Endocrinology

Question 1

RFs for Osteoporosis

Answer 1

• history of glucocorticoid use
  
  • rheumatoid arthritis
  • alcohol excess
  • history of parental hip fracture
  • low BMI
  • current smoking

Other risk factors
* sedentary lifestyle
* premature menopause
* Caucasians and Asians
* endocrine disorders: hyperthyroidism, hypogonadism (e.g. Turner’s, testosterone deficiency), growth hormone deficiency, hyperparathyroidism, diabetes mellitus
* multiple myeloma, lymphoma
* gastrointestinal disorders: inflammatory bowel disease, malabsorption (e.g. coeliac’s), gastrectomy, liver disease
* CKD
osteogenesis imperfecta, homocystinuria

Question 2

Medications that may worsen osteoporosis

Answer 2

Medications that may worsen osteoporosis STEROIDS
* SSRIs
* antiepileptics
* PPI
* glitazones
* long term heparin therapy
* aromatase inhibitors e.g. anastrozole
* phenytoin

Question 3

Secondary causes of Osteoporosis

Answer 3

• endocrine disorders: hyperthyroidism, hyperparathyroidism, diabetes mellitus
  hypogonadism (e.g. Turner’s, testosterone deficiency), growth hormone deficiency, Vitamin D Def
  
  • multiple myeloma, lymphoma
  • gastrointestinal disorders: inflammatory bowel disease, malabsorption (e.g. coeliac’s), gastrectomy, liver disease
  • CKD
    osteogenesis imperfecta, homocystinuria

Question 4

Most important Secondary causes of Osteoporosis (this card is here twice for re-enforcement)

Answer 4

Hypogonadism
Vitamin D deficiency
Hyperthyroidism
Hyperparathyroidism
Coeliac disease
Multiple myeloma
Drugs: corticosteroids, anti-epileptics (phenytoin), GnRH agonists, aromatase inhibitors
Chronic diseases: liver, kidney, RA…

Question 5

What is FRAX?

Answer 5

FRAX — fracture risk calculator
Developed by WHO to calculate fracture risk
* (other risk calculators available eg GARVAN)
Men and women aged 40-90
Integrates clinical risk factors and femoral neck BMD
calculates 10-year probability of fracture at hip or any site

Question 6

10 year risk > **

When should you consider tx based on FRAX score?

Answer 6

Treatment should be considered if 10 year risk of osteoporotic fracture is > 20% or hip
fracture > 3%.
So improves fracture prediction but relies on Femoral Neck BMD

Question 7

What’s in the FRAX score

Answer 7

FRAX - age, sex, weight, height, prev fracture, FHx fractures, smoking, alcohol, RA, Th, steroids, and femoral neck BMD

Question 8

What is DM effect on bone health?

Answer 8

DM - associated with increased fracture risk, esp T2DM.
Bone density with DM is higher, but despite this fracture risk is increased.

Question 9

What constitutes treatment failure whilst on tx for osteoporosis?

Answer 9

Tx failure eg loss of bone density and 1 or more fractures whilst on tx

Question 10

Two up two down

What endocrine causes for Osteoporosis

Answer 10

Endocrine Causes, two up two down
HyperThy
HyperparaThy
Hypogonad
HypoVitD

Question 11

Teriparatide is a PTH analogue, it’s main MOA is…

Answer 11

Increased osteoblastic activity

Question 12

Teriparatide has good efficacy for how long?

Answer 12

18months to 2 years in studies, then osteoclast activity increases

Question 13

Specific test for Growth Hornone def

Answer 13

Glucagon testing (1st line in aus)
Insulin tolerance test (2nd line)

Question 14

Growth Hormone peaks at what time of day

Answer 14

Just before midnight

Question 15

Cortisol peaks at what time of day

Answer 15

Early morning

Question 16

Growth Hormone XS test

Answer 16

IGF1 random
OGTT

Question 17

Growth Hormone XS causes

Answer 17

Primary (pit adenoma, pit ca, men1)
Extrapituitary GH XS (eg NET, panc tumour, lymphoma, iatrogenic)
GHRH XS (lung cancer, medullary Th cancer etc)

Question 18

GH XS is rarely associated with which other condition

Answer 18

MEN 1