Endocrinology Flashcards
Side effects of levothyroxine
Osteoporosis
Hyperthyroidism
AF
HbA1C Targets
Lifestyle +/- Metformin - 48
Lifestyle + hypoglycaemics - 53 (eg gliclazide)
T2DM Mx
Assess CVD risk (eg QRISK >10%)
- if no risk = metformin
- if risk = metformin first then + SGLT2 inhib (eg Dapagliflozin)
T2DM Mx when Metformin is contraindicated
No CVD risk = DPP‑4 inhibitor or pioglitazone or a sulfonylurea
CVD risk = SGLT2 inhib monotherapy (eg Dapagliflozin)
Obesity = add GLP-1 (Semaglutide)
CKD (eGFR <30) = DPP4-i (Linagliptin)
DVLA Diabetes rules
Can NOT drive unless:
- NOT been severe hypoglycaemia event in past 12 months
- 2 episodes hypoglycaemia in group 1 = no drive.
- 1 episode hypoglycaemia in group 2 = no drive
- has full hypoglycaemia awareness
- adequate blood sugar control (twice daily checks)
If Group 2 (HGV) - need to complete form for DVLA
All drivers must inform DVLA of diabetes on insulin
Blood pressure Mx for Diabetics
1st - ACEi or ARB
In Black patients choose ARB
Causes of raised prolactin
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone
Diabetes Diagnosis
If symptomatic:
- fasting Glucose >7.0
- random glucose >11.1 (or post glucose tolerance test)
HbA1C
- HbA1C >48 (6.5mmol) - check every 6 months once stable
- if asymptomatic test must be repeated
Prediabetes Ix
HbA1C 42-47 (6.0-6.4%) - checked once per year
Impaired fasting glucose
- fasting glucose 6.0-6.9
Impaired glucose tolerance
- fasting glucose <7.0
- and OGTT >7.8 but <11.1 (if above then diabetes)
Type 1 diabetes Mx
1st - basal–bolus using twice‑daily insulin detemir
2nd - basal-bolus using once-daily insulin determir or glargine
If BMI >25 add Metformin
Check HbA1c 3-6 monthly
HbA1c target <48
Thiazolidinediones (eg Pioglitazone) side effects
weight gain
liver impairment - monitor LFTs
fluid retention - contraindicated in CHF
fracture risk
bladder Ca
Metabolic syndrome Fx
> 3 of the following:
waist circumference: men > 102 cm, women > 88 cm
elevated triglycerides: > 1.7 mmol/L
reduced HDL: < 1.03 mmol/L in males, < 1.29 mmol/L in females
raised blood pressure: > 130/85 mmHg, or known HTN
raised fasting plasma glucose > 5.6 mmol/L, or known T2DM
Metabolic syndrome associated conditions
raised uric acid levels
non-alcoholic fatty liver disease
polycystic ovarian syndrome
Klinefelter’s syndrome biochemisty
Low Testosterone
High LH
Primary hyperparathyroidism biochemistry
High calcium
low phosphate
PTH can be high or normal
caused by parathyroid adenoma or hyperplasia
Secondary hyperparathyroidism biochemistry
Low or normal calcium
PTH very high
caused by chronic hypocalcaemia eg CKD
SGLT2 inhib (eg dapagliflozin) side effects
UTI + Fourniers gangrene
Normoglycaemia ketoacidosis
Ulcers - risk of amputation, feet need to be checked
weight loss - this can be of benefit
Carbimazole (for hyperthyroid) side effects
Agranulocytosis (need to check FBC)
T2DM insulin Mx
1st - Neutral Protamine Hagedorn (NPH) insulin [aka isophane insulin] OD or BD
2nd - NPH plus short acting insulin if HbA1C >75 (9.0)
3rd - Glargine or Detemir (if NPH contraindicated)
Over 60, new onset T2DM, weight loss ??
CT Abdo - ?pancreatic ca
Addisons crisis Mx
IM Hydrocortisone
Conditions where HbA1c may not be used for 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)
Bloods to differentiate T1DM and T2DM
C peptide
Anti-GAD
Primary hyperaldosteronism (Conns) Fx
Hypertension
HypoKal
Primary hyperaldosteronism (Conns) Ix
Aldosterone: Renin ratio
Phaechromocytoma Ix
24hour urinary metanephrines
Hypothyroidism in pregnancy Mx
Increase Levothyroxine dose once pregnancy confirmed (by 25-50mcg)
Addisons disease Ix
Short Synachten test
Addisons disease biochemisty
HypoNa
HyperKal
Pioglitazone SE
peripheral oedema (fluid retention) - therefore not suitable for heart failure patients
Exenatide (GLP-1 agonist) side effect
pancreatitis
renal impairment
Thiazolidinediones Fx
Eg Pioglitazone
PPAR-gamma receptor agonists - reduce peripheral insulin resistance
SE/
weight gain
liver impairment - monitor LFTs
Fluid retention - cautioned with heart failure
risk of fractures
risk of bladder Ca
Addison’s patient with intercurrent illness Mx of steroids
double the glucocorticoids (hydrocortisone), keep fludrocortisone dose the same
Kallmans biochemisty
LH + FSH low/ normal
Testosterone low
When is Metformin contraindicated or needs to be stopped
eGFR <30
creatinine >150
MODY (mature onset diabetes in young) Mx
Asymptomatic - no treatment
Symptoms - Sulphonylurea (Gliclazide)
Addisons Ix
9am Cortisol <150 = refer endocrine
Addisons Fx
Low BP
HypoNa
HyperK
Low blood Glu
