Endocrinology Flashcards
What is Addisons Disease?
Adrenal insufficiency leading to reduced cortisol and aldosterone (hypoadrenalism)
Key symptoms of Addisons Disease
- Lethargy and weakness
- Anorexia and salt cravings
- Hyperpigmentation in palmar creases
- Hyponatraemia and hyperkalaemia
Investigation to be done in Addisons disease
ACTH stimulation test (short synACTHen test)
How is the ACTH done?
Plasma cortisol measured before and 30 mins after administering synacthen 250ug IM
primary management of Addisons?
Hydrocortisone or fludrocortisone
Causes of Addisons crisis
Withdrawal from meds, sepsis, surgery, adrenal haemorrhage
What is Waterhouse friedrichsen syndrome?
Adrenal haemorrhage
Addisons crisis management?
Hydrocortisone IV
1L saline
Oral replacement
Hashimotos Thyroiditis what is it?
Autoimmune condition causing hypothyroidism and is more commmon in women
Associated symptoms to Hashimotos
Goitre
Bradycardia (bradycardia, reflex reduction, ataxia/amenorrhoea, dry hair/hair loss, yawn/tired, cold sensitivity, ascites, round puffy face, immobile, constipation
Antibodies for Hashimotos
Anti tpo and anti Tg
Secondary hypothyroidism causes?
Downs turners and coeliac disease
Investigations for hypothyroidism
Blood test and antibody test
- very high TSH, low T3/4 (primary)
- low TSH, LOW t3/4 (secondary)
MANAGEMENT OF HYPOTHYROIDISM
- Levothyroxine
- Avoid lithium and amiodarone
What is subacute de quervains
post viral infections, acute phase hyperthyroid and then hypothyroidism
Self-limiting
What is Graves’ disease?
most common form of hyperthyroidism.
what antibodies are seen with Graves’ disease
Anti TSH receptor antibodies that MIMIC TSH
And anti tpo in transient
Key symtpoms of graves
S: swearing
W: weight loss
E: exopthalmsu
A: anxiety/anorexia
T: pre-tibial myxoedema
I: irratable bowels
N: nervousness
G: goitre
what is the management for graves
- ATH drugs (propanolol for adrenergic symptoms) and carbimazole
- propylthiouracil (not good because can cause severe hepatic impairment = death and agranulocytosis) - Radioactive iodine - not if pregnant and usually requires years of supplements
- Beta blockers as mentioned for symptomatic management
- Surgery
What is toxic multinodular goitre
Multiple thyroid hormone releasing nodules
DKA key symptoms
Kussmaul breathing (deep hyperventilation)
Abdo pain
Headache
Acetone breath
Polydipsia and uria = dehydration
T1DM investigations
- Urine dip for ketons and glucose
- Fasting glucose >7.0
- Random glucose >11.1 (2 sep occasions if asymptomatic)
- C-peptide low
- Anti-GAD antibodies
What is C-peptide?
Predicted as a by product by the pancreas when insulin is produced it is in equal numbers to insulin produced
HbA1c parameters?
> /= - 48 (diabetic) asymptomatic needs repeating
42-47 pre diabetes
<41 normal
What is pre diabetic paramaeters
42-47 mmol/l
6.1-6.9 mmol/l
When shouldn’t HbA1c be used?
Children, gestational diabetes, iron deficiency anaemia, HIV, CKD
WHAT IS THE FIRST LINE TREATMENT OF T2DM
Metformin
How does metformin work?
Increases insulin sensitivity (moving GLUT-4)
Stops gluconeogenesis from liver
What enzyme is activated by metformin
AMPK
What is a key contraindication of metformin
Renal impairments <30 egfr
What is a key side effect to be careful of with metformin
GI issues but mainly LACTIC ACIDOSIS
WHAT CAN LACTIC ACIDOSIS CAUSE
Metabolic acidosis ( low pH, low HCO3-, low CO2)
What diabetic medication is good to use in CVD
SGLT-2 (empagloflozins)
What are sulfonyureas?
Gliclazides
- stimulates pancreatic beta cells to secrete insulin
What are major negatives of sulfonylureas
Weight gain
Hypos
Hyponatraemia
Oedema
What are major negatives of sulfonylureas
Weight gain
Hypos
Hyponatraemia
Oedema
DPP-4 inhibitor moa?
Stops DPP-4 enzyme from breaking incretin. Incretin hormones are GLP-1 and increases insulin secretion and causes satiety
Examples of DPP4 inhibitor
Sitagliptin
Side effects of DPP4 inhibitors
Headache and GI problems but most importantly PANCREATITIS due to overuse
When and why is saxagliptin good?
Can be used in renal impairment if at a titrated dose
What is thiazolidinediones
Pioglitazone - activated PPAR gamma in adipose toes to promote fatty acid uptake and releases adiponectin which promotes insulin sensitivity
Side effects on pioglitazone
Headache, GI problems, oedema
What are SGLT-2
Empagliflozin - they block glucose reabsorption from proximal tubules and increase glucose secretion
Main issue with SGLT-2 inhibitors
UTIs
Increased urination
Weight loss
Main issue with SGLT-2 inhibitors
UTIs
Increased urination
Weight loss
What are and give an example of a GLP-1 analogue
Exanatide
Incretin mimetic = inhibits glucagon secretion and increases insulin sensitivity
Metformin guideline?
Metformin if >48.
If >58 metformin + DPP4/ulfonylurea/pioglitazone/sglt-2
If still not working
Same again + another
If triple therapy not effective then GLP-1 Analogue and if BMI >35
When is insulin used in T2DM?
If metformin triple therapy not working and BMI <35
And if metfromin not tolerated therapy not working and hbA1c is still >58
What is impaired fasting glucose
Fasting glucose of 6.1-6.9 mmol/l
They should be offered OGTT
What is impaired glucose tolerance
Fasting glucose <7.0 AND OGTT 2-hour value of 7.8-11.1
What causes IFG
Hepatic insulin resistance
What causes impaired glucose tolerance
Due to muscle insulin resistance
What are the 2 types of diabetes Insipidus
- Cranial = decreased ADH secretion = polyduria = polydipsia
- Nephrogenic = insensitivity to ADH
What test is used to diagnose diabetes insipidus
Water deprivation test
What is seen on water deprivation test
High plasma osmolaltiy and low urine osmolality
What management is given to treat diabetes Insipidous
Nephrogenic diabetes = thiazides and low salt/protein
What is respiratory alkalosis
Respiratory cause of Loss of acid and increase bicarbonate
Usually caused by hyperventilation or mechanical breathing
Blow off too much CO2
Lead to hypoxia (less CO2= less O2), Cerebral constriction (fatigues, confusion, seizure and comas)
What is respiratory acidosis
Respiratory cause of loss of bicarb and increase acid
Hypoventilation and obstructive causes like asthma, GI syndrome, cystic fibrosis, severe pneumonia
What is seen on a blood gas for resp acidosis
Ph low
CO2 high
Bicarb normal or slightly high due kidney retention
What is see on a resp alkalosis blood gas
CO2 low
Ph high
Bicarb normal or lower (kidney compensating to remove bicarb)
Role of aldosterone
Causes sodium retention and potassium excretion and water retention with it
Role of cortisol
Blood volume monitor and water retainer.
Hypovolemia detected and cortisol released to retain water through secretion of ADH into renal collecting duct, independent of sodium
What is metabolic acidosis and blood gas
Blood gas: ph low, Hco3 low, co2 low kussmaul breathing
Caused by lactic acidosis, DKA or toxin metabolites
Or diarrhoea and CKD
Loss of Hco3 and gain of h+
Can cause CNS Depression, hypocalcameia and arrhythmia due to elongated QRS complex
What is metabolic alkalosis and blood gas
Loss of H+ and gain on HCO3-
Caused by vomiting, hyperaldosteronism and diuretics
Caused by more bicarb supplements, CKD, hypokalameia
