Endocrinology 2.0 Flashcards
Hyperkalaemic metabolic acidosis is characteristic of?
An addisonian crisis
Symptoms include: abdominal pain, N+V, confusion, dizziness and weakness of lower limbs
What is the therapeutic ‘goal’ of levothyroxine treatment and what is the usual dosing?
How soon after starting treatment do we recheck levels
Ton maintain regular levels of TSH ( 0.5-2.5 mU/l)
Normal dosing is around 50-100mcg od
We then check after 8-12 weeks
Side effects of levothyroxine
Hypothyroidism (due to overuse)
Decreased bone mineral density
Angina
Atrial fibrillation
What can interact with levothyroxine and how does it relate to food intake?
Can have reduced absorbtion if taken with iron. (give 2 hrs apart!)
Also take 30 minutes prior to food
Cushings gives you….. hyp__kalaemic metabolic _______??
Hypokalaemic metabolic alkalosis
Aim for HbA1c for T2DM patients, but how high until you add another medication on top of metformin?
Aim for 48mmol/L (6.5%)
But only add medication if 58 (7.5%)
a young man presenting with palpitations, tremor and a headache. What is the likely diagnosis and what should you give him?
Likely diagnosis of Phaochromocytosis
Alpha blockers should be prescribed, eg; phenoxybenzamine
Common causes of Pheochromocytoma
- Sporadic
- MEN I or II: RET gene mutation
- Von Hippell Lindau
- Neurofibromatosis type 1
What do you give first line for a patient coming in with a symptomatic episode due to Pheochromocytosis
- Alpha blocker: phenoxybenzine
- THEN beta-blocker if unsuccessful eg; propanolol
How do you grade the severity of Graves Disease on the eyes?
NO SPECS
No signs or symptoms
Only signs eg; upper lid retraction
Signs and symptoms
Extra ocular muscle invovment
Corneal involvement (worst sign)
Sight loss
Features seen in Graves’ but not in other causes of thyrotoxicosis
Opthalmic involvement
Pretibial Myexodema
Thryoid acropachy
The auto antibodies seen in graves are??
TSH receptor stimulating antibodies (90%)
Antithyroid peroxidase antibodies (75%)
Thyrotoxicosis with tender goitre
De Quervains thyroiditis (subacute)
What are the different types of MODY
- MODY 3: 60%
- Due to a defect in HNF-1 alpha gene
- ass with HCC
- MODY 2: 20%
- Due to a defect in the glucokinase gene
Treatment for MODYs?
These patients are usually very sensitive to sulfanureas (eg; glicazide) and don’t require insulin
What has decreased production post surgery / as a stress response?
Insulin
Oestrogen
Testosterone
A 51-year-old woman who is known to have poorly controlled type 1 diabetes mellitus is reviewed. Her main presenting complaint is bloating and vomiting after eating.
What is this due to and how can we treat?
This is due to gastroparesis as a complication of diabetic neuropathy affecting the vagus nerve which controls gastric emptying.
Tx: metoclopramide, domperidone or erythromycin (prokinetic agents)
