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
Diagnosis of Wilson’s disease
Elevated 24 hour urinary copper
Low ceruloplasmin
What medication should you stop in acute thyrotoxicosis?
Stop aspirin
= binds to thyroxine B globulin
Displaces fT4 means there is more in circulation = makes everything worse
Slate grey appearance
New diagnosis of diabetes
Diagnosis?
Haemochromatosis
If you give insulin what should happen to internal insulin production?
Should supress insulin production
If insulinoma present, will continue regardless - will see raised c-peptide reflecting insulin production
Hyperthyroid
Reduced uptake on scan
Consider thyrotoxicosis factitita
= taking exogenous levothyroxine
Contraindications to radio-iodine
Pregnancy
Thyroid eye disease
Under 16 years old
Management in thyroid storm
PTU not carbimazole
- PTU has additional action to inhibit peripheral conversion to T3
Family history of diabetes
Raised C-peptide
- diagnosis
- management
MODY
Gliclazide
> 2 hypoglycaemic episodes requiring assistance
Need to surrender driving licence
Diagnosis of Addison’s disease
Short synacthen
Initial investigation of 2y amenorrhoea
Prolactin
(TSH and FSH)
Target HbA1c in pancreatectomy
53 - don’t going chasing dreams
Autoimmune polyendocrinology syndrome
Type 1
Addison’s
Primary hypoparathyroidism
Chronic candidiasis
Autoimmune polyendocrinology syndrome
Type 2
Addison’s
T1DM or autoimmune thyroid condition
Differentiating between Cushing’s and pseudo-Cushing’s (e.g. XS alcohol)
Insulin stress test
Biochemical features of PCOS
High testosterone
Insulin resistance
Increased LH/FSH ration (due to raised LH)
Management of bilateral adrenal hyperplasia
Aldosterone antagonist
Management of PCOS
- main concern hirsutism or acne
Co-cyprindol
Repeated admission due to DKA/issues with insulin omission
- management
Switch long acting insulin to ultra long acting e.g. tresiba
Thyroid cancer monitoring - what are you aiming for with TSH
Keep them very low - don’t want TSH activating any naughty thyroid tissue
Management of lithium induced hypothyroidism
Levothyroxine
Irreversible effects of excessive steroid use
Male pattern baldness
Reversible effects of steroid use (4)
Acne
Erectile Dysfunction
Oedema
Libido change
Management of non-functioning adenoma causing hypopituitarism
Surgical management
BM recommendations T1DM
Morning - 5-7
Pre meal - 4-7
90 mins post meal - 5-9
Management of lithium induced diabetes insipidus
Thiazide diuretics
Consideration in management of panhypopituitarism
Must be steroid replete prior to starting treatment for hypothyroidism
- may trigger adrenal crisis
Post partum management of gestational diabetes
Need fasting blood glucose 6-12 weeks later
Grave’s disease treated with radioiodine
Planning child
Ensure long enough has passed
Check for TSH antibodies - can cross placenta: if present will need treatment even if euthyroid
Cause of pseudohyponatraemia
IV immunoglobulin
Investigation of choice
adrenal hyperplasia VS adenoma
Adrenal vein sampling
Management of withdrawing anabolic steroids
Nil taper needed
Congenital adrenal hyperplasia
- mutation
- diagnosis
21 hydroxylase mutation
Short synacthen test
What is subacute granulomatous thyroiditis?
de Quervain’s thyroiditis
Thyroid mass <1cm on imaging
Euthyroid
Needs no invasive investigation
Urine osmolality in hyponatraemia
Urine >100 = increasingly concentrated
e.g. SIADH, hypothyroidism, ACTH deficiency
Urine <100 = dilute urine
e.g. primary polydipsia, beer potomania
What manifestations are reversible in haemochromatosis with treatment?
Fatigue
Transaminitis
What insulin do you use in DKA?
Fixed rate
