Endocrinology

Question 1

Causes of cranial diabetes insipidus?

Answer 1

Causes of AVP Deficiency (Cranial DI)

Head trauma
Inflammatory conditions (e.g., sarcoidosis)
Cranial infections such as meningitis
Vascular conditions such as sickle cell disease
Rare genetic causes

Question 2

Causes of nephrogenic diabetes insipidus?

Answer 2

Causes of AVP Resistance (Nephrogenic DI)

Drugs (e.g., lithium)
Metabolic disturbances (e.g., hypercalcaemia, hypokalaemia, hyperglycaemia)
Chronic renal disease
Rare genetic causes (e.g., Wolfram’s syndrome)

Question 3

common causes of osteoporosis?

Answer 3

history of glucocorticoid use
rheumatoid arthritis
alcohol excess
history of parental hip fracture
low body mass index
current smoking

Question 4

Medications that may worsen osteoporosis (other than glucocorticoids)

Answer 4

SSRIs
antiepileptics
proton pump inhibitors
glitazones
long term heparin therapy
aromatase inhibitors e.g. anastrozole

Question 5

further investigations for osteoporosis?

Answer 5

History and physical examination
full blood count
urea and electrolytes
liver function tests
bone profile
CRP
thyroid function tests
Bone densitometry ( DXA)
myeloma screen + Bence Jones proteins

PSA
Prolactin

Question 6

adverse effects of bisphosphonates?

Answer 6

oesophagitis/ ulcers
osteonecrosis of the jaw -> needs dental check
increased risk of atypical stress fracture
acute phase reactant-> myalgia, fever, arthralgia

Hypocalcaemia/vitamin D deficiency should be corrected before giving bisphosphonates.

Question 7

investigations for gestational diabetes?

Answer 7

Diagnosis of GDM is based on a 75g OGTT:

-Fasting blood glucose level (fasting glucose ≥5.6 mmol/L)
-2-hour plasma glucose level (2-hour glucose ≥7.8 mmol/L)

This can be remembered as ‘diagnosis of GDM is as easy as 5678’

Additional tests may include:

HbA1c: Helpful in distinguishing between gestational and pre-existing diabetes early in pregnancy
Urinalysis: To check for glycosuria

Question 8

maternal complications of gestational DM?
foetal complications of gestational DM?

Answer 8

Maternal:
HNT and pre-eclampsia

Foetal:
Macrosomia -> shoulder dystocia-> c-section
Sacral agenesis
NRDS
Neonatal hypoglycaemia

Question 9

Management of gestational DM?

Answer 9

-Lifestyle
-Metformin
-If fasting glucose levels are ≥7 mmol/L, insulin therapy with or without metformin is often the first-line treatment.
-Postpartum management includes glucose testing to ensure resolution of GDM and long-term follow-up due to the increased risk of future type 2 diabetes.

Question 10

Causes of smooth goitre?

Answer 10

Grave’s disease
Hashimoto’s
Lithium
Amiodarone
Iodine deficiency/ excess
De Quervain’s thyroiditis

Question 11

Causes of nodular goitre?

Answer 11

Toxic solitary adenoma
Non-functional thyroid adenoma
Multinodular goitre
Thyroid cyst
Thyroid Ca

Question 12

Investigations for goitre?

Answer 12

TFTs
Thyroid USS
Thyroid FNA biopsy

Question 13

Management for goitre?

Answer 13

Observation: Small, asymptomatic goitres may simply be observed.

Pharmacotherapy: Anti-thyroid drugs for hyperthyroidism, levothyroxine for hypothyroidism.

Radioiodine treatment: Used in hyperthyroid conditions or large goitres.

Surgery: Considered for large goitres causing compressive symptoms, suspicious or malignant cytology on FNA, or for cosmetic reasons.

Question 14

causes of hypoglycaemia?

Answer 14

Causes of hypoglycaemia include:

Drugs: Insulin, Sulphonylureas, GLP-1 analogues, DPP-4 inhibitors, Beta-blockers
Alcohol
Acute liver failure
Sepsis
Adrenal insufficiency
Insulinoma
Glycogen storage disease