Endocrinology Flashcards
A young man with short stature, short 5th metacarpals, subcutaneous calcification, intellectual impairment and hypocalcemia.
Pseudohypoparathyroidism.
That is loss of function mutation affecting the G protein-linked receptor for PTH.
Hormones involved in calcium regulation.
1- PTH ( Calcium increased)
2- Vit D ( Calcium Increased)
3- Calcitonin ( Calcium decreased)
Diabetic Neuropathy
- Distal. symmetrical polyneuropathy
- Autonomic Neuropathy
- Diabetic Amyotrophy
Thyrotoxicosis
-Thyrotoxicosis is divided into
1- Graves’ Disease ( TSH-receptor antibody positive 95%, TPO antibody positive in 80%)
Exophthalmos, Lid retraction, Ptrtibial Myxoedema, Thyroid acropachy.
Carbimazole is the Rx.
2- Nodular Thyroid Disease ( Solitary toxic nodule, Toxic Multinodular goitre)
-Radioactive iodine therapy ( dose of 300- 500 MBq) is used to treat thyrotoxicosis.
3- Thyroiditis ( Viral, post partum, Drugs)
Direct precursor to Oestradiol
Testosterone is derived from cholesterol and is converted to oestradiol by aromatase.
Diabetes
0.2 U/kg or a flat dose of 10 U is the recommended starting dose for intermediate acting insulin.
MODY
Monogenic diabetes/MODY is associated with gene mutations, most commonly HNF-1 alpha
24 hours urinary free cortisol
Initial screening test to diagnose Cushing syndrome
Weight Reduction
- it should be used in patients who have demonstrated dietary compliance with at least a 2.5 kg weight reduction.
Orlistat functions through inhibiting the absorption of dietary fat from the GI tract. Consequently, its side effects include flatulence and diarrhoea.
Short synacthen test is used to diagnose addison’s disease.
The link between Addison’s and primary hypothyroidism is that they are both conditions in the complex of autoimmune polyendocrine syndrome. Other possible associations of this cluster would be:
- Type 1 diabetes
- vitiligo
- pernicious anaemia, and
- chronic active hepatitis.
Pheochromocytoma
Phenoxybenzamine should be intiated first to treat phaeochromocytoma.
Diagnosis of Type 2 DM
Fasting glucose > 6.9 on two separate occasions
Grave’s Eye disease
Block replace ( high dose carbimazole and thyroxine replacement) is initial choice for managing thyrotoxicosis in patients with significant thyroid eye disease.
» Radioiodine leads to transient worsening of thyroid eye disease.
Tapering steroids
In patients on long-term glucocorticoid therapy, particularly those with low morning cortisol levels, switching to a shorter-acting glucocorticoid like hydrocortisone and tapering gradually is recommended to reduce the risk of adrenal insufficiency during the tapering process.
Adrenal insufficiency
( Hyponatremia, Hyperkalemia, Postural hypotension)
Short synacthen test
Acromegaly
Gold standard test to confirm growth hormone excess is IGF-1 serum levels
Role of metformin in PCOS
Polycystic ovarian syndrome is recognised to be a condition associated with increased insulin resistance and metformin is effective through improvements in insulin sensitivity resulting in ovulation and improvements in hormonal perturbations
Metformin adjustment in Ramadan
During Ramadan, one-third of the normal metformin dose should be taken before sunrise and two-thirds should be taken after sunset
Addisons disease
- lethargy, weakness, anorexia, nausea & vomiting, weight loss, ‘salt-craving’
hyperpigmentation (especially palmar creases) - vitiligo
- loss of pubic hair in women
- hypotension
- hypoglycaemia
- hyponatraemia and hyperkalaemia may be seen
crisis: collapse, shock, pyrexia
Causes of primary hyperparathyroidism
Causes of primary hyperparathyroidism
85%: solitary adenoma
10%: hyperplasia
4%: multiple adenoma
1%: carcinoma
Treatment of primary hyperparathyroidism
Investigations
- bloods
raised calcium, low phosphate
- PTH may be raised or (inappropriately, given the raised calcium) normal
- technetium-MIBI subtraction scan
x-ray findings
pepperpot skull
osteitis fibrosa cystica
Treatment
the definitive management is total parathyroidectomy
Subacute (De Quervain’s) thyroiditis
Thyrotoxicosis with tender goitre = subacute (De Quervain’s) thyroiditis
The correct answer is naproxen. The diagnosis here is that of subacute (De Quervain’s) thyroiditis, given the history of following a viral illness, raised ESR, tender goitre and initial hyperthyroid phase. Ultimately, this condition is usually self-limiting, and simple analgesia is all that is required.
Subacute Thyroiditis
Subacute thyroiditis (also known as De Quervain’s thyroiditis and subacute granulomatous thyroiditis) is thought to occur following viral infection and typically presents with hyperthyroidism.
There are typically 4 phases;
- phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
- phase 2 (1-3 weeks): euthyroid
- phase 3 (weeks - months): hypothyroidism
- phase 4: thyroid structure and function goes back to normal
Investigations
thyroid scintigraphy: globally reduced uptake of iodine-131
Management
usually self-limiting - most patients do not require treatment
thyroid pain may respond to aspirin or other NSAIDs
in more severe cases steroids are used, particularly if hypothyroidism develops
Thyroid lymphoma
Hashimoto’s thyroiditis is associated with thyroid lymphoma
