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Year 5 Notes > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Addisons:

Presentation

A 
Tired
Tearful
Lethargic
Nausea
Vomiting/diarrhoea
Pigmented buccal area or palmar creases
Weight loss
Pain
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2
Q

Addisons:

Bloods

A 
⬇️Na
⬆️K
⬆️Ca
Uraemia
Anaemia
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3
Q

Synacthen test

A

Give 250mg of syncathen (synthetic cortisol) measure after 30 mins. If >550ml then not addisons

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4
Q

Addisons:

Treatment

A

Hydrocortisone replacement, 10mg in the morn then 5mg lunch 5mg evening. If come in actually unwell immediately x4 their normal dose stat.

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5
Q

Addison’s disease:

Causes

A

TB
Autoimmune
Adrenal metastases

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6
Q

DKA:

Sx

A

Drowsiness, vomiting, dehydration, abdo pain, polyuria, polydypsia, anorexia, deep breathing in type 1 (rarely type2)
Triggered by chemo, new drug, UTI/infection , surgery, MI, pancreatitis

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7
Q

DKA:

Diagonsis

A
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8
Q

DKA:

Management

A

If plasma glucose >20 give 4-8u soluble insulin
Fluid and K+ replacement
LMWH until mobile, - immobile + high plasma osmolality

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9
Q

DKA:

Investigations

A 
Glucose
U+E (potassium)
ABG ( for ph and bicarbonate) 
Amylase
Osmolality 
FBC
Cultures (underlying inf)
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10
Q

SIADH:

Diagnosis

A

Concentrated urine ie Na+ >20, osmolality >500

In presence of hypo atresia

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11
Q

SIADH:

Causes

A

Malignancy - SCLC, pancreas, prostate, thymus, lymphoma
CNS - meningitis, access, stroke, SAH/SDH, injury
Chest - TB, pneumonia, abscess, aspergillosis
Endocrine - hypothyroid ( not true SIADH)
Drugs - opiates, psychotropics, SSRIs
HIV

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12
Q

SIADH:

Tx

A

Treat cause
Restrict fluid
If severe, salt +- loop diuretic

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13
Q

Diabetes insipidus

A

Loads of dilute urine due to either not enough ADH from posterior pituitary or impaired response of the kidney to ADH

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14
Q

Diabetes insipidus:

Symptoms

A

Polyuria, polydypsia, dehydration - uncontrollable thirst

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15
Q

Diabetes insipidus:

Causes

A 
Congenital, tumour (craniopharyngoma, pituitary) 
Trauma
Haemorrhage
Infection (meningitis) 
Lithium
Chronic renal disease

Diagnosis with water deprivation test

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16
Q

What fasting blood level confirms diabetes?

A

> 7

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17
Q

What level of blood glucose after glucose load confirms diabetes?

A

> 11

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18
Q

Subacute (De Quervains) thyroiditis

A

Hyperthyroidism following viral illness
Painful goiter

Self limiting, steroids if severe or hypothyroid develops

⬇️ TSH
⬆️ T4
⬆️ESR

19
Q

HONK

A

Triad of:
hyperglycaemia + dehydration + Mild/absent ketonuria

Tx: slowly replace fluid, insulin sliding scale

20
Q

Causes of hypothyroidism

A

Iodine deficiency (developing world)
Hashimotos
De Quervains (painful)
Thyroid adenomas

21
Q

HONK

A

Triad of:
hyperglycaemia + dehydration + Mild/absent ketonuria

Tx: slowly replace fluid, insulin sliding scale

22
Q

Causes of hypothyroidism

most to least common

A

Iodine deficiency (developing world)
Hashimotos
De Quervains (painful)
Thyroid adenomas

23
Q

Side effects of Gliptins

A

Weight neutral

No hypos

24
Q

When to add GLP1?

A

e.g exenatide
if already on triple therapy ( e/g metformin+gliptin+sulfonylurea)
Or BMI more than 35

25
Q

When do you treat subclinical hypothyroidism?

A

TSH >10
Thyroid antibody +ve
Autoimmune disorder
Previous tx of Graves

otherwise risks leading to overt hypothyroid

26
Q

Side effects of radioiodine tx of hyperthyroid

A

Pregnancy (up to 6m after tx)
Thyroid eye disease may worsen
V likely to be hypothryoid in future

27
Q

MODY

A 
TD2M before 25 yr old
Autosomal dominant
HNF alpha mutation
V sensitive to sulfonylureas, shouldnt need insulin
No ketosis
28
Q

Unwell Addisons pt

A 
Double glucocorticoids (hydrocortisone) 
Keep mineralcorticoid (fludrocortisone) the same
29
Q

CI to glitazones

A

Heart failure

30
Q

Addisons features

A

hypoglycaemia
hyponatraemia
hyperkalaemia
acidosis

31
Q

De Quervains

A

Hyperthyroid
Tender goitre
Reduced iodine uptake
Self limiting

32
Q

Primary Hyperparathyroidism

A 
elderly females
unquenchable thirst - bones, moans, groans
Raised calcium
Low phosphate
normal/ high PTH level
usually from solitary adenoma
33
Q

Secondary hyperparathyroidism

A 
High PTH
Low calcium
High phosphate
High vit D
ax w CKD
Parathyroid gland hyperplasia from low calcium
34
Q

Normal/high PTH
Raised Calcium
Low Phosphate

A

Primary Hyperparathyroidism

35
Q

Normal/high PTH
Low Calcium
High Phosphate

A

Secondary hyperaparthyroidism

36
Q

Tertiary Hyperparathyroidism

A 
High PTH
Normal/high calcium
Low Phosphate
ALP High
Vit D normal or low
Ongoing hyperplasia after corrected CKD
37
Q

Multiple Endocrine Neoplasia II

A

thyroid carcinoma
parathyroid adenoma
phaeochromocytoma

38
Q

TFTs Thyrotoxicosis/Graves

A

TSH - Low

T4 - High

39
Q

TFTs

Primary Hypothyroid

A

TSH - high

T4 - Low

40
Q

TFTs

Secondary Hypothyroidism

A

TSH - low

T4 - low

41
Q

TFTs

Sick Euthyroid

A

TSH - low
T4 - low
T3 - low
hx of illness

42
Q

TFTs

Subclinical hypothyroidism

A

TSH - high

T4 - normal

43
Q

Cushings metabollic affect

A

hypokalaemic metabollic alkalosis

Year 5 Notes (19 decks)

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