Endocrinology Flashcards
What is meal ratio? Formula?
The amount of carbohydrate one unit of fast acting insulin will ‘metabolise’ to keep BLS in optimal range.
Meal ratio = 500/Total daily dose
If total daily dose in 50, then meal ratio = 10.
Ie, one unit of insulin will cover 10g carbohydrate
What is insulin sensitivity factor
The amount that the BSL will drop with 1 unit insulin
ISS = 100/Total daily dose
growth hormone
increased by: sleep, exercise, stress, trauma, sepsis, protein
decreased by: age, obesity, sugar
amiodarone induced thyrotoxicosis Rx
type 1: rx with carbimazole (increased vascularity)
type 2: rx with prednisolone (decreased vascularity)
High risk HLA for T1DM
HLA DR2/DQ3
HLA DR4/DQ8
What in utero infection increases the risk of T1DM
Congenital rubella
Primary hyperparathyroidism - indications for surgery
Ca >0.25 LLN
Cx - bone disease, renal calculi
Age <50 y.o.
Want surg
Markers of bone resorption
Hydroxyproline
Deoxypyridiniline
N or C telopeptide
Markers of bone formation
ALP
Osetocalcin
Procollagen C terminal propeptide
Procollagen N terminal propeptide
exenatide / byetta MOA
GLP1 analogue; increases glucose dept secretion of insulin
high cholesterol
hypothyroid
nephrotic syndrome
cholestatic liver disease
pregnancy
high TGL
alcohol oestrogens DM renal disease use fibrates? but no benefit added to statins; trend toward mortality
SERM
raloxifene
decreases vertebral fractures in OP
decreases breast cancer
MEN2
medullary thyroid CA + phaeo
2A: + parathyroid adenoma
2B: + neuromas + marfanoid
MEN1
pituitary + parathyroid + pancreas
Carney Syndrome
pituitary tumour + spotty skin pigmentation + myxomas + testicular / adrenal adenomas
PPKAR1A
autoimmune polyglandular syndrome
Addisons + hypothyroid + candida + hypoparathyroidism
giving thyroxine can precipitate adrenal crisis
Hyponatraemia
serum osmol (expect low unless BGL, protein) urine osmol (> 100 unless drinking too much H2O) urine Na ( < 20 if low volume) urine Cl (> 20 w diuretics)
appetite stimulants
ghrelin
neuropeptide Y
appetite suppressants
leptin
alpha MSH
CCK
PYY3-36
testosterone
morning peak
low post food, in DM
SHBG low in obesity, DM; low total testosterone but free level normal in moderate obesity
totally low in severe obesity
GH deficiency
< 5 post insulin tolerance test
brown fat
thermogenic; mitochrondria rich
pregnancy thyroid
over hypothyroid; increase thyroxine by 30%
hyperthyroid OK: aim high normal T4
PTU 1st ™; carbimazole 2nd, 3rd
post partum thyroiditis - avoid antithyroid drugs
atypical femoral #
prodromal pain, bilateral, femoral shaft, minimal trauma, delayed healing, >5-7 years bisphosphonate use, GCC, PPI, no comminution, thick cortices, transverse or short oblique, medial braking
Rx: cease bisphos; teriparatide; prophylactic pinning of contralateral side
diabetic retinopathy
less likely to require laser if fenofibrate used
use ranibizumab for oedema (VEGF)
Von Hippel Lindau
VHL tumour suppressor gene mutation
auto domt
noradrenaline secreting phaeos
renal cell, retinal, pancreatic, neuroendocrine tumours
MEN2
ret gene mutation
adrenaline secreting phaeos
medullary thyroid cancer, primary hyperparathyroid
Neurofibromatosis 1
neurofibromas, cafe au laid spots, CNS gliomas
adrenaline secreting phaeo
SDHB
malignant paragangliomas
dopamine secreting phaeos
maternal imprinting
corrected sodium
corr Na = Na + BGL / 3
PCOS LH: FSH ratio
LH > FSH
ie: ratio > 1:1
