Endocrinology Flashcards
What are the pathologies of the different types of amiodarone-induced thyrotoxicosis
T1 = increased thyroid hormone production driven by iodine
T2 = autoimmune destructive thyroiditis
Management of papillary or follicular thyroid cancer
Thyroidectomy (total)
THEN radioiodine
Risk of tamoxifen
VTE
Contra-indications to testosterone replacement (4)
Prostate cancer
PSA >4
Male breast cancer
Severe OSA (in theory may worsen, increase length and frequency of apnoea)
Inconclusive short synacthen test
- possible diagnoses
- investigation
Long synacthen test - 1,4,8 and 24 hours
Helps differentiate primary and secondary adrenal failure (steroid use, panhypopituitarism)
Success of desmopressin in generating response
> 50% rise in urine osmolality
Management of PCOS
Clomifene citrate
Management of acromegaly if surgery unsuccessful
Octreotide
(cabergoline now not in favour - side effects include cardiac fibrosis)
Ectopic ACTH biochemical feature
Profound hypokalaemia
Management of amiodarone-induced hypothyroidism
Continue amiodarone
Start levothyroxine
Side effects of carbimazole
Agranulocytosis
Liver dysfunction
When do you see flushing and increased stool frequency in carcinoid?
When has metastasised to the liver
Investigation of suspected phaeochromocytoma
MIBG scan
- CT may be negative - remember a proportion are extra-adrenal
Hyperthyroidism in early pregnancy
Consider molar pregnancy as diagnosis
- need US abdomen, hyperthyroidism will correct itself
Medication causing erectile dysfunction
SSRI
- will see elevated prolactin in association
Investigation of choice for Cushing’s
- consideration
High dose dexamethasone suppression test
- if on OCP won’t be reliable, need to use 2x urinary free cortisol measurements
Investigation of acromegaly
Screen = IGF-1 level
Diagnosis
Oral glucose tolerance test + growth hormone levels
Mechanism of SIADH due to head injury
- management
Release of stored vasopressin due to damage to hypothalamic axons
(from trauma)
Low plasma osmolality + high urine osmolality
Can then progress to DI = failure to release ADH
MODY - common mutation
HNF1a mutation
Respond well to low dose sulphonylurea
Starting a statin in diabetes (4)
- Older than 40 years
- Had diabetes for more than 10 years
- Established nephropathy
- Other CVD risk factors
Non visible haematuria
- contraindication to what diabetes management?
Pioglitazone due to bladder cancer
Carcinoid
- associated with what endocrine condition?
Cushing’s Syndrome
= cause of ACTH secretion, well circumscribed lesion on XR
Management of proliferative diabetic retinopathy
Intravitreal VEGF
e.g. ranibizumab
Management of sulphonylurea overdose
= octreotide
(BMs will not respond well to glucose)
Urine sodium in Addison’s
High
= no hormone action instructing kidneys to retain sodium
Low testosterone
Normal FSH/LH
Lack of secondary sexual characteristics
Kallman’s Syndrome
= hypogonadotrophic hypogonadism
FSH and LH should be high to try and increase testosterone
Addison’s disease
- what should they always have?
IM hydrocortisone
Over replacement with levothyroxine - risk?
Osteoporosis
How can you assess how steroid replete someone is in Addison’s?
Cortisol day curve
Early 2y sexual characteristics in man
Hypokalaemia
11 beta hydroxylase deficiency
Addison’s + T1DM
(or + autoimmune thyroid disease)
- diagnosis
Autoimmune polyendocrine syndrome type 2
Advice for steroids in excessive exercise in Addison’s
Double glucocorticoid and mineralocorticoid
Advice for diabetic on insulin + HGV
Can keep licence as long as
- have not suffered hypo in last 12 months that needed 3rd party assistance
- No visual field impairment
Need annual review by diabetologist
Gestational diabetes
- decision about insulin
Give insulin if fasting glucose >7
Management of relapse of Grave’s Disease
- contraindications (2)
Radioiodine treatment
= pregnancy, thyroid eye disease
Investigation of choice for GH deficiency
GNRH arginine stimulation test
Raised calcium
Raised/normal PTH
- diagnosis?
Familial benign hypocalciuric hypercalcaemia
Raised C peptide
Raised insulin levels
- differential?
SU abuse
Insulinoma
Insulin levels in insulinoma > SU abuse
