Endocrinology Flashcards
what increases when glucose is low
glucagon, adrenaline, GH, cortisol
criteria for diagnosis of diabetes
symptoms + 1 chemical
or no symptoms + 2 seperate chemical
> 6.9 fasting
11 random
48/ 6.5% HbA1c
11 2 hour OGTT
diagnosis of pre diabetes
5.5-7 fasting
7.8 - 11.1 random
42 -47 HbA1c
diagnosis for gestational diabetes
> 5.6 fasting
>7.8 2h OGTT
management of gestational diabetes
metformin or insulin
what monitoring should diabetics have
HbA1c 3 monthly
BP, cholesterol, eyes, kidney, neuropthy anually
first line management of T2DM
weight loss - 5-10% for 3 months
first line drug used in T2DM (side effects, contraindications, mechanism)
metformin
- lactic acidosis and GI upset
- C/I kidney disease
- increases sensitivity to insulin
3 drugs that may be added second line to metformin
side effects, contraindications, mechanism
- sulfonyureas (glicazide)
- hypoglycaemia and weight gain
- stimulates insulin secretion - DPP4I’s (gliptins)
- pancreatitis, weight loss
- increases incretin = increase insulin - pioglitizone
- weight gain, liver failure, bladder ca
- C/I Heart failure
- increases insulin sensitivity
drugs added into metformin + second line to make triple therapy for T2DM
(side effects, contraindications, mechanism)
- SGLT2 i’s (flozins)
- weight loss, hypos, DKA, UTIs
- glucose lost via kidney - GLP1 antagonists (exenotide)
- weight loss
- mimicks incretin = increase insulin
which daibetes drugs cause hypos and what is target HbA1c?
sulfonylureas (gliclazide)
flozins (SGLT2 i’s)
aim for <58
management of diabetic with proteinuria
ACEi
BP aim in diabetes
130/80
causes of hypothyroidism
hashimoto's thyroiditis iodine deficiency pituitary tumour subclinical/ de quervain's drugs: lithium, amioderone, radioiodine thyroidectomy
causes of hyperthyroidism
graves disease
toxic nodules
drugs: overtreatment with levothyroxine, amioderone, IFN alpha, iodine
DDx for high TSH and low T4
primary hypothyroidism
- TPO Abs = hashimotos
- iodine deficiency
- subclinical
DDx for low/normal TSH and low T4
secondary hypothyroidism
- pituitary tumour
investigation findings in graves disease
TSH r Abs
low TSH and high T4
increased uptake of radioactive iodine
USS - enlarged vascular thyroid (bruits)
management of graves disease
radioactive iodine/ surgery
carbimazole
propanolol
management of toxic thyroid nodules
radioactive iodine
what do you need for diagnosis of diabetes insipidus (and other findings)
> 3 L DILUTE urine a day
high sodium, high plasma osmolality, low urine osmolality, polydipsia, polyuria
how to tell apart nephrogenic and cranial diabetes insipidus
desmopressin:
cranial = urine becomes concentrated
nephrogenic = no response to desmopressin, remains dilute
diagnosis of SIADHS
concentrated urine
hyponatremia
euvolemic
absence of oedema and diuretics
causes of SIADHS
malignancy - SCLC, pancreatic, lymphoma
CNS disorders - stroke, subdural, vasculitis
management of SIADHS
fluid restriction
hypertonic saline
furosemide
what does the anterior pituitary secrete
GH, TSH, ACTH, FSH, LH, prolactin
what does the posterior pituitary secrete
ADH, oxytocin
explain pathophysiology and symptoms of acromegaly
pituitary tumour secretes GH which increases ILGF1
ILGF1 binds to insulin receptors so causes DM (OGTT)
large hands and feet, sweating, coarse facial features, gap between teeth, paresthesia and muscle weakness
investigations in acromegaly
ILGF1 and GH measurement
OGTT (measure GH)
MRI pituitary
management of acromegaly
transsphenoidal surgery
octreotide
explain pathophysiology of cushing’s disease
high ACTH from pituitary causes high cortisol from zona fasciculata in adrenal cortex
(ACTH can be from ectopics: SCLC)
what investigations can you do in cushing’s
24 hour urinary cortisol:
high
dexamethasone suppression test:
high cortisol = pituitary adenoma or ectopic (SCLC)
suppressed cortisol = adrenal adenoma/carcinoma
CT abdomen for adrenal cause, CT chest for SCLC
low potassium
describe pathophysiology of addisons
hypocortisolism adrenal cortex cannot produce steroids due to; autoimmunity malignancy sarcoid amyloid TB surgery stopping steroids abruptly (crisis)
what investigations can you do in addisons
short ACTH test (cortisol does not increase) 21 hydroxylase adrenal antibodies high renin low aldosterone high potassium
how does addisons present
thin, tanned, tired, low BP, depression, GI problems, abdo pain
describe the pathophysiology of Conns
hyperaldosteronism
increased aldosterone from zona glomerulosa due to adrenal tumour
or increase in aldosterone due to kidney disease (increased renin)
what investigations can you do in Conn’s
renin and aldosterone levels
CT adrenals
low potassium
HTN
investigations in pheochromocytoma
24 hour urinary catecholamines
diagnosis of DKA
high glucose (>11)
acidosis (pH <7.35)
bicarbonate <15
urine or blood positive for ketones
management of DKA
saline, insulin and potassium
measure BMs
