremor, edema, pretibial myxoedema, muscle weakness GU: amenorrhea
29
What should you consider if TSH and T4 are high
MRI - suspect TSH secreting pituitary adenoma
30
Treatment of primary hyperthyroidism
1. Beta blocker 2. Methimazole - for 12-18 months then taper and d/c if asymptomatic and normal TSH (3. Propylthiouracil. Risk of hepatic failure) Radioactive iodine - high cure rate Subtotal thyroidectomy treatment of choice in pregnancy and less than 40 y/o
31
Signs and symptoms of thyroid storm
Fever*** CNS agitation Tachycardia CHF GI ?Precipitant
32
Investigations for thyroid storm
Low TSH High fT4 Low Hb High WCC High glucose High calcium High LFTs
33
Treatment for thyroid storm
*Can be fatal* - Decrease thyroid synthesis - methimazole - Inhibit hormone release - potassium iodide 5 drops - Decrease HR - BB - Support circulation - glucocorticoids, fluids, O2, cooling
34
Causes of primary hypothyroidism
Chronic autoimmune thyroiditis Postpartum thyroiditis (Hashimotos) Thyroid sx Iodine deficiency Cancer Drugs - amiodarone, lithium, iodine Agenesis/dysgenesis of the thyroid
35
Causes of central hypothyroidism
Pituitary adenoma Pituitary damage Infiltrative
36
Signs and symptoms of hypothyroidism
General: Fatigue, weakness, coled intolerance, increased weight Cognitive: depression, decreased memory, sleep dissturbance HEENT: enlargement of tongue, hoarseness, goitre CVS: bradycardia, pericardial effusion, HTN, CHF and angina Resp: Decreased exercise capacity, muscle weakness, sleep apnea GI: Constipation Neuro: Parasthesia, muscle cramps, delayed relaxation of deep tendon reflexes, carpal tunnel GU: menorrhagia, amenorrhea, impotence Derm: perioribital edema, cool pale dry skin, hair loss, thinning lateral eyebrow, brittle nails
37
Investigations for hypothyroidism
TSH T4 Trab TPOab Thyroglobulin
38
When not to treat subclinical hypothyroidism
If TSH <10, asymptomatic, not pregnant
39
When to treat hypothyroidism
Elevated TPO antibodies Goitre Strong FH autoimmune disease Pregnancy
40
What to treat subacute granulomatous thyroiditis with
NSAIDs
41
How often to monitor TSH in hypothyroid
6-8 weeks after starting dose and q6-8 weeks until in target