Endocrinology Flashcards
Diagnostic measures for diabetes
- Glucose >11
- Fasting glucose >6.9
- Ketones
- Hba1c
Specific test for type 1
-Islet cell autoAb’s
Chance test that can be elevated in diabetes
Serum amylase
Aetiology of type 1 type 1 diabetes
Autoimmune destruction of pancreatic Beta-cells. Associated with other autoimmune conditions including thyroid, coeliac and enteroviruses
Pathological features of type 2 diabetes
- Beta cell apoptosis
- Free fatty acids
- Alpha cell dysfunction = Increased glucagon
Hba1c - what is it and how long does it indicated glucose activity
Hb that has been altered due to glucose presence in the blood stream.
-90 days
What level of Hba1C is diagnostic for diabetes
> 6.5
Metformin
- MOA
- SE
- Interactions + contraindications
- Targets AMP kinase increasing sensitivity to insulin and inhibiting gluconeogenesis
- GI
- ACEi, MAOI and contrast
- Renal/hepatic failure
Gliclazide and Glimepiride
- Class
- MOA
- SE
- contraindications
- Sulphonylureas
- Islet cell depolarisation and increases insulin secretion
- Weight gain and electrolyte disturbances
- Renal and hepatic failure
When is Gliclazide first line and what is a requirement for its use
- Low BMI patients
- Functional Beta cells
Exanatide and Liraglutide “tides”
- Class
- MOA
- SE
- contraindications
- GLP-1-Analogue
- Binds to GLP-1 receptor increasing insulin secretion and suppresses glucagon
- Pancreatitis
- Renal failure
Thiazolidinediones
- Examples
- MOA
- SE
- contraindications
- Glitazones
- Agonist PPAR alpha receptor assisting glucose transport into cells.
- Only effective with insulin
- weight/fluid gain
- Liver or renal impairment
DPP4 inhibitor
- Examples
- MOA
- SE
- Gliptins
- Inhibits incretin degradation increasing GLP-1
- Pancreatitis/hepatotoxic
SGLT-2 Inhibitors
- Examples
- MOA
- SE
- Contraindications
- Flozins
- Inhibit resorption of glucose in kidneys
- Weight loss, UTI
- Renal failure
Definition of hypo-event
Glucose<3.5
Triad of DKA and diabetics affected
- Hyperglycemia
- Ketonaemia
- Acidosis
- Type 1
Electrolyte and BP changes associated with DKA
- Variable (hyper/hypo) K
- Low BP
Definition of HHS, presentation -time course and diabetics affected
Osmolarity without ketoacidosis. Low levels of bodily insulin prevent lipolysis.
- Presents slowly over days or weeks
- Lesser version of DKA
- Type 2 diabetics
Why are do micro-vascular changes affect the eyes, kidneys and nerves in diabetes.
These areas don’t require insulin for glucose uptake so can be easily overloaded
Three features of diabetic eye disease
- Dot hemorrhages
- Cotton wool spots
- Leading to maculopathy (cause of blindness presenting with macular oedema)
3 effects of Diabetes on the glomerulus and changes to GFR
- Thickened membrane (hypertrophy)
- Increased albumin
- Nephrotic syndrome
- High GFR
3 internal consequences of Nephropathy
- Erectile dysfunction
- Bladder issues
- GI dysfunction
Which thyroid hormone is more bioactive
T3
Diagnostic picture of hyperthyroidism
- Low TSH
- High T3/4
- autoAb’s TSH receptor(Graves)
Disease picture of multinodular goitre
Longer progression than Graves often with an older onset
Symptoms of Thyroid Storm
- Fever
- Seizures
- Vomiting
- Jaundice
- Coma
Two drugs that suppress Thyroid hormone production and the contraindications for each
- Carbimazole - contraindicated in pregnancy
- Prophythiouricil - Hepatotoxic
Main risk of Carbimazole
Agranulocytosis - abnormal WCC drop with fever rash and infections
Protocol for radioactive iodine treatment, salt used and contraindications
- 131I salt administered in single dose
- contraindicated in pregnancy and thyroid eye disease
Diagnostic picture of hypothyroidism
- High TSH
- Low T3/4
- TPO (Hashimotos)
- Raised ESR (Hashimotos)
3 Primary causes of hypothyroidism
- Hashimotos
- Iodine deficiency
- Drugs
Secondary causes of hypothyroidism
-Pituitary insufficiency - adenoma
What Thyroid conditions produce goitre
Mostly hyper but also Hashimotos
Biggest risk to uncontrolled hypothyroidism
Myxoedema coma - fall in temp, coma and 50% mortality
- MOA Levothyroxine
- Patient information
- Interaction
- Agonist thyroid nuclear receptor
- Empty stomach - no food or drink for 30-60mins after
- Increases Warfarin effect
Definition and diagnostic picture of subclinical thyroid disorders
- Do not produce symptoms
- Hypo = High TSH normal T3/4
- Hyper = Low TSH normal T3/4
Most common and second most common thyroid cancer subtypes
- Papillary
- Follicular
Relationship between radionucleotide scan and pathology extent
more uptake = more likely to be benign
Hormone released by Hypothalamus and pituitary during cortisol release
- Hypothalamus = CRH
- Pituitary = ACTH
Adrenal cortex layers, hormones released
HINT: GFR
SALT = aldosterone - glomerulosa SWEET = cortisol = fasciculara SEX = DHEA = reticularis
What does adrenal medulla secrete
Adrenaline and Noradrenaline
Actions of Aldosterone
- Lowers K
- Increases Na
- Increases BP
Diagnostics for Cushings
- Dexamathesone 48hr supression test = *
- High dose supression test
- 24hr free cortisol
Define Cushings sndrome
Caused by exogenous steroids
2 types of Cushings disease
ACTH+ secreted from pituitary or +CTH = adenoma
High cortisol from suppressed ACTH = ACTH independent
Features of Addisons (adrenal insufficiency)
- Low Na
- Low BP
- High K
Diagnostic test Addisons
-ACTH stimulation test
Primary causes of Addisons (High ACTH)
- TB
- Sepsis
- Metastasis
Secondary causes of Addisons (Low ACTH)
Pituitary disoders (present with pigment and high K)
Treat Addisons
Replace glucocorticoid = hydrocortisone
Replace mineralcorticoid = Fludrocortisone
What feature is typically of Addisonian crisis and how do you treat it
Dramatic BP drop (Na/BP fall, K/Ca Rise)
-IV hydrocortisone - dont wait!
Features of Conns (hyperadrenalism)
- High Na
- High BP
- Low K
Diagnostic test
Plasma aldosterone:renin ratio
High aldosterone due to no feedback
Treatment Conns
- Spironalactone
- Adrenalectomy
Diabetes Insupidus
- Cause
- Pathology-hormone involved
- Diagnostic test
- Drug treatment
- Lithium/cranial pathology
- Fall in ADH from P pituitary
- Water-deprivation test
- Desmopressin (ADH analogue)
First Line treatment for prolactinoma
Bromocryptine - dopamine agonist
Acromegaly
- hormone responsible
- Cause
- Diagnostic test
- Treatment
- Excess GH (somatotropin)
- Pituitary adenoma
- Oral-glucose tolerance test = because normally glucose suppresses GH level
- (Serum IGF-1)
- Surgery or somatotropin analogue “otides”
How often does insulin usually need to be injected
4xper day
What pathology shows most uptake on thyroid scan
Thyroid adenoma
Human-quick acting insulin
Humulin-S
Analogue quick acting insulins
Lispro
Aspart
NPH/Intermediate/Isophane insulin
Insulatard
Human Biphasic insulin
Humulin-M3
Long-acting insulins
- Glargine
- Degludec
Features of levothyroxine non-compliance
- Still symptomatic
- Increase in T3/4 due to quick loading dose before appointment
- TSH ++ high
What medicine interferes with Levothyroxine absorption
Iron - give 2hrs apart
