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
