Endocrinology Flashcards
What are some causes of hyperthyroidism?
- Graves’ disease
- toxic adenoma or toxic MNG
- early Hashimoto thyroiditis
- drugs: amiodarone
What are some causes of hypothyroidism?
- Hashimoto thyroiditis
- drugs: lithium, amiodarone
- previous thyroid treatment or surgery
What are some causes of hypopituitarism?
- adenoma
- craniopharyngioma
- iatrogenic: surgery, radiation
- postpartum necrosis: Sheehan syndrome
- head injury
In hypopituitarism, in what order does hormone loss progress?
1) GH and FSH/LH
2) TSH
3) ACTH
Findings in Cushings?
Moon face, acne
Buffalo hump
Abdominal striae and central obesity
Proximal myopathy
How would you investigate a goitre / hyperthyroidism?
TSH Free T3, T4 Thyroid autoantibodies: TSI (thyroid stimulating immunoglobulin) Thyroid U/S Thyroid uptake scan
How would you investigate hypothyroidism?
TSH (high)
Free T4/T3
Anti TPO (thyroid peroxidase)
Anti thyroglobulin
Features of acromegaly?
- hand shape: spade
- axilla acanthosis nigricans
- facies: frontal bossing
- macroglossia
- visual field defects
- CCF, Organomegaly
- signs of hypothyroidism
What investigations for acromegaly?
IGF1 (increased)
OGTT (should suppress GH level)
MRI
What are some causes of diffuse goitre?
- Graves’ disease
- thyroiditis: Hashimoto, subacute
- iodine deficiency
- iodine excess
- medications: lithium, amiodarone
How to investigate Cushing’s syndrome further?
- mane cortisol
- 24hr urine collection
- dexamethasone suppression test (Cushing’s syndrome cortisol level not suppressed)
- ACTH level
- petrosal sinus sampling
How to diagnose diabetes?
Fasting BSL > 7
Or
OGTT > 11
IGT: OGTT BSL 7-11
What lifestyle mods or mx for T2DM?
- trial 2-3 months of lifestyle mod
- aim: reduce BMI and waist:hip
- diet
- exercise
What class of OHG is metformin? How does it work? What are the side effects?
- biguanide
- increases insulin sensitivity, decrease hepatic glucose production; bonus wt loss
- SE: lactic acidosis, B12 malabsorption
Don’t use in renal failure
eGFR
What are some sulfonylurea class OHG? How do they work? What are the side effects?
- Gliplizide, gliclazide (good for fat people)
- Increase insulin secretion from pancreatic B cells
- Hypoglycaemia, wt gain
Avoid in elderly or renal failure
- What are examples of thiazolidenidiones?
- How do they work?
- What are the side effects?
- Pioglitazone
- Activates PPAR-gamma -> increases periph gluc uptake
- Fluid retention/CCF, increase bladder CA, Rosiglitazone increases CVD events, pio might be ok
- What are some DPP4 inhibitors?
- How do they work?
- What are the side effects?
- The gliptins: sitagliptin, saxagliptin
- Inhibits DPP4, which breaks down GLP1: Slows gastric emptying, suppress glucagon
- Hypoglycaemia with sulfonylureas, N/V
- Name one GLP-1 mimetic
- How does it work?
- What are the side effects?
- Exanatide
- Slows gastric emptying, suppressed glucagon
- Hypoglycaemia when used with sulfonylureas, N/V
What does dapaglifozin do?
What are the side effects?
Inhibits glucose transport in the kidneys, leading to excretion
Side effects: UTI risk
How would you commence insulin therapy?
0.5 units/kg/day
With 40% being long acting
Aim BSL 3.5 - 7
What are factors that contribute to hypoglycaemic episodes?
- altered diet
- injection errors
- renal disease
- exercise
What is the Somogyi effect and how is it treated?
Rebound hyperglycaemia after nocturnal hypoglycaemia
Mx: reduce note Insulin dose
What is the dawn phenomenon?
Morning hyperglycaemia without nocturnal hypo
Treat: increase Nocte insulin
What are the criteria for micro, macro and nephrotic range proteinuria?
Micro: 30-300mg/day
Macro: >300mg/day
Nephrotic: >3g/day
What are the investigations for diabetic nephropathy?
- Urine ACR
- 24hr urine collection for protein
- EUC
- renal ultrasound: look for small kidneys
- hba1c
How do you manage diabetic nephropathy?
- control BP (Aim 125/75
What are signs of diabetic retinopathy on fundoscopy?
- dot and blot haemorrhages
- hard and soft exudates (soft: cotton wool spots)
- neovascularisatiom
What is the usual order of progression of microvascular complications?
- retinopathy
- nephropathy
- neuropathy
What are the features of diabetic neuropathy?
- sensory neuropathy/parasthesia
- ulcers
- Charcot foot
- autonomic neuropathy: impotence, postural hypotension, delayed gastric emptying, bladder dysfunction
How do you manage diabetic neuropathy?
Non pharm: - podiatrist, orthotics, footwear Pharm: - BSL control - analgesia, adjuncts (pregabalin, TCA)
How would you manage autonomic neuropathy in diabetes?
Postural hypotension: med review, stockings, fludrocortisone
Impotence: med review, exclude other causes, sildafenil, implant
Gastroparesis: promotility agents, such as metoclopramide
Large bowel: (constipation or diarrhea) loperamide, codeine, aperients
Bladder: self cath, regular toileting
What investigations for osteoporosis?
- BMD (-2.5 or -1.5 on steroids)
- Ca and Vit D
- PTH
- LFT/ALP
- TFT
- EUC
- EPG/IEPG
- testosterone in males
What are the management options for osteoporosis?
Non pharm: prevent falls and fracture
Pharm:
- Ca and Vit D replacement
- bisphosphonates
- denosumab (use if CRF)
- raloxifene: SERM - reduces postmenopausal bone loss; decreased risk of breast Ca, higher risk of DVT - use if high risk of breast ca
- teriparatide: synthetic PTH - increases bone formation; side effect of sarcoma risk. (2nd line)
