Endocrinology 2 Flashcards
What is sick euthyroid?
Management?
incidental finding of low fT4 with normal TSH on a background of an acute infection
Repeat thyroid function test in 6 weeks
Subclinical hyperthyroidism is associated with (3)
Causes (2)
see what in tests?
- atrial fibrillation
- osteoporosis
- and possibly dementia
- multinodular goitre, particularly in elderly females
- excessive thyroxine
normal serum free thyroxine and triiodothyronine levels
with a thyroid stimulating hormone (TSH) below normal range (usually < 0.1 mu/l)
How do youmanage asymptomatic patient with fasting glucose > 7.0 or random glucose/ OGGT > 11.0?
MUST demonstrate on two seperate occasions before giving diag and giving med.
Freebee- PTH can be inappropriatley normal in primary hyperparathyroidism
Diabetic Neuropathy management
- first-line- 4 options
- Use 1 of the other 3
- Breakthrough pain-
- Localised neurpathic pain use—
- Finally
- first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
- Doesn’t work, try one of the other
- tramadol as rescue thrapy
- topical capsaicin
- pain management clinics if tx. resistant
Gastroparesis
symptoms (3)
management (3 options)
Chronic diarrhoea
often occurs at night
Gastro-oesophageal reflux disease
caused by decreased lower esophageal sphincter (LES) pressure
erratic blood glucose control, bloating and vomiting
metoclopramide, domperidone or erythromycin (prokinetic agents)
Investigations for acromegaly
- First line = (if raised)
- Diagnostic-
- First line = IGF-1 levels, (if raised)
- Diagnostic- oral glucose tolerance test (OGTT) with serial GH measurements is suggested to confirm the diagnosis
Kallman’s syndrome - bloods
LH & FSH low-normal and testosterone is low
absence of GnRH producing cells.
Further, failure of olfactory nerve development causes a reduced or absent sense of smell, which is characteristic
The presence of an elevated prolactin level along with secondary hypothyroidism and hypogonadism is indicative of stalk compression is consistent with a non-functioning pituitary adenoma
The presence of an elevated prolactin level along with secondary hypothyroidism and hypogonadism is indicative of stalk compression is consistent with a non-functioning pituitary adenoma
What should you do if ketonaemia and acidosis have not been resolved within 24 hours?
Endocrinology review- patient should be reviewed by a senior endocrinologist
educe blood ketones by around 1mmol/hr and glucose by around 3mmol/hr.
patient is expected to be eating and drinking normally by 24hrs- at this point can be switched to subcutaneous insulin.
which anti-diabetic drug is associated with an increased risk of bladder cancer
Thiazolidinediones- pioglitazone
What medication can reduce the absorption of levothyroxine?
should be taken how long apart form each other?
Iron / calcium carbonate tablets
- should be given 4 hours apart
HHS or DKA how do you tell the difference?
diagnostic criteria for hyperosmolar hyperglycaemic state (HHS): (3)
HHS
- over days
- No ketonaemia
- no acidosis
- obvs have hyperglycaemia and stupidly high Na+ (serum osmolality > 320)
DKA
- over hours
- obvs ketonaemia
- obvs acidosis
- hyperglycaemia (same)
- hypovolaemia
- hyperglycaemia (blood sugar > 30mmol/L)
- serum osmolality > 320mosmol/kg.
Presentation includes hypovolaemia, fatigue, lethargy, altered consciousness, hypotension and tachycardia.
HHS management
1.
- rate?
2. DONT GIVE….. UNLESS
3. WHy?
Complications of the disorder? (2)
- fluid replacement
(estimated to be between 100 - 220 ml/kg)
- IV 0.9% sodium chloride solution
- typically given at 0.5 - 1 L/hour depending on clinical assessment
- potassium levels should be monitored and added to fluids depending on the level - insulin
should not be given unless blood glucose stops falling while giving IV fluids - VTE prophylaxis
patients are at risk of thrombosis due to hyperviscosity
Due to increase blood viscosity:
1. MI
2. Stroke
Phaeochromocytoma typically presents with a triad of:
Risk factors (2)
Investigations
- first-line
- second-line
- sweating
- headaches
- palpitations in association with severe hypertension
- MEN 2
- Neurofibromatosis type 1
Investigations
- first-line = urinary metanephrines
- second-line = Clonidine suppression tests
WHat do you see on Cushings ABG? + why? (2)
hypokalaemic metabolic alkalosis
- High aldosterone- lose K+ (opposite of K+ sparing sprinolcatone)
- High aldosterone - also lose H+ in the renal tubules, with bicarbonate being retained, leading to metabolic alkalosis.
Factors which artificially RAISE HbA1c are due to SHORTENING of RBC life span- these include: (4)
(all the weird ones)
Factors which articially LOWER HbA1c are due to RBC life-span LENGTHENING, this includes: (3)
SHORTENING RBC LIFE:
- Sickle cell
- GP6D deficiency
- Hereditary spherocytosis
- Haemodialysis
LENGTHEN RBC LIFE:
- Splenectomy (don’t remove them)
- Vit B12/ folic acid deficiency
- Iron def anaemia
SGLT -2 Inhibitor CI
- Foot ulcer disease (increase risk of amputation)
Management of acromegaly
- First-line =
- If 1 CI or unsuccessful then give… class=
- 2 other drugs and classes
- First-line = Transphenoidal surgery
- If 1 CI or unsuccessful then give Ocreotide, class= Somatostatin analogue whih diretly inhibits GH
- 2 other drugs and classes
- Pegvisomant, GH rec anatgonist, decrease IGF-1
- Bromcriptine, D2 Agonist
External irradiation is sometimes used for older patients or following failed surgical/medical treatment
Diagnositc criteria of sublinicial hypothyroidism:
what do you give and what age?
- Raised TSH, normal T4, T3
- Two +ve readings 3 months apart
- Give < 65 yo a 6-month trial of thyroxine
Steroid use not only causes osteoperosis but also…. (2)
think of a particular fracture this could affect
Osteonecrosis/ Avascular necrosis
- Scaphoid fractures
- And proximal myopathy (not too relevant here)
Addison’s: the hydrocortisone doses given how much and at what times?
- Standard release corticosteroid
- two doses
hydrocortisone dose is split with the majority given in the first half of the day, don’t need late on as it will prevent them sleeping
if 30mg = ‘hydrocortisone 20mg at 8am and 10mg at 5pm.
What is the max dos metformin can be titrated up to before adding the next med
1g BD
