Endocrinology Flashcards
Which medications can cause gynacomastia?
Spironolactone
GnRH agonists
What is the management of hypocalcaemia?
Oral calcium carbonate
BUT DO ECG TO CHECK FOR PROLONGED QT
BUT if TETANY/SEIZURE/PROLONGED QT = IV CALCIUM GLUCONATE
what are the causes of hypocalcaemia?
hypoparathyroidism
Vitamin D deficiency
CKD
what are the causes of hyperkalaemia?
AKI
K+ sparing diuretics (e.g. spiro)
Addisons
Rhabdomyolysis
Metabolic acidosis
ACEi
What are the diagnostic criteria for DKA?
pH <7.3
Ketones >3
Glucose >11
(bicarb <15)
What is the management of DKA?
IV Fluid rescuscitation
(1L over 1h)
(1L over 2hrs)
(1L over 2hrs)
(1L over 4hrs)
(1L over 4hrs)
etc.
They are around 5-8 L deplete!
Also need Fixed Rate Insulin Infusion (0.1units/kg/hr)
Once glucose <14, require dextrose infusion alongside fluids
Monitor K with the insulin. Unless K is high, K is given alongside all this.
What marks the resolution of DKA? How long should this take max?
ph>7.3
Ketones <0.6
Glucose <11
Bicarbonate >15
What are the causes of raised prolactin?
1) prolactinoma
2) endocrine - hypothyroid, acromegaly, PCOS
3) physiological - pregnancy, breastfeeding
4) Dopamine suppression (drugs such as 1st gen antipyschotics)
Remember dopamine suppresses prolactin
NB// Cushing’s is always caused by either a tumour or exogenous steroid use
Investigations for Cushing’s?
LDDST
then 9am cortisol, ACTH
Then can do HDDST
What is Kallmann’s?
X-linked recessive
Hypogonadotrophic hypogonadism (low Lh,fsh, testosterone)
delayed puberty, short, small balls, anosmia,
What are the endocrine causes of palpitations?
Thyroid
Phaechromocytoma
1st line investigation for Addison’s?
Short SYNACTHEN test
If unable to, then 9am and midnight cortisol+ACTH levels are 2nd line
What is the Hba1c target in T2DM and when do you add a second drug?
Target 48, but if on hypoglycaemic medication it is 53
Add second drug if HbA1c reaches 58
Do you always add metformin only as 1st line drug in T2DM?
Nope
If CVD/chronic HF/QRISK>10% also add SGLT-2 inhibitor (dapagliflozin) once established on metformin
What are the pros and cons of 2nd line drugs in T2DM?
SGLT-2 inhibitors good for CVD/HF (given as 1st line with metformin)
BUT not good for UTIs, euglycaemic ketoacidosis, foot disease
glilazide (sulfonylurea) - increases activity of insulin so it does cause weight gain.
DPP4 (-gliptins) can be used in renal impairment
GLP1-agonists (-etide) are 3rd line and if BMI>35
Starting doses of levothyroxine>
25 micrograms in over 50yrs
Otherwise 50-100
Diagnostic criteria for DM?
Symptoms plus fasting >7 or random >11
if asymptomatic, need to show on 2 occasions.
Test for t1DM?
antibodies
anti-GAD
anti-islet cells
autoantibodies
(NB// weight loss)
Causes of hyperaldosteronism?
1st line Ix?
Most common - BAH
2nd - adrenal adenoma
1st Line Ix is aldosterone:renin ratio
Then CT Abdomen
If inconclusive adrenal vein sampling
Causes of hypercalcaemia?
Malignancy vs hyperparathyroidism
What must patients always be counselled for when starting carbimazole?
To attend if unwell/coryzal/cough to check FBCC
Ix for acromegaly?
1st - IGF1
Definitive - OGTT
Features of acromegaly?
soft tissue growth
OSA
High BP
1/3rd have prolactin production
How do you treat Conn’s?
If BAH - medical -> Spiro
If adrenal adenoma - surgical -> removal
If hypothyroid patient not being sufficiently replaced on thyroxine, what should you check?
If also taking iron or calcium, as these reduce thyroxine absorption
Which medication can mask patient’s awareness they’re having a hypo?
beta blockers
(suppress tachycardia and tremor caused by low sugar)
What is normal anion gap?
8-14
In T1DM, is c-peptide high or low?
LOW
How do DPP4 inhibitors work?
DPP4 breaks down incretins such as GLP§
DPP4 therefore reduce GLP1 breakdown, increasing it’s levels
(GLP1 helps augment insulin, reduce glucagon and promotes satiety)
