Endocrinology Flashcards
DKA resolution defined as
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
Tx once DKA resolved
Switch the patient to subcutaneous insulin so long as patient is eating and drinking normally
Insulin stress test:
insulinoma vs inappropriate exogenous insulin injection
Insulinoma- C-peptide levels do not fall
Inappropriate exogenous insulin injection: C-peptide levels fall
Medullary thyroid cancer gene association
RET oncogene
Endocrine parameters reduced in stress response:
Insulin
Testosterone
Oestrogen
DKA insulin dose
fixed rate IV insulin infusion at 0.1 unit/kg/hour
High dose dexamethasone suppression test- Cushings disease
suppressed cortisol and ACTH
falsely high HbA1c
due to increased lifespan of RBC:
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
falsely low HbA1c
due to decreased lifespan of RBC:
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
most common complication of thyroid eye disease
exposure keratopathy
(red and painful eye)
How to distinguish between primary adrenal failure and secondary adrenal insufficiency?
skin pigmentation
atypical features of T1DM that require further investigation (c-peptide levels, autoantibodies)
age 50 years or above
BMI of 25 kg/m² or above
slow evolution of hyperglycaemia or long prodrome
insulin vs gliclazide overdose
insulin: raised insulin levels, c-peptide normal
gliclazide: raised insulin and c-peptide levels
Insulinoma Whipple’s triad of symptoms
1) hypoglycaemia with fasting or exercise
2) reversal of symptoms with glucose,
3) recorded low BMs at the time of symptoms
Gradual withdrawal of steroids if:
received more than 40mg prednisolone daily for more than one week
received more than 3 weeks of treatment
recently received repeated courses
Cx of fluid resuscitation in DKA
cerebral oedema:
headache, irritability, visual disturbance, focal neurology etc.
Non-functioning pituitary adenomas
hypopituitarism and mass effect symptoms, (postural headache and visual loss)
serum osmolality
2Na + urea + glucose
phaeo Ix
urinary metanephrines
Thyroid nodules Ix
Ultrasonography
tender goitre
De Quervain’s thyroiditis
Sx specific to Graves
Eye signs (exophthalmos, ophthalmoplegia)
pre-tibial myxoedema
thyroid acropachy
Drugs causing galactorrhea
metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids
De Quervains thyroiditis Tx
NSAIDs- self-limiting
causes of raised Prolactin
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone
Patients with type I diabetes and a BMI > 25
Metformin in addition to insulin
first line insulin regimen in children with T1DM
multiple daily injection basal-bolus insulin regimen
Gastroparesis Tx
metoclopramide
presents as upper gastrointestinal symptoms and erratic glucose control due to gastric emptying dysfunction
Most important blood test to measure response to levothyroxine
TSH
MODY Tx
sulphonylureas - gliclazide
hypercalcaemia secondary to malignancy
PTH is low, although PTHrP may be raised
high dose dexamethasone test: adrenal adenoma
cortisol not suppressed
ACTH suppressed
secondary hypothyroidism Ix
MRI pituitary
Acromegaly Ix
First line= IGF-1
gold standard= OGTT
HHS risk
central pontine myelinolysis
subclinical hypothyroidism in elderly
watch and wait if age>80
if <65–> trial of levothyroxine, and recheck TFT in 6 months
drug induced gynaecomastia
spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids
In type 1 diabetics, blood glucose targets:
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
high dose dexamethasone test adrenal adenoma
cortisol not suppressed
ACTH suppressed
tumour produces excess cortisol
kallmann vs klinefelters
kallman= hypogonadotrophic hypogonadism
klinefelters= hypergonadotrophic hypogonadism
Sick euthyroid syndrome =
low T3/T4 and normal TSH with acute illness
hyperthyroidism in pregnancy
in the first trimester –> propylthiouracil
C-peptide levels in T1 vs T2 DM
low in T1
high in T2
MALT lymphoma associations
hashimotos
H.pylori
gliclazide drug class
sulphonylurea
subclinical hypothyroidism Investigation
Check thyroid peroxidase antibodies
–> can indicate patients who are more likely to progress to overt hypothyroidism
pre-diabetes and BMI>35
liraglutide
Cushing’s syndrome ABG
hypokalaemic metabolic alkalosis
Erratic blood glucose control, bloating and vomiting
gastroparesis
klienfelters
47XXY
high LH FSH low testosterone
gynaecomastia
tall
small firm testes
infertile
-gliptins mechanism of action
DPP-4 inhibitors
reduce peripheral breakdown of incretins such as GLP-1
metformin contraindicated if
eGFR of less than 30 ml/min.
Thyrotoxic storm is treated with
beta blockers, propylthiouracil and hydrocortisone
diabetes medication contraindicated in HF
pioglitazone
