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
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)
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
