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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
Major SEs of pioglitazone?
Risk of oedema (contraindicated in heart failure) Weight gain + dilutional anaemia Distal limb fractures
26
Advantage of Pioglitazone over metformin?
Can be used in renal failure
27
How do DDP4 inhibitors (gliptins) work?
Gliptin effect - increase endogenous GLP1
28
Benefits of gliptins?
Weight neutral Safe in renal impairment CV benefit
29
What is exenatide?
GLP1 agonist - suppresses appetite so induces weight loss, promotes insulin secretion, preserves B cell function
30
What is the gliptin effect?
Insulin secretion via GLP1 agonist action, caused by GLP agonists e.g. Exenatide and gliptins (DD4 inhibitors)
31
Side effects of GLP1 agonists (exenatide)?
Nausea, GI upset | Risk pancreatitis
32
3 SEs of insulin therapy?
Hypoglycaemia Weight gain Lipohypertrophy
33
What constitutes a hypoglycaemia?
BM 4 or less (4 is the floor)
34
Causes of hypoglycaemia?
Missed or late meals Too much insulin Increased physical activity, high temperature Alcohol (delayed onset)
35
Symptoms of hypoglycaemia?
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
36
Management of hypo?
``` Dextrose/sugar if oral available IV dextrose Glucagon IM Follow with complex carb meal e.g. Sandwich Don't miss out insulin subsequently! ```
37
Causes of DKA?
``` Illness and infection Pregnancy Missed insulin MI First presentation ```
38
Mechanism for DKA?
Low insulin -> mega high glucose -> osmotic diuresis | Lipolysis -> fatty acids -> ketone conversion in liver -> metabolic acidosis
39
Hyperglycaemic symptoms of DM?
Thirst Polyuria Dehydration -> hypovolaemic shock
40
Ketoacidotic symptoms of DKA?
``` Nausea and vomiting Abdo pain -> acute abdomen Anorexia SOB, deep laboured Kussmaul breathing (ketotic breath) -> LoC, coma, cerebral oedema, DIC ```
41
Investigations for DKA?
Glucose and ketones (dip) BM > 15 but lower than in HHS ABG - metabolic acidosis +/- respiratory compensation
42
Management of DKA?
Insulin! Fluid replacement - bolus if shocked Monitor potassium as insulin can induce hypokalaemia
43
What is HHS/HONK?
Hyperosmolar hyperglycaemic state Hyperosmolar non-ketotic state Typical of DM2 as small amount of insulin inhibits lipolysis
44
Causes of HHS?
Infection Poor glycaemic control Medications - diuretics (low blood volume), steroids, B blockers/Ca channel blockers
45
Glucose levels in DKA vs HONK?
DKA > 15 | HHS > 33 but often well over 40 or 50
46
What is LADA?
Latent Autoimmune Disease of Adulthood - like DM1 but presents as adult
47
3 common causes of hyperthyroidism?
Graves' disease Toxic multinodular goitre Toxic adenoma
48
2 medications that can induce hyperthyroidism?
Amiodarone | Lithium
49
Symptoms of hyperthyroidism?
``` Weight loss Diarrhoea Heat intolerance Palpitations Tremor ```
50
Signs of hyperthyroidism?
``` Fast, irregular pulse Warm sweaty skin Fine tremor Palmar erythema Goitre Lid lag Hyperreflexia Bruits ```
51
4 graves-specific signs of hyperthyroidism?
Exophthalmos Ophthalmoplegia Pretibial myxoedema Thyroid acropachy
52
Blood tests to investigate hyperthyroidism?
Thyroid function - low TSH, high T4 and T3 | Thyroid antibodies
53
Imaging that might be useful in thyroid disease?
USS thyroid/neck
54
Medical management of hyperthyroidism?
Carbimazole Radio-iodine Symptomatic relief via B blockers -> surgical removal
55
Alternatives to carbimazole for hyperthyroidism? Under what circumstances?
Propiothiouracil (PTU) | Doesn't cross placenta so safer in pregnancy
56
Rare side effects of carbimazole?
Bone marrow suppression - neutropenia, agranulocytosis
57
Complications of hyperthyroidism?
Heart disease - AF, heart failure, cardiomyopathy, angina Pregnancy related complications Thyroid storm Osteoporosis
58
Common causes of hypothyroidism?
Hashimoto's thyroiditis Iodine deficiency atrophic hypothyroidism Iatrogenic (thyroidectomy or radio-iodine) Congenital
59
Symptoms of hypothyroidism?
``` Lethargy Depression Cold intolerance Weight gain Constipation ```
60
Signs of hypothyroidism?
``` Bradycardia Cold peripheries Ankle jerks Dry skin, thin hair Round puffy face Goitre in Hashimotos Pretibial myxoedema ```
61
Medical management of hypothyroidism?
Titrated dose levothyroxine
62
Complications of hypothyroidism?
Heart disease via hypercholesterolaemia Pregnancy complications Myxoedema coma Carpal tunnel syndrome
63
MSK complication of hypothyroidism?
Carpal tunnel syndrome
64
2 substances that parathyroid glands control?
Calcium | Phosphate
65
What does PTH do and how?
Increases Ca levels in blood via increased osteoclast activity, active Ca resorption in kidneys and intestinal absorption via vit D
66
What does calcitonin do?
Decreases Ca in blood via inhibition of osteoclast/increased osteoblast activity, decreased intestinal absorption and decreased resorption in kidneys
67
What is the main purpose of calcitonin?
To prevent bone loss in hypocalcaemia, pregnancy, lactation etc. and to prevent postprandial hypercalcaemia
68
Symptoms of hyperparathyroidism?
Bone pain, tenderness due to breakdown Weakness, fatigue, myalgias Dehydration
69
Common cause of hyperparathyroidism?
Chronic renal disease Vitamin D deficiency Essentially Ca deficiency -> increased PTH
70
Symptoms of hypoparathyroidism?
Paraesthesia around hands, feet, mouth Muscle spasms, tetany, cramps Fatigue, bone pain, headaches, abdo pain
71
CATS Go numb of hypocalcaemia?
Convulsions Arrhythmia Tetany and hyperreflexia Go numb - numbness and paraesthesia in hands, feet, mouth
72
4 causes of Cushing's syndrome?
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
Symptoms of Cushing's syndrome?
``` Weight gain Acne Lethargy Mood change - depression, psychosis Proximal muscle weakness Gonadal dysfunction - hirsutism, ED, irregular menses ```
74
Signs of Cushing's syndrome?
``` Central obesity + abdominal striae Moon face and buffalo hump Thin skin (plethoric) and easy bruising Muscular atrophy Hirsutism, gynaecomastia ```
75
2 steps of investigations for Cushing's syndrome?
Confirm Cushing's syndrome | Identify cause
76
How do you confirm Cushing's syndrome?
Dexamethasone suppression test overnight | For Cushing's ACTH will be high in the morning
77
How to determine the cause of Cushing's syndrome once confirmed?
Measure ACTH - if high, Cushing's disease or ectopic tumour | If low, adrenal adenoma
78
Next line of investigation when Cushing's confirmed and ACTH measured?
MRI pituitary +/- adrenal CT +/- whole body CT
79
Management of Cushing's disease?
Trans-sphenoidal surgical removal
80
5 major complications of Cushing's syndrome?
``` DM Weight gain Immunosuppression Hypertension Osteoporosis ```
81
Major causes of Addison's disease?
Primary disease of adrenals (autoimmune) | Rapid cessation of exogenous steroids
82
Signs and symptoms of Addison's disease?
``` Weight loss, anorexia Tiredness Mood change Tanning (increased MSH), pigmented palmar creases, vitiligo Weakness Dizziness, postural hypotension ```
83
Symptoms of addisonian crisis?
Hypotension Tachycardia Coma
84
What electrolyte disturbances may be visible in Addison's disease? What happens to blood glucose?
Hyponatraemia Hyperkalaemia Low BM
85
Gold standard test for Addison's disease?
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
Management of Addison's disease?
Corticosteroids (hydrocortisone) for life | Consider mineralocortoids e.g. Fludrocortisone
87
What needs to be adjusted if an Addisonian patient becomes unwell, increase exercise or is stressed?
Increase steroid dose
88
Hormones secreted by the anterior pituitary?
``` ACTH/MSH LH/FSH TSH Prolactin GH ```
89
Hormones secreted by the posterior pituitary?
ADH | Oxytocin
90
Differentials for polyuria and polydipsia?
``` DM DI Hypercalcaemia CKD Psychogenic ```
91
2 blood tests that can be used in investigating DM 1?
GAD - glutamic acid decarboxylase | Islet cell autoantibodies
92
What endocrine disease yields ankle jerks?
Hypothyroidism
93
What do ankle jerks in terms of thyroid disease?
Hypothyroid
94
Why is there an increased risk of CVD in hypothyroidism?
Causes hypercholesterolaemia

Revision Qs (28 decks)

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