Endocrinology Flashcards
What is the most common endogenous cause of Cushing’s?
Pituitary adenoma
What are the ACTH dependent causes of Cushing’s? (2)
- Cushing’s (disease)- pituitary adenoma
- Ectopic ACTH e.g. small cell lung Ca
What are the ACTH independent causes of Cushing’s? (5)
- iatrogenic (steroids)
- adrenal adenoma
- adrenal carcinoma
- carney complex- cardiac myxoma including syndrome
- micronodular adrenal dysplasia
What would you expect to see in regard to glucose, sodium and potassium in Addison’s?
Hypoglycaemia, hyponatraemia, hyperkalaemia
What is the management of diabetic gastroporesis?
Metoclopramide, Domperidone or erythromycin (prokinetic agents)
When are SGLT-2 used in management of diabetes?
- High risk of CVD (Q-risk >10%)
- Established CVD
- Chronic heart failure
What is the most common cause of primary hyperaldosteronism?
Bilateral idiopathic adrenal hyperplasia
What are the causes of primary hyperaldosteronism? (5)
- bilateral idiopathic adrenal hyperplasia: the cause of around 60-70% of cases
- adrenal adenoma: 20-30% of cases
- unilateral hyperplasia
- familial hyperaldosteronism
- adrenal carcinoma
Two key features of primary hyperaldosteronism (2)
Hypertenison
Hypokalaemia
Management of primary hyperaldosteronism (2)
- adrenal adenoma= surgery (laparoscopic adrenalectomy)
- bilateral adrenocortical hyperplasia= aldosterone antagonist e.g. spironolactone
Management of painful diabetic neuropathy?
- first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
- if the first-line drug treatment does not work try one of the other 3 drugs
- tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
Which diabetic medications are contraindicated in heart failure?
Pioglitazone (thiazolidinedione)- causes fluid retention which can exacerbate heart failure
What do TFTs look like in sick euthyroid syndome?
Low T3/4 and normal/low TSH
When do you test C-peptide levels and how do they differentiate between T1DM and T2DM?
If patient is at intermediate age check C-peptide. if low indicates T1DM
What are impaired fasting glucose levels?
6.1-7.0 mmol/l
What are impaired glucose tolerance levels?
Fasting plasma glucose less than 7.0 mmol/l AND OGTT 2-hour value 7.8-11.1 mmol/l
What is the mechanism of action of pioglitazone (insulin sensitiser)?
1) Increase insulin sensitivity
2) Decrease free fatty acid release
What is the mechanism of action of DPP-4?
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
What is the mechanism of action of metformin (biguanide)?
1) Increase insulin sensitivity
2) Increase glucose uptake
3) Decreases glycogenolysis
What is the mechanism of action of sulfonylureas (insulin scretalogue)?
Increased insulin secretion by stimulating pancreatic B cells
What is the mechanism of action of glP mimetics?
GLP mimetics, e.g. exenatide, Increase insulin release
FSH/LH and testosterone levels in Kallman’s syndrome?
Low-normal LH/FSH and low testosterone
How does Myxoedema coma present?
Confusion, hypothermia, non-pitting periorbital oedema and eye oedema, reduced respiratory drive, pericardial effusions, anaemia, seizures.
How does thyrotoxic storm present?
Hyperthermia, tachycardia, vomiting and agitation
How does an Addisonian crisis present?
Malaise, nausea and vomiting, abdominal pain, muscle cramps and parasthesia.
What is the acid-base balance/K+ in Cushing’s?
Hypokalaemia metabolic alkalosis
What are the causes of raised prolactin?
Causes of raised prolactin - the p’s
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone
What are the classes of diabetic drugs and examples of each?
DPP-4 e.g. linagliptin
Pioglitazone
Sulfonylurea e.g. gliclazide
SGLT-2 e.g. dapagliflozin
GLP-1 e.g. eventide
What are options for triple therapy in management of T2DM?
metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea
metformin + (pioglitazone or sulfonylurea or DPP-4 inhibitor) + SGLT-2 if certain NICE criteria are met
insulin-based treatment
What are the signs of hypocalcaemia?
1) Tetany- muscle twitching, cramping, spasm
2) Perioral parasthesia
3) Trousseau’s sign- carpal spasm upon occluding brachial artery
4) Chvostek’s sign- tapping over parotid causes twitch of facial muscles
5) Convulsions
ECG signs of hyper- and hypo-calcaemia?
Hypocalcaemia- prolonged QT
Hypercalcaemia- shortened QT
What are the ECG changes for hyperkalaemia?
1) Talented T waves
2) Small P waves
3) Widened QRS
What would you expect from ALP and other LFTs in malignancy?
Raised ALP in the presence of normal LFT’s should raise suspicion of malignancy. Particularly bone cancer/ metastases
What is the investigations for acromegaly?
1st line: Serum IGF-1 levels
2nd line: OGTT (if GH not suppressed then acromegaly)
What is the management of acromegaly?
1st line: Trans-sphenoidal surgery
2nd line: somatostatin analogue (Octreotide) or dopamine agonist (bromocriptine) or GH receptor antagonist (pegvisomant)
What is the investigation for Addison’s disease?
ACTH stimulation test (short Synacthen test)
What is the management of Addisons?
Hydrocortisone
Fludrocortisone
What is the management of Addisons?
Hydrocortisone
Fludrocortisone
Cushing investigations
1st line: overnight (low-dose) dexamethasone suppression test
Also: 24hr urinary cortisol OR bedtime salivary cortisol (both require two measurements)
What is the management of Grave’s disease?
1st line: propranolol for symptoms
2nd: ATD therapy- carbimazole: gradual decrease until euthyroid OR block and replace
3rd line: Radioiodine treatment
What are TFTs like in subclinical hypothyroidism?
TSH raised but T3, T4 normal
What are the causes of Primary hyperparathyroidism?
1) 85%: solitary adenoma
2) 10%: hyperplasia
3) 4%: multiple adenoma
4) 1%: carcinoma
What is the management of Primary hyperparathyroidism?
definitive management: total parathyroidectomy
patients not suitable for surgery may be treated with cinacalcet, a calcimimetic
What are the important possible side effects of metformin?
1) GI upset
2) Anorexia
3) Lactic acidosis
When is metformin contraindicated?
In renal and liver dysfunction
What are the important side effects of sulfonylureas?
1) Weight gain
2) Hypoglycaemia
What are the important side effects of pioglitazone?
1) CHF
2) Anaemia
3) Peripheral oedema
4) fracture
What do TFTs look like in subclinical hypothyroidism?
High TSH but normal T3/T4
What are bloods like in hypoparathyroidism?
Low Calcium, high phosphate
What is the management of hypoparathyroidism?
Alfacalcidol
What is the management of primary hyperparathyroidism?
total parathyroidectomy
What is the management of primary hyperparathyroidism?
total parathyroidectomy
What is the plasma osmolality equation?
2Na + Urea + glucose
What is the most common thyroid Ca?
Papillary carcinoma
What is the management of SIADH?
Mild to moderate: fluid restrict
Acute symptomatic hyponatraemia: hypertonic (3%) saline)
If fluid overload: IV furosemide
What is the management of haemochromatosis?
Primary disease: frequent phlebotomy
Secondary: iron chelation therapy
