Endocrinology Flashcards
PTH level in primary hyperparathyroid?
what is calcium and phosphate?
PTH can be normal / high
calcium is high
phosphate is low
causes of primary Hyperparathryoidism?
pituitary adenoma
bilateral hyperplasia
multiple adenoma
management of acute DKA?
what should insulin be?
fixed rate insulin
continue long acting
hold short acting
intravenous infusion rate of insulin for DKA includes?
0.1 unit/kg/hour of insulin
aim is to reduce ketones
when should you add dextrose infusion
once glucose <14mmol
start 10% dextrose infusion rate of 125ml / hour
primary hyperaldosteronism
how to differentiate between bilateral hyperplasia and conns?
Adrenal venous sampling
T2DM
mx
if triple therapy fails?
switch a drug to either
GLP-1 mimetic
insulin
2nd line T2DM
if not able to get under 58 mmol
7.5%
dual therapy
metformin
metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea
metformin + SGLT-2 inhibitor
example of a Dpp-4 inhibitor?
act on incretin system
DPP-4 usually breaks down GLP-1
Sitagliptin is an example
pioglitazone MOA and example
negative s/e
thiazolidinedione
improves insulin sensitivity
weight gain
worsen HF
Sulfonyureas
cause release of insulin from beta pancreatic cells
Glipizide
SGLT2 inhibitors?
dapagliflozin
most common cause of malignancy thyroid?
papillary carcinoma
First line in thryoid nodules?
ultrasonograohy
High-dose dexamethasone suppression test with a pituitary adenoma
affects on cortisol?
on acth?
cortisol not suppressed
ACTH suppressed
an HBA1c of what is considered diagnostic if patient also has symptoms?
HBa1c of 48mmol >
6.5%
Random glucose test diagnostic of T2DM?
11.1
fasting glucose?
7.0 mmol/l
what is pre diabetes?
42-47
6.0-6.4%
OGTT impaired fasting glucose?
OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
Diffusely reduced uptake of radioactive iodine-131
is shown in what?
subacute de quervein thyroiditis
High-dose dexamethasone suppression test with an ectopic source of ACTH
not suppressed
not suppressed
tender goitre and hyperthyroid signs
subacute (De Quervain’s) thyroiditis
Graves is not tendeer
is the single most important blood test to assess a patient’s response to treatment with levothyroxine for Hashimoto’s thyroiditis.
TSH
what is klinefelters?
47 XXY
primary hypogonadism
testicular failure
neoplastic lesions in the pituitary gland
parathyroid gland
pancreas
multiple endocrine neoplasia type 1
all p’s
multiple endocrine neoplasia 2?
2a
2p’s
parathyroid
phaeochromocytoma
men type 2b?
medullary thyroid cancer
1P
phaechromocytome
marfanoid
prednisolone / glucocorticoids can cause?
neutrophilia
what is the difference between impaired fasting glucose
impaired glucose tolerance
impaired fasting is on a fasting plasma
6.1- 6.9
Impaired glucose tolerance is on an OGTT
7.8-11
congenital androgen insensitivity syndrome
phenotype is female - female genitalia
genotype is male
diabetic neuropathy
GI
Gastroparesis
GORD
chronic diarrhoea
what is the pathophysiology of gastroparesis?
sensory loss from diabetes
autonomic
neuropathy
what is the trademarks of gastroparesis?
delayed gastric emptying (due to autonomic dysfunction = erratic BM)
bloating
nausea
early satiety
vomiting
why does cushing cause hypokalaemia metabolic alkalosis?
excess of cortisol production
= sodium and water retention
=htn
and hypokalaemia
hypoglycaemia mx?
oral glucose 10-20
quick-acting carbohydrate
intravenous 20% glucose solution
modifiable risk factor for development of thyroid eye disease?
smoking
thyroid eye disease presenting with change
Any change in vision with thyroid eye disease requires urgent review by a specialist
Mx DKA
1st line isotonic saline - fluid !!!
fixed rate insulin
when glucose <14 add 10% dextrose
check and manage potassium 1u/kg/day
which class of antidiabetics are good for weight loss>?
Dpp-4 inhibitors
GLP1 mimetics (obvi)
Primary hyperaldosteronism management?
spironolactone
thiazides cause which electrolyte abnormality?
hypercalcaemia
T1DM how often should you monitor as a minimum?
4 times before bed and every meal
Blood glucose targets
T1DM
on waking
5-7 mmol
Blood glucose targets
T1DM
after meals?
4-7 mmol/l
regime of choice for t1dm?
twice-daily insulin detemir
Once-daily insulin glargine or insulin detemir
