Endocrinology Flashcards
Type 1 Diabetes mellitus
Features: chronic polydipsia, polyuria and weight loss with ketonemia/ketonuria + hyperglycaemia
Differentiate T2 – body habitus, age, insulin resistance signs, FH
Ix: RFPG, OGGT, anti-GAD antibodies (not present in 15%)
Mx: patient education, nutrition, exercise, psychosocial, immunizations
Insulin
Diabetic ketoacidosis (Ix + Mx)
Ix: serum glucose, corrected Na, K, Ca
Mx: ABC + continuous cardiac monitoring
Fluid challenge 0.9% saline
Insulin infusion + K
Type 2 Diabetes mellitus management
Conservative: Patient education, diet modification, physical exercise, optimise other cardiac risk factors, eye and foot examinations
Medical:
1. Metformin
2. Add sulphonylurea or gliptin or pioglitazone or SGLT-2 inhibitor
3. Gliptin+sulphonylurea or pioglitzone+sulphonylurea or sulphonylurea+SGLT-2 inhib or pioglitzone+SGLT-2 inh
4. Consider GLP1 memtic if BMI >35 kg/m2 or occupational implications of insulin
5. Insulin therapy
Surgical: Bariatric surgery
Type 2 DM complications
Microvascular:
• Diabetic retinopathy
• Diabetic nephropathy
• Peripheral neuropathy
Macrovascular:
• Coronary heart disease
• Peripheral vascular disease/diabetic foot
• Cerbrovascular accident
Other:
Hyperosmolar hyperglycaemic state (HONK)
Necrobiosis lipodica dibeticorum
Adrenal Crisis
Features: Shock + anorexia, N+V, ab pain, weakness, fatigue, lethargy, confusion
Rarer feature: hypoglycaemia, fever, hyperpigmentation/vitiligo
Ix: serum cortisol/ACTH, aldosterone/renin, Hyponatraemia, hyperkalaemia, azotemia, hypercalcaemia, eosinophilia. Other autoimmune endocrine deficiency
Precipitation: acute stress/infection, vomiting/GI disturbance, adrenal infarction, Pituitary infarction, abrupt steroid withdrawal
Mx: ABC. Resus IV 0.9% saline or 5% dextrose (hypoglycaemia)
4mg IV bolus of dexamethasone + treat cause
Osteoarthritis Mx
Conservative: See other card Medical: • Analgesia: Paracetamol + topical NSAIDs, Short course NSAIDs + PPI, Codeine • Intra-articular steroid injection Surgical: • Arthroscopic washout • Realignment osteotomy • Arthroplasty • Arthrodesis (fusion)
Cushings syndrome complications
Centripetal obesity Facial plethora Glucose intolerance Weakness and proximal myopathy Hypertension Psychological changes – depression, psychosis Easy brusing Hirsuitism Oligomenorrhea or amenorrhea Impotence Acne/oily skin Abdominal striae Ankle oedema Backache, vertebral collapse, fracture – osteoporosis Polydipsia, polyuria Rneal calculi Hyperpigmentation Headache Exophthalmos Immune deficiency – tine versicolor Abdo pain