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Revision Qs > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Over what time period do insulin levels decrease from low->none in DM1?

A

Over a year or 2

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2
Q

What is MODY?

A

Maturity Onset Diabetes of the Young - like DM2 but presenting in kids, needs less insulin than expected
Autosomal dominant insulin defect of mitochondria

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3
Q

4 Ts of diabetes presentation? 2 extra Sx?

A 
Tired
Thirsty
Toilet
Thin (not necessarily for 2) 
\+ xerostomia and hunger
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4
Q

Biochemical diagnosis of DM?

A

Random glucose > 11.1
Fasting glucose > 7.0 (2 hours post prandial >11.1)
If symptomatic, diagnostic. Otherwise repeat tests

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5
Q

Biochemical requirements for impaired glucose tolerance?

A

Fasting glucose

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6
Q

Biochemical requirements for impaired fasting glucose?

A

Fasting glucose 6.1-7

2 hour post prandial

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7
Q

What 2 conditions constitute prediabetes?

A

Impaired glucose tolerance

Impaired fasting glucose

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8
Q

What is used for the oral glucose tolerance test?

A

75mg glucose

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9
Q

HbA1c criteria for diagnosing DM2?

A

HbA1c >48

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10
Q

Name some contraindications to HbA1c use in diagnosing DM?

A

Increased red cell turnover - pernicious anaemia, acute blood loss, haemolytic anaemia, malaria, haemaglobinopathies e.g. Thalassaemia
Pregnancy, liver disease, renal disease

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11
Q

Underlying problem in DM2?

A

Peripheral insulin resistance so relative deficiency, eventually leading to B cell failure

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12
Q

4 causes of secondary DM?

A

Chronic pancreatitis
Cushing’s syndrome
Acromegaly
Haemachromatosis

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13
Q

3 macrovascular complications of DM?

A

CVA
IHD
PVD

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14
Q

3 microvascular complications of DM?

A

Retinopathy
Nephropathy
Peripheral neuropathy

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15
Q

What basic abnormality in DM causes microvascular complications?

A

High glucose

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16
Q

What basic abnormalities cause macrovascular complications in DM?

A

High BP and lipids

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17
Q

Initial management of prediabetes?

A

Lifestyle - exercise, weight loss
6 monthly or annual checks
Aim for 5-10% body fat drop over year

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18
Q

Initial management of DM2?

A

Reassess lifestyle factors

Metformin

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19
Q

2 major contradictions to metformin?

A 
Renal disease - creatinine > 150
Contrast scans (stop before)
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20
Q

Major side effects of metformin?

A

GI upset - MR preparations for this

Lactic acidosis risk

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21
Q

Major benefits of metformin?

A

Weight loss
Low risk of hypos
Cardioprotective

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22
Q

Major side effects of sulfonylureas e.g. Gliclazide, glibenclamide?

A

Weight gain

Risk of hypos

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23
Q

3rd line drug for DM management?

A

Thiazolidinediones e.g. Pioglitazone

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24
Q

How does Pioglitazone work?

A

Bit like biguanides/metformin

Treats underlying peripheral insulin resistance, delaying decline in B cell function

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25
Q

Major SEs of pioglitazone?

A

Risk of oedema (contraindicated in heart failure)
Weight gain + dilutional anaemia
Distal limb fractures

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26
Q

Advantage of Pioglitazone over metformin?

A

Can be used in renal failure

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27
Q

How do DDP4 inhibitors (gliptins) work?

A

Gliptin effect - increase endogenous GLP1

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28
Q

Benefits of gliptins?

A

Weight neutral
Safe in renal impairment
CV benefit

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29
Q

What is exenatide?

A

GLP1 agonist - suppresses appetite so induces weight loss, promotes insulin secretion, preserves B cell function

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30
Q

What is the gliptin effect?

A

Insulin secretion via GLP1 agonist action, caused by GLP agonists e.g. Exenatide and gliptins (DD4 inhibitors)

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31
Q

Side effects of GLP1 agonists (exenatide)?

A

Nausea, GI upset

Risk pancreatitis

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32
Q

3 SEs of insulin therapy?

A

Hypoglycaemia
Weight gain
Lipohypertrophy

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33
Q

What constitutes a hypoglycaemia?

A

BM 4 or less (4 is the floor)

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34
Q

Causes of hypoglycaemia?

A

Missed or late meals
Too much insulin
Increased physical activity, high temperature
Alcohol (delayed onset)

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35
Q

Symptoms of hypoglycaemia?

A

Sympathetic response - sweat, tachy, palps, paraesthesia, cold, pale, dilated pupils, anxiety
Nausea, vomiting, headache
Neuro change - decreased consciousness, confusion, irritability, fatigue, lethargy, visual and speech changes

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36
Q

Management of hypo?

A 
Dextrose/sugar if oral available
IV dextrose
Glucagon IM
Follow with complex carb meal e.g. Sandwich 
Don't miss out insulin subsequently!
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37
Q

Causes of DKA?

A 
Illness and infection
Pregnancy
Missed insulin
MI
First presentation
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38
Q

Mechanism for DKA?

A

Low insulin -> mega high glucose -> osmotic diuresis

Lipolysis -> fatty acids -> ketone conversion in liver -> metabolic acidosis

39
Q

Hyperglycaemic symptoms of DM?

A

Thirst
Polyuria
Dehydration -> hypovolaemic shock

40
Q

Ketoacidotic symptoms of DKA?

A 
Nausea and vomiting
Abdo pain -> acute abdomen
Anorexia
SOB, deep laboured Kussmaul breathing (ketotic breath)
-> LoC, coma, cerebral oedema, DIC
41
Q

Investigations for DKA?

A

Glucose and ketones (dip)
BM > 15 but lower than in HHS
ABG - metabolic acidosis +/- respiratory compensation

42
Q

Management of DKA?

A

Insulin!
Fluid replacement - bolus if shocked
Monitor potassium as insulin can induce hypokalaemia

43
Q

What is HHS/HONK?

A

Hyperosmolar hyperglycaemic state
Hyperosmolar non-ketotic state
Typical of DM2 as small amount of insulin inhibits lipolysis

44
Q

Causes of HHS?

A

Infection
Poor glycaemic control
Medications - diuretics (low blood volume), steroids, B blockers/Ca channel blockers

45
Q

Glucose levels in DKA vs HONK?

A

DKA > 15

HHS > 33 but often well over 40 or 50

46
Q

What is LADA?

A

Latent Autoimmune Disease of Adulthood - like DM1 but presents as adult

47
Q

3 common causes of hyperthyroidism?

A

Graves’ disease
Toxic multinodular goitre
Toxic adenoma

48
Q

2 medications that can induce hyperthyroidism?

A

Amiodarone

Lithium

49
Q

Symptoms of hyperthyroidism?

A 
Weight loss
Diarrhoea
Heat intolerance
Palpitations
Tremor
50
Q

Signs of hyperthyroidism?

A 
Fast, irregular pulse
Warm sweaty skin
Fine tremor
Palmar erythema
Goitre
Lid lag
Hyperreflexia
Bruits
51
Q

4 graves-specific signs of hyperthyroidism?

A

Exophthalmos
Ophthalmoplegia
Pretibial myxoedema
Thyroid acropachy

52
Q

Blood tests to investigate hyperthyroidism?

A

Thyroid function - low TSH, high T4 and T3

Thyroid antibodies

53
Q

Imaging that might be useful in thyroid disease?

A

USS thyroid/neck

54
Q

Medical management of hyperthyroidism?

A

Carbimazole
Radio-iodine
Symptomatic relief via B blockers

-> surgical removal

55
Q

Alternatives to carbimazole for hyperthyroidism? Under what circumstances?

A

Propiothiouracil (PTU)

Doesn’t cross placenta so safer in pregnancy

56
Q

Rare side effects of carbimazole?

A

Bone marrow suppression - neutropenia, agranulocytosis

57
Q

Complications of hyperthyroidism?

A

Heart disease - AF, heart failure, cardiomyopathy, angina
Pregnancy related complications
Thyroid storm
Osteoporosis

58
Q

Common causes of hypothyroidism?

A

Hashimoto’s thyroiditis
Iodine deficiency atrophic hypothyroidism
Iatrogenic (thyroidectomy or radio-iodine)
Congenital

59
Q

Symptoms of hypothyroidism?

A 
Lethargy
Depression
Cold intolerance
Weight gain
Constipation
60
Q

Signs of hypothyroidism?

A 
Bradycardia 
Cold peripheries
Ankle jerks
Dry skin, thin hair
Round puffy face
Goitre in Hashimotos
Pretibial myxoedema
61
Q

Medical management of hypothyroidism?

A

Titrated dose levothyroxine

62
Q

Complications of hypothyroidism?

A

Heart disease via hypercholesterolaemia
Pregnancy complications
Myxoedema coma
Carpal tunnel syndrome

63
Q

MSK complication of hypothyroidism?

A

Carpal tunnel syndrome

64
Q

2 substances that parathyroid glands control?

A

Calcium

Phosphate

65
Q

What does PTH do and how?

A

Increases Ca levels in blood via increased osteoclast activity, active Ca resorption in kidneys and intestinal absorption via vit D

66
Q

What does calcitonin do?

A

Decreases Ca in blood via inhibition of osteoclast/increased osteoblast activity, decreased intestinal absorption and decreased resorption in kidneys

67
Q

What is the main purpose of calcitonin?

A

To prevent bone loss in hypocalcaemia, pregnancy, lactation etc. and to prevent postprandial hypercalcaemia

68
Q

Symptoms of hyperparathyroidism?

A

Bone pain, tenderness due to breakdown
Weakness, fatigue, myalgias
Dehydration

69
Q

Common cause of hyperparathyroidism?

A

Chronic renal disease
Vitamin D deficiency
Essentially Ca deficiency -> increased PTH

70
Q

Symptoms of hypoparathyroidism?

A

Paraesthesia around hands, feet, mouth
Muscle spasms, tetany, cramps
Fatigue, bone pain, headaches, abdo pain

71
Q

CATS Go numb of hypocalcaemia?

A

Convulsions
Arrhythmia
Tetany and hyperreflexia
Go numb - numbness and paraesthesia in hands, feet, mouth

72
Q

4 causes of Cushing’s syndrome?

A

Cushing’s disease (pituitary ACTH secreting tumour)
Iatrogenic - exogenous steroids
Adrenal adenoma - increased cortisol
Ectopic ACTH secreting tumour e.g. Small cell lung cancer

73
Q

Symptoms of Cushing’s syndrome?

A 
Weight gain
Acne
Lethargy
Mood change - depression, psychosis
Proximal muscle weakness
Gonadal dysfunction - hirsutism, ED, irregular menses
74
Q

Signs of Cushing’s syndrome?

A 
Central obesity + abdominal striae
Moon face and buffalo hump
Thin skin (plethoric) and easy bruising
Muscular atrophy
Hirsutism, gynaecomastia
75
Q

2 steps of investigations for Cushing’s syndrome?

A

Confirm Cushing’s syndrome

Identify cause

76
Q

How do you confirm Cushing’s syndrome?

A

Dexamethasone suppression test overnight

For Cushing’s ACTH will be high in the morning

77
Q

How to determine the cause of Cushing’s syndrome once confirmed?

A

Measure ACTH - if high, Cushing’s disease or ectopic tumour

If low, adrenal adenoma

78
Q

Next line of investigation when Cushing’s confirmed and ACTH measured?

A

MRI pituitary +/- adrenal CT +/- whole body CT

79
Q

Management of Cushing’s disease?

A

Trans-sphenoidal surgical removal

80
Q

5 major complications of Cushing’s syndrome?

A 
DM
Weight gain
Immunosuppression
Hypertension
Osteoporosis
81
Q

Major causes of Addison’s disease?

A

Primary disease of adrenals (autoimmune)

Rapid cessation of exogenous steroids

82
Q

Signs and symptoms of Addison’s disease?

A 
Weight loss, anorexia
Tiredness
Mood change
Tanning (increased MSH), pigmented palmar creases, vitiligo
Weakness 
Dizziness, postural hypotension
83
Q

Symptoms of addisonian crisis?

A

Hypotension
Tachycardia
Coma

84
Q

What electrolyte disturbances may be visible in Addison’s disease? What happens to blood glucose?

A

Hyponatraemia
Hyperkalaemia
Low BM

85
Q

Gold standard test for Addison’s disease?

A

Synacthen test - measure cortisol, give synacthen then measure at 30 mins
Cortisol > 550 excludes diagnosis
Then measure ACTH - will be high in primary Addison’s, low in pituitary causes

86
Q

Management of Addison’s disease?

A

Corticosteroids (hydrocortisone) for life

Consider mineralocortoids e.g. Fludrocortisone

87
Q

What needs to be adjusted if an Addisonian patient becomes unwell, increase exercise or is stressed?

A

Increase steroid dose

88
Q

Hormones secreted by the anterior pituitary?

A 
ACTH/MSH
LH/FSH
TSH
Prolactin
GH
89
Q

Hormones secreted by the posterior pituitary?

A

ADH

Oxytocin

90
Q

Differentials for polyuria and polydipsia?

A 
DM
DI
Hypercalcaemia 
CKD
Psychogenic
91
Q

2 blood tests that can be used in investigating DM 1?

A

GAD - glutamic acid decarboxylase

Islet cell autoantibodies

92
Q

What endocrine disease yields ankle jerks?

A

Hypothyroidism

93
Q

What do ankle jerks in terms of thyroid disease?

A

Hypothyroid

94
Q

Why is there an increased risk of CVD in hypothyroidism?

A

Causes hypercholesterolaemia

Revision Qs (28 decks)

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