Endocrinology Flashcards
Investigations for cushings
Pregnancy test Blood glucose 24 hour urinary free cortisol or late night salivary cortisol dexamethasone suppression test MRI pituitary
Management cushing’s disease
Pituitary adenomectomy
Prior to surgery need somatostatin analogue (pasireotide), steroidogenesis inhibitor(ketonazole) and glucocorticoid receptor antagonist (mifepristone)
Complications of cushings
HTN
Diabetes
Osteoporosis
Complications of acromegaly
Diabetes
HTN
Increased risk of cardiac problems
Increased risk of colon cancer
Investigations acromegaly
IGF-1 Serum growth hormone Glucose, calcium and phosphate MRI to check pituitary ECG Echo HbA1c
Treatment acromegaly
Surgery or octreotide (GH inhibiting hormone)
What is a pheochromocytoma?
Catecholamine secreting neuroendocrine tumour of adrenal medulla
What is the classical presentation of pheochromocytoma?
Headache, sweating and tachycardia
Investigations for phaeo
24hr for free metanephrines and catecholamines
Clonidine suppression test
Management of phaeo
Surgery
Phenoxybenzamine (alpha blocker) then beta blocker pre op
How to diagnose diabetes
HbA1c >50
2x fasting glucose >7mmol/L or 2 hour post prandial glucose >11.1
Complications of diabetes
Microvascular Retinopathy Neuropathy (sensory, acute painful, mononeuropathy, amyotrophy, autonomic) Nephropathy Macrovascular MI, TIA, Stroke, PVD
Risk factors for type 2 diabetes
Family history BMI, age, race Gestational diabetes Hypertension Polycystic ovaries
Progression of diabetes
Control/compliance
Check sugars
Hyperglycaemic/hypoglycaemic episodes
What to examine for diabetes
Lying and standing BP
Eyes
Abdomen-injection sites
Legs: PV exam
Palpate temperature, cap refill, peripheral pulses
Lower limb neuro exam-microfilament sensation test
Investigations for type 1 diabetes
Antibodies (Insulin antibody, islet cell antibody, insulinoma antigen)
Ketones in urine
Oral agents used in diabetes
Metformin 500mg BD
Causes GI side effects and can cause lactic acidosis
Contraindicated in heart failure, MI, sepsis
Glipazide 5mg BD/40mg BD
Causes weight gain, water retention and hypos
Contraindicated with warfarin
Can also use: GLP-1 analogues, thiazolidnediones, DPP-IV inhibitors
Starting dose of insulin
0.2 units/kg/day up to 1 unit/kg per day but adjust gradually
Meal time insulins
Humalog/Novarapid (last 1-3 hours)
Humalin/ Actrapid (lasts 3-4 hours)
Basal insulin types
Humalin/Protophane (lasts 4-16 hours)
Lantus (lasts 24 hours)
Management of neuropathy
Amitriptyline (causes anti cholinergic side effects), orthotics and podiatry foot checks
Management of nephropathy
Control BP
ACEi and ARBs
Treatment of UTIs
Dietary protein restriction
Management of retinopathy
Laser therapy and regular follow up
Risk factors for osteoporosis
Steroids Hyperthyroid Alcohol Testosterone Thin Early menopause Renal/liver failure Erosive bone disease Dietary (low calcium, t1DM)
Investigations for osteoporosis
Calcium, phosphate P1NP
DEXA scan if <2.5 then osteoporosis
Treatment osteoporosis
Weight bearing exercises
Bisphosphonates (alendronate or zoledronic acid)
HRT will prevent but not treat
Blood results in osteomalacia
Low calcium and phosphate and high PTH
Causes of hyperthyroidism
Graves Toxic multinodular goitre Toxic adenoma Thyroiditis Drug
Causes of hypothyroidism
worldwide: iodine deficiency
iatrogenic
Autoimmune-hashimotos
amiodarone
Treatment for hyperthyroidism
Carbimazole
Radioiodine
Thyroidectomy
Treatment for hypothyroidism
Levothyroxine 50micrograms OD
Pathophysiology of addison’s disease
Autoimmune/TB causes destruction of adrenal cortex resulting in deficiency in corticosteroids and mineralcorticoids
Examination findings with addisons disease
Pigmented palmer creases and buccal mucosa Postural hypotension lean tearful abdo pain
Investigations for addison’s disease
Low Na high K Low glucose Synacthen test (synthetic ACTH)-measure cortisol before and after Adrenal autoantibodies CXR
Treatment for addisons
Crisis? Hydrocortisone 100mg IV stat
Otherwise just replace steroids-higher dose of glucocorticoids if unwell
Causes of SIADH
Malignancy
Hypothyroidsim
Opiates and SSRIs
Diagnosis of SIADH
Always check volume, thyroid and cortisol first
High urine osmolality
Low plasma osmolality (hyponatreamia)
Diagnosis of diabetes insipidus
High serum osmolality
Low urine osmolality
8 hr water deprivation test
Desmopressin test
