Endocrinology Flashcards
Drug causes of gynaecomastia?
Spironolactone
Cimetidine
Digoxin
Cannabis
Finasteride
GnRH agonists (goserelin, buserelin)
Oestrogens
Examples of SGLT2 Inhibitors?
Dapagliflozin
Gene associated with medullary thyroid cancer?
RET Oncogene
What type of TSH, T3/T4 level would a patient with pneumonia have?
TSH: Normal/low
Thyroxine: low
T3: Low
Euthyroid sick syndrome
1st line treatment of diabetic neuropathy?
Duloxetine
Amitriptyline
Gabapentin
Pregablin
SEs of piaglitazone?
Wt gain
Liver impairment
Fluid retention
Bladder cancer
Globally recued uptake on technetium thyroid scan indicative of?
Subacute thyroiditis
Drug used in residual symptoms of acromegaly?
Ocreotide
SEs of sulfonylureas (Gliclazide)?
Wt gain
Hypoglycaemic episodes
Hyponatraemia
Bone marrow suppression
Hepatotoxicity
Piaglitazone is contraindicated when?
Patients with CHF
Example of DPP4 inhibitor?
Sitagliptan
Drugs causing galactorrhoea?
Metaclopramide, domperidone
Phenothiazines
Haloperidol
SSRIs/opioids
What does over-replacement with thyroxine increase the risk of?
Osteoporosis
Interactions of drugs with levothyroxine?
Iron
Calcium carbonate
What auto antibody is most commonly found in Grave’s disease?
Anti-TSH receptor antibodies
Conditions which can give lower than expected levels of HbA1c and reason?
Sickle cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
RBC decreased life span
Conditions giving higher than expected levels of HbA1c and reason?
Vit B12/Folic acid deficiency
Iron deficiency anaemia
Splenectomy
Increased RBC lifespan
What can an ABG be like in hyperaldosteronism?
Metabolic alkalosis
Hypokalaemia
Vomiting Addisons patient should take what?
IM hydrocortisone
Radioiodine treatment can precipitate what?
Hypothyroidism
1st line treatment for prolactinomas?
Cabergoline
Genetically male patient with phenotypically female genitalia?
Congenital androgen insensitivity syndrome
MEN Type 1 symptoms?
HyperParathyroidism
Pituitary disease
Pancreatic disease
In DKA what do you do if ketonaemia and acidosis have not been resolved within 24 hours?
Senior endocrinology review
Most common complication of papillary thyroid cancer?
Spread to cervical lymph nodes
Cushing’s syndrome ABG?
Hypokalaemic metabolic alkalosis
Iodine uptake on scan (thyroid scintigraphy) is increased/decreased in de quervain’s thyroiditis (subacute thyroiditis)?
DECREASED
Sitagliptan is a ?
DPP4 Inhibitor
Man with diabetic neuropathy + BPPH…what medication would you start him with?
Pregablin
If he didn’t have BPPH I would use amitriptyline, however in this case that would predispose to urinary retention
If a patient is on a drug which may cause hypoglycaemia (sulfonylurea), what is their HbA1c target?
53 mmol/mol
MEN 1 Common tumour?
Insulinoma
MODY inheritance pattern?
AD
Optimal treatment for HNF1A MODY?
Sulfonylureas (Gliclazide)
What syndrome causes High LH and FSH?
Klinefelter’s syndrome
Low FSH & LH + Low testosterone?
Kallman syndrome
Patient with T1DM and BMI >25 consider what drug regimen?
Insulin + metformin
When do you add a second drug in T2DM?
If HbA1c rises to above 58mmol/mol(7.5%)
Flow diagram of treating diabetes type 2?
-Metformin
If ineffective add SGLT2 Inhibitor (once established) (or if CVD, CHF
If standard release not tolerated, use modified release trial )
-If metformin (CI due to CVD/CHF) use SGLT2 inhibitor and if that’s not enough add sulfonylurea
-If metformin not tolerated but not due to CVD:
DPP-4 Inhibitor or piaglitazone or sulfonylurea
-If none of these work it is time to try a GLP-1 mimetic (if BMI 35 or over) must be under specialist care
What is octreotide?
Synthetic form of natural hormone somatostatin
What is pegvisomant used for?
Treatment of acromegaly
-Mainly used if the pituitary gland tumour cannot be controlled with surgery etc
Medication used in primary hyperthyroidism when patient is not fit for surgery?
Cinacalcet (calcimimetic drug) mimics action of calcium
In treating DKA what do you do when the BG goe sto <14 mmol/L?
Start infusion of 10% dextrose at 125mls/hr in addition to saline
WHat is PTH in myeloma?
Suppressed
Causes of hypoglycaemia + pneumonic?
EX ogenous drugs (sulfonylurea/insulin)
P ituitary insufficiency
L iver failure
A ddison’s disease
I slet cell tumours (insulinomas)
N on-pancreatic neoplasms
Tender Goitre?
Thyrotoxicosis (D Quervain’s)
Criteria for T1DM and driving?
-Adequate hypoglycaemic awareness
-No more than 1 episode of severe hypo while awake preceeding 12 months AND most recent was more than 3 months ago
-Appropriate glucose monitoring
-Not regarded as a risk
-Meets visual acuity and field standards
-Under regular review
What should you do with insulin in DKA? LA and SA?
Insulin should be fixed rate
Continue regular injected long acting insulin
Stop short acting injected insulin
Insulin regime for newly diagnosed T1DM adult?
Twice daily basal insulin detemir
Insulin aspart bolus with meals
What do these blood levels indicate?
Suppressed TSH levels
Normal Serum thyroxine (T4)
Cpeptide levels are low in which pateints?
T1DM
What is C peptide a result of?
Cleavage of proinsulin into insuli so in v low levels that idnicates the absolute absence of insulin»_space; T1DM
Primary hyperaldosterinism management?
Spironolactone
Clinic reading target BP in T2DM <80 years old?
<140/90
How does myxoedema coma typically present?
Confusion + hypothermia
What should very person with insulin treatment have?
Glucagon kit
Glucocorticoid treatment can give you neutropaenia/neutrophilia?
Neutrophilia
Commonly inherited thyroid cancer?
Medullary carcinoma (autosomal dominant)
Hot solitary nodule?
Toxic adenoma
Criteria about MODY relating to
-BMI
-Fam History
- Inheritance
-DKA?
BMI typically low or normal (distinguishes from T2DM)
Usually a strong family history
Autosomal dominant inheritance
DKA not so common
What can be a common electorylyte imbalance once a DKA is treated with insulin?
Hypokalaemia
- Untreated DKA causes potassium efflux and H+ influx, and additionally insulin deficiency adds to this
-Therefore once treated with insulin potassium moves from extracellular space into intracellular space
In acromegaly if patient has raised IGF-1 levels what tests should you do next?
OGTT with serial GH measurements to confirm diagnosis
1st line treatment for phaeochromocytoma?
PHenoxybenzamine before B blockers
If a patient is unconcious with impaired GCS and in hypo what you wanna give them?
IV 20% glucose
Which diabetes drug is linked to nec fash of genitalia or perineum and what is the term for that?
Fournier’s gangrene
SGLT-2 inhibitors dapagliflozin
Triad of symptoms in MEN IIa?
Parathyroid hyperplasia and phaeochromocytoma
XS parathyroid hormone excretion results in _______phosphate excretion?
Excess (rule of E’s)
Hypertension treatment in diabetics?
ACEis (renoprotetective)
Hyponatraemia + hyperkalemia + wt loss =
Addison’s disease
What diabetic drug poses greater risk to the kebs and has a drug warning?
Canagliflozin
Symptoms in MEN I?
Peptic ulceration, galactorrhoea, hypercalacaemia
Which diabetes drug is CI-ed in bladder cancer and can cause weight increase?
Pioglitazone
Features of Klinefelter’s?
Small testes
Infertility
Gynaecomastia
Above average height
Lack of 2ndary sexual characteristics
Criteria for T2DM diagnosis?
Fasting glucose = or >7.0 mmol/L
Random glucose = > 11.1mmol/L (or after 75g oral glucose tolerance test)
MALT lymphoma is associated with which endocrine condition?
Hashimotos thyroiditis
Common cause of Cranial DI?
Recent transphenoidal pituitary surgery
What DI is Lithium a RF for?
Nephrogenic diabetes
Schizophrenia cause what type of DI?
Psychogenic polydipsia
