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Long Case > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Investigations for cushings

A 
Pregnancy test
Blood glucose
24 hour urinary free cortisol or late night salivary cortisol
dexamethasone suppression test
MRI pituitary
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2
Q

Management cushing’s disease

A

Pituitary adenomectomy
Prior to surgery need somatostatin analogue (pasireotide), steroidogenesis inhibitor(ketonazole) and glucocorticoid receptor antagonist (mifepristone)

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3
Q

Complications of cushings

A

HTN
Diabetes
Osteoporosis

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4
Q

Complications of acromegaly

A

Diabetes
HTN
Increased risk of cardiac problems
Increased risk of colon cancer

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5
Q

Investigations acromegaly

A 
IGF-1
Serum growth hormone
Glucose, calcium and phosphate
MRI to check pituitary
ECG 
Echo
HbA1c
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6
Q

Treatment acromegaly

A

Surgery or octreotide (GH inhibiting hormone)

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7
Q

What is a pheochromocytoma?

A

Catecholamine secreting neuroendocrine tumour of adrenal medulla

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8
Q

What is the classical presentation of pheochromocytoma?

A

Headache, sweating and tachycardia

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9
Q

Investigations for phaeo

A

24hr for free metanephrines and catecholamines

Clonidine suppression test

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10
Q

Management of phaeo

A

Surgery

Phenoxybenzamine (alpha blocker) then beta blocker pre op

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11
Q

How to diagnose diabetes

A

HbA1c >50

2x fasting glucose >7mmol/L or 2 hour post prandial glucose >11.1

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12
Q

Complications of diabetes

A 
Microvascular
Retinopathy
Neuropathy (sensory, acute painful, mononeuropathy, amyotrophy, autonomic)
Nephropathy
Macrovascular
MI, TIA, Stroke, PVD
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13
Q

Risk factors for type 2 diabetes

A 
Family history
BMI, age, race
Gestational diabetes
Hypertension
Polycystic ovaries
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14
Q

Progression of diabetes

A

Control/compliance
Check sugars
Hyperglycaemic/hypoglycaemic episodes

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15
Q

What to examine for diabetes

A

Lying and standing BP
Eyes
Abdomen-injection sites
Legs: PV exam
Palpate temperature, cap refill, peripheral pulses
Lower limb neuro exam-microfilament sensation test

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16
Q

Investigations for type 1 diabetes

A

Antibodies (Insulin antibody, islet cell antibody, insulinoma antigen)
Ketones in urine

17
Q

Oral agents used in diabetes

A

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

18
Q

Starting dose of insulin

A

0.2 units/kg/day up to 1 unit/kg per day but adjust gradually

19
Q

Meal time insulins

A

Humalog/Novarapid (last 1-3 hours)

Humalin/ Actrapid (lasts 3-4 hours)

20
Q

Basal insulin types

A

Humalin/Protophane (lasts 4-16 hours)

Lantus (lasts 24 hours)

21
Q

Management of neuropathy

A

Amitriptyline (causes anti cholinergic side effects), orthotics and podiatry foot checks

22
Q

Management of nephropathy

A

Control BP
ACEi and ARBs
Treatment of UTIs
Dietary protein restriction

23
Q

Management of retinopathy

A

Laser therapy and regular follow up

24
Q

Risk factors for osteoporosis

A 
Steroids
Hyperthyroid
Alcohol
Testosterone
Thin
Early menopause
Renal/liver failure
Erosive bone disease
Dietary (low calcium, t1DM)
25
Q

Investigations for osteoporosis

A

Calcium, phosphate P1NP

DEXA scan if <2.5 then osteoporosis

26
Q

Treatment osteoporosis

A

Weight bearing exercises
Bisphosphonates (alendronate or zoledronic acid)
HRT will prevent but not treat

27
Q

Blood results in osteomalacia

A

Low calcium and phosphate and high PTH

28
Q

Causes of hyperthyroidism

A 
Graves
Toxic multinodular goitre
Toxic adenoma
Thyroiditis
Drug
29
Q

Causes of hypothyroidism

A

worldwide: iodine deficiency
iatrogenic
Autoimmune-hashimotos
amiodarone

30
Q

Treatment for hyperthyroidism

A

Carbimazole
Radioiodine
Thyroidectomy

31
Q

Treatment for hypothyroidism

A

Levothyroxine 50micrograms OD

32
Q

Pathophysiology of addison’s disease

A

Autoimmune/TB causes destruction of adrenal cortex resulting in deficiency in corticosteroids and mineralcorticoids

33
Q

Examination findings with addisons disease

A 
Pigmented palmer creases and buccal mucosa
Postural hypotension
lean
tearful
abdo pain
34
Q

Investigations for addison’s disease

A 
Low Na high K
Low glucose
Synacthen test (synthetic ACTH)-measure cortisol before and after
Adrenal autoantibodies
CXR
35
Q

Treatment for addisons

A

Crisis? Hydrocortisone 100mg IV stat

Otherwise just replace steroids-higher dose of glucocorticoids if unwell

36
Q

Causes of SIADH

A

Malignancy
Hypothyroidsim
Opiates and SSRIs

37
Q

Diagnosis of SIADH

A

Always check volume, thyroid and cortisol first
High urine osmolality
Low plasma osmolality (hyponatreamia)

38
Q

Diagnosis of diabetes insipidus

A

High serum osmolality
Low urine osmolality
8 hr water deprivation test
Desmopressin test

Long Case (11 decks)

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