Endocrinology 2.0

Question 1

Hyperkalaemic metabolic acidosis is characteristic of?

Answer 1

An addisonian crisis

Symptoms include: abdominal pain, N+V, confusion, dizziness and weakness of lower limbs

Question 2

What is the therapeutic ‘goal’ of levothyroxine treatment and what is the usual dosing?
How soon after starting treatment do we recheck levels

Answer 2

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

Question 3

Side effects of levothyroxine

Answer 3

Hypothyroidism (due to overuse)

Decreased bone mineral density

Angina

Atrial fibrillation

Question 4

What can interact with levothyroxine and how does it relate to food intake?

Answer 4

Can have reduced absorbtion if taken with iron. (give 2 hrs apart!)

Also take 30 minutes prior to food

Question 5

Cushings gives you….. hyp__kalaemic metabolic _______??

Answer 5

Hypokalaemic metabolic alkalosis

Question 6

Aim for HbA1c for T2DM patients, but how high until you add another medication on top of metformin?

Answer 6

Aim for 48mmol/L (6.5%)

But only add medication if 58 (7.5%)

Question 7

a young man presenting with palpitations, tremor and a headache. What is the likely diagnosis and what should you give him?

Answer 7

Likely diagnosis of Phaochromocytosis

Alpha blockers should be prescribed, eg; phenoxybenzamine

Question 8

Common causes of Pheochromocytoma

Answer 8

• Sporadic
• MEN I or II: RET gene mutation
• Von Hippell Lindau
• Neurofibromatosis type 1

Question 9

What do you give first line for a patient coming in with a symptomatic episode due to Pheochromocytosis

Answer 9

• Alpha blocker: phenoxybenzine
• THEN beta-blocker if unsuccessful eg; propanolol

Question 10

How do you grade the severity of Graves Disease on the eyes?

Answer 10

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

Question 11

Features seen in Graves’ but not in other causes of thyrotoxicosis

Answer 11

Opthalmic involvement

Pretibial Myexodema

Thryoid acropachy

Question 12

The auto antibodies seen in graves are??

Answer 12

TSH receptor stimulating antibodies (90%)

Antithyroid peroxidase antibodies (75%)

Question 13

Thyrotoxicosis with tender goitre

Answer 13

De Quervains thyroiditis (subacute)

Question 14

What are the different types of MODY

Answer 14

• 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

Question 15

Treatment for MODYs?

Answer 15

These patients are usually very sensitive to sulfanureas (eg; glicazide) and don’t require insulin

Question 16

What has decreased production post surgery / as a stress response?

Answer 16

Insulin

Oestrogen

Testosterone

Question 17

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?

Answer 17

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)