Endocrinology Flashcards
A normal fasting plasma glucose is?
normal FGT post 8hours no food should be <6mmol/L
6.1-6.9: prediabetes
>7 : Diabetes
if higher this could be indicative of diabetes
What is the difference between IGT and IFG and howdo you differentiate?
- IGT: fasting glucose <7 and additional OGTT 2-hour value of 7.8-11mmol/l
- IFG: Fasting glucose over 6 mmol/l and less then 7
**Oral Glucose Tolerance Test should be done n patients with IFG to rule out diabetes and is done (7.8-11 confirms IGT)
What are the causes of Addisonian crisis
- sepsis or surgery causing an acute exacerbation of chronic insufficiency (Addison’s, Hypopituitarism)
- adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant meningococcemia)
- steroid withdrawal
Reccommended treatment for an Addisonian crisis?
- Hydrocortisone IV, continue for 6 hours or until stable
- Fluids: 0.9 normal saline (with dextrose if they are hypoglycaemic)
WHat are the two main causes of Primary hyperaldosteronism, and why is it important to distinguish?
- Conn’s Disease (adrenal adenoma): treat with surgery
- Bilateral idiopathic adrenal hyperplasia: aldosterone antagonist eg; spirolactone
What is the presentation via lab tests of primary aldosteronism, and what is the gold standard diagnostic test?
Hypokalaemia and hypertension!
Dx: aldosterone:renin ratio
should show high aldosterone levels alongside low renin levels (negative feedback due to sodium retention from aldosterone)
What is achropathy and when would you see it?
Graves Disease: Soft tissue swelling of the hands and clubbing of the fingers
What is Phaeochromocytoma?
what will it cause?
a rare catecholamine secreting tumour, 10% familal (MEN II), 10% bilateral, 10% malignant.
Hypertension, headaches, anxiety, palpitations, diaphoresis.
How should you diagnose phaechromocytoma?
24-hour collection of urinary metanephrines
should you lower or increase steroid usage during illness?
You should 2x dose during concurrent illness
Clinical presentation of sick euthyroid syndrome
Low T4/T3 and inappropriately low TSH
What are the primary causes of Addisons Disease?
- Autoimmunity
- Tuberculosis
- Metastases
- meningicoccal septicaema
- HIV
- antiphospholipid
Cushings ACTH-independent causes are?
- iatrogenic steroids
- adrenal adenoma (5%)
- adrenal carcinoma
*
Cushings ACTH-dependent causes are?
- Cushings Disease (ACTH secreting tumour producing adrenal hyperplasia)
- Ectopic ACTH production: eg; small cell lung cancer
What is Kussumal Breathing?
Deep breathing seen in DKA and metabolic acidosis where additional CO2 is breathed off to compensatefor the acidosis
Subacute (De Quervain’s) thyroiditis occurs when?
thought to be following a virus
What should you give a child with Turners Syndrome?
GH replacement
How can you grade the severity of Graves Disease?
No signs/symptoms
Only signs (eg upper lid retraction)
Signs/symptoms
Proptosis
Extraocular muscle involvement
Corneal involvement
Slight loss due to optic nerve involvement
What are some of the most common signs/symptoms of Graves?
- Weight loss
- Height Intolerance/sweating
- Tremors
- Palpations
- Anxiety
- Increased bowel motions
- SOB
+ Goitre and opthalmology (lid retraction, corneal involvement)
What are the different subtypes of Thyroid cancers and what are the important things to note from them?
- Papillary 70% Often young females - excellent prognosis
- Follicular 20%
- Medullary 5% Cancer of parafollicular (C) cells, secrete calcitonin, part of MEN-2
- Anaplastic 1% Not responsive to treatment, can cause pressure symptoms
- Lymphoma RareAssociated with Hashimoto’s
What is the main diagnostic test
oral glucose test with + growth hormones
How do you diagnose an insulinoma?
The Whipple’s Triad
- Symptoms and signs of hypoglycemia
- Plasma glucose < 2.5 mmol/L
- Reversibility of symptoms on the administration of glucose
**there will be no change in C-peptide with administered insulin
Small testes, infertility, gynaecomastia, above average height and a lack of secondary sexual characteristics.
What Syndrome causes this?
Klinefelter’s (XXY)
- often taller than average
- lack of secondary sexual characteristics
- small, firm testes
- infertile
- gynaecomastia - increased incidence of breast cancer
- elevated gonadotrophin levels
What are the causes for raised Prolactin?
The p’s
- pregnancy
- prolactinoma
- physiological
- polycystic ovarian syndrome
- primary hypothyroidism
- phenothiazines, metoclopramide, domperidone
Who get Neuroblastoma
it’s a tumour of infants. <20mths made of neural creast crest cvells (predisposers of SNS)
Signs and symptoms of neuroblastoma?
- abdominal mass
- pallor, weight loss
- bone pain, limp
- hepatomegaly
- paraplegia
- proptosis
Investigations indicating neuroblastoma?
increased VMA and HVA (breakdowns of NE and NA)
biopsy
Calcifications
Hypothermia, hyporeflexia, bradycardia and seizures, think…
myxodemic coma due to severe hypothyroidism
nasogastric tubes are easy to use if pH is under …..
<5.5
If aspirate >5.5, request a chest x-ray to confirm the position of the NG tube.
What is used to acutely treat a myxoedmic coma?
Levothyroxine and hydrocortisone
What combination of drugs should be used to treat a thyrotoxic storm
B-blockers, carbimazole and hydrocortisone
Beta blockers are used to treat the tachycardia, however, these as always would be contraindicated in patients suffering from asthma.
Carbimazole is used as an anti-thyroid treatment to help reduce the effect of raised serum thyroid hormones that are causing her symptoms.
Hydrocortisone is used to treat any underlying adrenal insufficiency which is more common in patients suffering from hyperthyroidism and can also help to reduce serum thyroid hormone levels.
