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XUAN MSRA > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is the most common endogenous cause of Cushing’s?

A

Pituitary adenoma

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2
Q

What are the ACTH dependent causes of Cushing’s? (2)

A
  1. Cushing’s (disease)- pituitary adenoma
  2. Ectopic ACTH e.g. small cell lung Ca
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3
Q

What are the ACTH independent causes of Cushing’s? (3)

A
  1. iatrogenic (steroids)
  2. adrenal adenoma
  3. adrenal carcinoma
  4. carney complex- cardiac myxoma including syndrome
  5. micronodular adrenal dysplasia)
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4
Q

What would you expect to see in regard to glucose, sodium and potassium in Addison’s?

A

Hypoglycaemia, hyponatraemia, hyperkalaemia

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5
Q

What is the management of diabetic gastroporesis?

A

Metoclopramide, Domperidone or erythromycin (prokinetic agents)

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6
Q

When are SGLT-2 used in management of diabetes?

A
  1. High risk of CVD (Q-risk >10%)
  2. Established CVD
  3. Chronic heart failure
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7
Q

What is the most common cause of primary hyperaldosteronism?

A

Bilateral idiopathic adrenal hyperplasia

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8
Q

What are the causes of primary hyperaldosteronism? (5)

A
  1. bilateral idiopathic adrenal hyperplasia: the cause of around 60-70% of cases
  2. adrenal adenoma: 20-30% of cases
  3. unilateral hyperplasia
  4. familial hyperaldosteronism
  5. adrenal carcinoma
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9
Q

Two key features of primary hyperaldosteronism (2)

A

Hypertenison
Hypokalaemia

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10
Q

Management of primary hyperaldosteronism (2)

A
  1. adrenal adenoma= surgery (laparoscopic adrenalectomy)
  2. bilateral adrenocortical hyperplasia= aldosterone antagonist e.g. spironolactone
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11
Q

Management of painful dibetic neuropathy?

A
  1. first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
  2. if the first-line drug treatment does not work try one of the other 3 drugs
  3. tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
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12
Q

Which diabetic medications are contraindicated in heart failure?

A

Pioglitazone (thiazolidinedione)- causes fluid retention which can exacerbate heart failure

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13
Q

What do TFTs look like in sick euthyroid syndome?

A

Low T3/4 and normal TSH

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14
Q

When do you test C-peptide levels and how do they differentiate between T1DM and T2DM?

A

If patient is at intermediate age check C-peptide. if low indicates T1DM

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15
Q

What are impaired fasting glucose levels?

A

6.1-7.0 mmol/l

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16
Q

What are impaired glucose tolerance levels?

A

Fasting plasma glucose less than 7.0 mmol/l AND OGTT 2-hour value 7.8-11.1 mmol/l

17
Q

What is the mechanism of action of DPP-4?

A

Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1

18
Q

What is the mechanism of action of metformin?

A

Metformin increases peripheral insulin sensitivity and reduces hepatic gluconeogenesis

19
Q

What is the mechanism of action of sulfonylureas?

A

Sulfonylureas augment pancreatic insulin secretion. Increased insulin secretion can lead to hypoglycaemia.

20
Q

What is the mechanism of action of glP mimetics?

A

GLP mimetics, e.g. exenatide, augment pancreatic insulin secretion, suppress glucagon release, slow gastric emptying and promote satiety.

21
Q

What would you expect from TFTs in sick euthyroid syndrome?

A

Normal/low TSH and low T3/4

22
Q

FSH/LH and testosterone levels in Kallman’s syndrome?

A

Low-normal LH/FSH and low testosterone

23
Q

How does Myxoedema coma present?

A

Confusion, hypothermia, non-pitting periorbital oedema and eye oedema, reduced respiratory drive, pericardial effusions, anaemia, seizures.

24
Q

How does thyrotoxic storm present?

A

Hyperthermia, tachycardia, vomiting and agitation

25
Q

How does an Addisonian crisis present?

A

Malaise, nausea and vomiting, abdominal pain, muscle cramps and parasthesia.

26
Q

What is the acid-base balance/K+ in Cushing’s?

A

Hypokalaemia metabolic alkalosis

27
Q

What are the causes of raised prolactin?

A

Causes of raised prolactin - the p’s
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

28
Q

What are the classes of diabetic drugs and examples of each?

A

DPP-4 e.g. linagliptin
Pioglitazone
Sulfonylurea e.g. gliclazide
SGLT-2 e.g. dapagliflozin
GLP-1 e.g. eventide

29
Q

What are options for triple therapy in management of T2DM?

A

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

30
Q

What are the signs of hypocalcaemia?

A

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

31
Q

ECG signs of hyper- and hypo-calcaemia?

A

Hypocalcaemia- prolonged QT
Hypercalcaemia- shortened QT

32
Q

What are the ECG changes fir hyperkalaemia?

A

1) Talented T waves
2) Small P waves
3) Widened QRS

33
Q

What would you expect from ALP and other LFTs in malignancy?

A

Raised ALP in the presence of normal LFT’s should raise suspicion of malignancy. Particularly bone cancer/ metastases

34
Q

What is the investigations for acromegaly?

A

1st line: Serum IGF-1 levels
2nd line: OGTT (if GH not suppressed then acromegaly)

35
Q

What is the management of acromegaly?

A

1st line: Trans-sphenoidal surgery
2nd line: somatostatin analogue (Octreotide) or dopamine agonist (bromocriptine) or GH receptor antagonist (pegvisomant)

36
Q

What is the investigation for Addison’s disease?

A

ACTH stimulation test (short Synacthen test)

37
Q

What is the management of Addisons?

A

Hydrocortisone
Fludrocortisone

38
Q

What is the management of Addisons?

A

Hydrocortisone
Fludrocortisone

39
Q

Cushing investigations

A

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XUAN MSRA (20 decks)

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