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Endocrinology Flashcards

1
Q

What is T1DM

A

autoimmune destruction of pancreatic islet cells –> reduced insulin

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2
Q

What is T2DM

A
  • hypersecretion of insulin by depleted beta cell mass

- increased insulin resistance

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3
Q

comps of DM

A
  • retinopathy
  • neuropathy
  • nephropathy
  • infections
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4
Q

pancreatic alpha cells produce?

A

glucagon

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5
Q

insulins action on cells?

A

allows glucose to enter cell

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6
Q

pres of t1DM

A

polyuria, pokydipsia, wt loss, lethargy +/- DKA

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7
Q

Ix of DM

A

-urine, dip, FPG, RPG, GTT, HbA1c

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8
Q

Screening in DM

A
  • urine (protein)
  • BP
  • fasting lipid
  • eyes
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9
Q

Neuropathy seen in DM

A

glove and stocking

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10
Q

mx of nephropathy in DM

A

ACEi/ARB

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11
Q

Minimise CVSRFs in DM

A
  • control BP
  • lifestyle
  • basically lower QRISK
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12
Q

Reduced chest infections in DM

A
  • pneumococcal vaccine

- annual influenza vaccine

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13
Q

what causes diabetic foot?

A
  • Periph artery disease
  • neuropathy
  • infection
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14
Q

pres of diabetic foot?

A
  • ulcers (neuropathic = painless, arterial = loss of pulse, painful)
  • charcot foot
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15
Q

2 signs in diabetic eye?

A
  • microaneurysm
  • hard exudate
  • haemorrhages
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16
Q

pres of diabetic retinopathy?

A
  • painless

- patch loss of vision

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17
Q

mx of diabetic retinopathy?

A
  • optimise DM control
  • BP control
  • laser photocoagulation
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18
Q

General mx of DM

A

-education (DAFNE), lifestyle,

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19
Q

HbA1c
in DM?
in pre-DM?

A

> 48mmol

42-47mmol

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20
Q

Pharma mx of T2DM?

A
  1. Metformin (if HbA1c>58)
  2. +gliptin/sulfonylurea/pioglitazone (if HbA1c remains > 58)
  3. triple therapy
  4. insulin
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21
Q

Metformin

  1. mechanism
  2. CI
  3. SE
A
  1. increase insulin sensitivity (GLUT4), decrease gluconeogen
  2. eGFR<30
  3. GI upset
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22
Q

Gliptin

  1. mechanism
  2. CI
  3. SE
A
  1. DPP-4 inhibitor (destroys incretin)
  2. 3.
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23
Q

Sulfonylurea

  1. mech
  2. CI
  3. SE
A
  1. increase pancreatic insulin secretion
  2. pregnancy
  3. hypos, wt gain
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24
Q

Pioglitazone

  1. mech
  2. CI
  3. SE
A
  1. increase insulin sensitivity
  2. HF, osteoporosis
  3. wt gain, fluid retention, osteoporosis
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25
Q

Hypo mx

  1. conscious
  2. unconscious
A
  1. glucogel/glucose tablets

2. IM glucagon

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26
Q

Why does being unwell increases risk of DKA?

A
  • Stress response to illness –> increased cortisol

- cortisol increases blood sugar, decreases insulin

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27
Q

Triggers of DKA (5Is)

A
  • insulin (missed)
  • infection
  • intoxication
  • ischaemia
  • infarction
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28
Q

Pres of DKA

A
  • N+V
  • abdo pain
  • dehydration
  • Kussmaul breathing
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29
Q

What is kussmaul breathing?

A 
deep hyperventilation
(to correct metabolic acidosis)
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30
Q

hypokalaemia ECG

A
  • PR prolomged
  • ST depression
  • flat/invert T wave
  • prominent U wave
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31
Q

3 ix in DKA

A
  • Plasma glucose > 11
  • plasma ketones >3
  • ABG –> metabol acidosis (pH < 7.3)
  • urine dip: ketones ++, glucose ++
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32
Q

mx of DKA

A
  • ABCDE + catheterise
  • IV NaCl
  • IV insulin (FIXED RATE) 0.1U/kg/h
  • Correct hypokalaemia
  • if acidaemic –> IV bicarbonate
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33
Q

Hyperosmolar hyperglycaemic state

  1. who in
  2. features
A
  1. T2DM

2. v. high blood glucose > 40, v.high serum osmolality

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34
Q

Triggers of HOHG

A

infection, infarction, dehydration, not taking meds, thiazides, loops

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35
Q

Pres of HOHG

A

dehydration, altered mental stae +/- seizures, delirium

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36
Q

ix in HOHG

A
  • urinalysis
  • cap glucose > 30
  • serum osmolarity > 320
  • U+Es = AKI
  • Blood cultures r/o sepsis
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37
Q

Mx of HOHG

A
  • ABCDE
  • treat cause
  • replace fluids + electrolytes
  • IV insulin
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38
Q

Hypothyroid

  1. most common cause
  2. other
  3. presentation
A
  1. hashimotos
  2. Iodine def, lithium, De Quervians, amiodarone
  3. Bradycardia, constipation, menorrhagia, cold intol, depressed, TATT, decreased appetite, wt gain
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39
Q

complication of hypothyroid?

how does it present??

A

myxoedema coma

hypoventilation + seizures + hypothermia + decreased consciousness

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40
Q

mx of myxoedema coma

A
  • IV levothyroxine
  • IV hydrocortisone
  • resp support
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41
Q

mx of hypothyroid

A
  • lifelong levothyroxine

- screen for osteroporosis, arhhythmias

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42
Q

antibody in graves

A

-anti-TSHr

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43
Q

ix in hyperthyroid

A
  • TFT
  • Anti-TSHr
  • imaging
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44
Q

mx of hyperthyroid

A
  • BB
  • Carbimazole/propylthiouracil
  • levothyroxine
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45
Q

which antithyroid is CI in preg?

A

carbimazole

use propylthiouracil

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46
Q

thyroid storm pres

A
  • Hyperpyrexia > 41
  • HR > 140
  • Hypotension
  • N+V, jaundice, diarrhoea
  • Confusion, agitatino
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47
Q

Ix in thyroid storm

A
  • septic screen
  • TFT
  • ECG
  • ABG
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48
Q

Mx of thyroid storm

A
  • ABCDE
  • Resus
  • carbimazole/propylthiouracil
  • IV propanolol
  • IV hydrocortisone
  • keep cool with sponge
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49
Q

What causes PTH release?

A

low Ca

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50
Q

PTH effects?

A

Bone –> increase osteoclast activity

Kidney –> increase reabs Ca, decrease reabs PO4
–> vit d metabolism –> acts on gut to increase Ca absorp

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51
Q

who gets primary hyperparathyroid?

A

post menopausal women (benign adenoma of parathyroids)

52
Q

secondary hyperparathyroid causes?

A

low Ca –> PT hyperplasia

CKD

53
Q

what hormone inhibits osteoclasts?
(opposes PTH)
where is it produced?

A
  • calcitonin

- produced by para-follicular C cells of thyroid

54
Q

sx of hypercalcaemia?

A 
Bones (pain, fractures)
Stones (renal colic)
Abdo moans (diarrhoea, pain, vom)
Thrones (polyuria, poldipsia)
Psych overtones (depression, altered consciousness)
\+ muscle weakness
55
Q

mx of primary hyperparathyroid?

A

Treat hypercalcaemia with:

  • Vitamin D
  • Fluids
  • Bisphosphonates

+/- surgical resection of parathyroids

56
Q

mx of secondary hyperparathyroid?

A
  • Vitamin D
  • Calcium supplements
  • phosphate binders
  • calcimimetics
57
Q

Tertiary hyperparathyroid?

A

after longstanding secondary

58
Q

ddx for Hypercalcaemia

A
  • Hyperparathyroid
  • malignancy [PTHrP, osteolysis]
  • endocrine
  • drugs [thiazide, vit D]
59
Q

ix in hypercalcamia

A
  • corrected calcium
  • alk phos
  • XR
60
Q

mx of hypercalcaemia

A

0.9% saline
loop diuretic
IV bisphosphonates

61
Q

causes of hypocalcamia

A

low PTH
Vit D deficiency
CKD
acute pancreatitis

62
Q

sx of hypocalcamiea

A

paraesthesia
tetany
carpopedal spasm
cramps

63
Q

ix in hypocalcamiea

A

correct calcium
U+Es
ECG - long QT

64
Q

signs in hypocalcaemia

A

Chvosteks [tap facial nerve –> spasm]

Trousseaus [

65
Q

mx of hypocalcaemia

A
  • 10ml 10% calcium gluconate infusion [stabilises cardiac memb]
  • oral calcium
  • correct hypoMg if present
  • LT [Ca + Vit D]
66
Q

Anterior pituitary hormones

A
  • GH
  • Prolactin
  • FSH
  • LH
  • ACTH
  • TSH
67
Q

Posterior pituitary hormones

A
  • ADH

- oxytocin

68
Q

2 local effects of pituitary tumours

A
  • cavernous sinus = CN 3, 4, 5, 6
  • optic chiasm =bitemp hemianopia
  • headaches
69
Q

ddx of pituitary adenoma local effects

A

craniopharyngioma

70
Q

mx of pituitary adenoma

A

transsphenoidal surgery

71
Q

pharma mx of prolactinoma

A

bromocriptine

72
Q

pharma mx of GH adenoma

A

somatostatin

73
Q

which drugs raise prolactin?

A

antipsychotics

antidepressants

74
Q

SEs of bromocriptine

A
  • somnolence
  • hypotension
  • fibrosis (pulm., cardiac, retroperitoneal)
75
Q

2 hormones in acromegaly

76
Q

3 features of acromegaly

A
  • local –> headache, visual field defect
  • big hands/feet
  • frontal bossing, macroglossia
  • skin pigmentation
  • carpal tunnel
  • T2DM
77
Q

3 ix in acromegaly

A
  • IGF-1 raised
  • OGTT
  • GH
  • Pituitary MRI
  • Visual fields
78
Q

mx of acromegaly

A
  • Surgical [transsphenoidal surgery]

- Medical [somatostatin, bromocriptine]

79
Q

layers of adrenals (from outside to inside)

A
  • Glomerulosa (mineralocorticoids - aldosterone)
  • Fasciculata (glucocorticoids - cortisol)
  • Reticularis (androgens - DHEA)

“the deeper you get the sweeter it gets”
GFR - salt sugar sex

80
Q

Cortisol effects

A

RIDGE

  • suppression or Reproduction
  • suppression of Immunity
  • suppression of Digestion
  • suppression of Growth
  • mobilisation of Energy (increase glucose, decrease insulin_
81
Q

High cortisol syndrome

A

Cushing’s

82
Q

classification of Cushing’s syndrome?

egs of cause of each

A
  • ACTH dependent [ACTH prod pituitary tumour = Cushing’s disease; ectopic ACTH prod tumours (SCLC)}
  • ACTH independent [adrenal adenoma/carcinoma]
  • most common is IATROGENIC from excess glucocorticoids
83
Q

signs of Cushing’s syndrome

A
  • Buffalo hump
  • Moon face
  • Weight gain
  • Proximal muscles wasting
  • DM, HTN
84
Q

ix for Cushing’s

A
  • glucose
  • dexamethasone suppression test (low dose, high dose)
  • 24h urinary free cortisol
85
Q

Addison’s

A
  • adrenal insufficiency autoimmune

- primary hypoaldosteronism

86
Q

Causes of adrenal insufficiency

A
  • Primary [addisons, surgical, metabolic failure]

- Secondary [steroids, TB]

87
Q

signs of addisons

A

pigmentation of skin

88
Q

Antibody in addisons

A

anti-21 hydroxylase

89
Q

sx of chroinc addisons (5Ts)

A

thin, tanned, tired, tearful and tumbling

  • GI: N+V, wt loss
  • hyperpigmented skin
  • fatigue + weakness
  • depression, personality change
  • muscle cramps
90
Q

signs of addisons

A
  • pigmental palmar crease and buccal mucosa

- hypotension

91
Q

What test to differentiate between primary vs secondary addisons?

A

-ACTH levels
High = primary
low = secondary

92
Q

ix in addisons

A
  • ACTH
  • U+Es [hyponatraemia, hypokalaemia]
  • renin (high), aldosterone (low)
  • CT adrenals
  • short synacthen test
93
Q

mx of addisons

A
  • education
  • steroid card
  • REPLACE STEROIDS
  • glucocorticoid –> hydrocortisone
  • mineralocorticoid –? fludrocortisone
94
Q

Addisonian crisis pres

A

malaise, fatigue, N+V, low grade fever, muscle cramps, confusion

-DEHYDRATION: hypotension + hypovolaemic shock

95
Q

mx of addisonian crisi

A
  • IV hydrocortisone
  • rehydration
  • Glucose
96
Q

Conn’s syndrome

A

primary hyperaldosteronism

97
Q

Pathophys of Conn’s

A

hypernatraemia, water retention, hypokalaemia

98
Q

pres of Conns

A
  • oedema
  • HTN
  • hypokalaemia –> weakness, cramps, paraesthesia
  • metabol alkalosis
  • polyuria
99
Q

ix in conns

A
  • U+Es
  • BP
  • aldosterone:renin ratio
  • ECG
  • CT/MRI of adrenals
100
Q

mx of conns

A
  • Spironolactone

- adrenalectomy (if u/l)

101
Q

causes of hyperkalaemia

A
  • Renal [AKI, CKD, addisons, RTA]
  • Drugs [spiro, ACEi, ARB, NSAID]
  • DKA
  • Other [rhabdomyolysis, burns, trauma. blood transfusion]
102
Q

pres of hyperkalaemia

A

weakness, fatigue, flaccid paralysis, palpitations, chest pain

103
Q

ix in hyperK

A
  • med r/v
  • U+Es
  • ABG
  • ECG
104
Q

ECG in hyperK

A

loss of P
PR prolonged
QRS widened
T - peaked

can progress to VF

105
Q

mx of hyperK

A
  • stop drugs
  • IV fluids
  • cardiac protection [calcium gluconate IV]
  • Insulin + glucose
  • Neb salbutamol
106
Q

cause of hypoK

A
  • non-K sparing diuretics

- N+V

107
Q

pres of hypoK

A

-weakness, constipation, hypotonia

108
Q

ix of hypoK

A
  • U+Es.
  • ABG
  • Glucose
  • ECG
  • Mg (also usually low)
109
Q

mx of hypoK

A

-give potassium

110
Q

sx of phaeochromocytoma

A

headache, sweating, HTN, tremor, flushing, tachycardia

111
Q

ix of phaeochromocytoma

A
  • 24h urinary catecholamines

- abdo CT/MRI

112
Q

what is phaeochromocytoma

A

catecholamine producing adrenal tumour

113
Q

mx for phaeochromocytoma

A

Surgical resection of tumour

a-blockade with phenoxybenzamine, followed by -
b-blockade with propanolol –> prevents a hypertensive crisis

114
Q

what is carcinoid syndrome

A

tumour of enterochromaffin cell –> prod serotonin

115
Q

pres of carcinoid syndrome

A

flushing and diarrhoea

116
Q

ix in carcinoid

A 
urinary 5HT
CT CAP (find tumour!)
117
Q

mx of carcinoid

A

surgical resection

medical - octreotide

118
Q

what is diabetes inspidus

A

large amounts of dilute urine, inability to concentrate urine (ADH hyposecretion or resistance)

119
Q

2 causes of diabetes insipidus

A

cranial

nephrogenic

120
Q

mx of diabetes insipidus

A

ADH replacement (desmopressin)

121
Q

mx of SIADH

A

IV hypertonic saline

Treat cause

Furosemide

122
Q

what is dex suppression test?

A

Give steroids –> should lower cortisol

if it doest = +ve test
therefore pituitary adenoma or ectopic prod of ACTH

123
Q

low dose dexamethasone suppression test

A

1mg –> no suppression of cortisol = Cushing’s syndrome

124
Q

high dose dexamethasone suppression test

A

8mg –> suppression = Cushing’s disease

no suppression = ectopic ACTH or adrenal cause

125
Q

mx of Cushing’s

A
  • Surgery –> treat cause [remove tumour!]

- Medical –> metyrapone (inhibits cortisol synthesis) / ketoconazole / mifepristone

Finals (20 decks)

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