Endocrinology

Question 1

Investigations for cushings

Answer 1

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

Question 2

Management cushing’s disease

Answer 2

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

Question 3

Complications of cushings

Answer 3

HTN
Diabetes
Osteoporosis

Question 4

Complications of acromegaly

Answer 4

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

Question 5

Investigations acromegaly

Answer 5

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

Question 6

Treatment acromegaly

Answer 6

Surgery or octreotide (GH inhibiting hormone)

Question 7

What is a pheochromocytoma?

Answer 7

Catecholamine secreting neuroendocrine tumour of adrenal medulla

Question 8

What is the classical presentation of pheochromocytoma?

Answer 8

Headache, sweating and tachycardia

Question 9

Investigations for phaeo

Answer 9

24hr for free metanephrines and catecholamines

Clonidine suppression test

Question 10

Management of phaeo

Answer 10

Surgery

Phenoxybenzamine (alpha blocker) then beta blocker pre op

Question 11

How to diagnose diabetes

Answer 11

HbA1c >50

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

Question 12

Complications of diabetes

Answer 12

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

Question 13

Risk factors for type 2 diabetes

Answer 13

Family history
BMI, age, race
Gestational diabetes
Hypertension
Polycystic ovaries

Question 14

Progression of diabetes

Answer 14

Control/compliance
Check sugars
Hyperglycaemic/hypoglycaemic episodes

Question 15

What to examine for diabetes

Answer 15

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

Question 16

Investigations for type 1 diabetes

Answer 16

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

Question 17

Oral agents used in diabetes

Answer 17

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

Question 18

Starting dose of insulin

Answer 18

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

Question 19

Meal time insulins

Answer 19

Humalog/Novarapid (last 1-3 hours)

Humalin/ Actrapid (lasts 3-4 hours)

Question 20

Basal insulin types

Answer 20

Humalin/Protophane (lasts 4-16 hours)

Lantus (lasts 24 hours)

Question 21

Management of neuropathy

Answer 21

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

Question 22

Management of nephropathy

Answer 22

Control BP
ACEi and ARBs
Treatment of UTIs
Dietary protein restriction

Question 23

Management of retinopathy

Answer 23

Laser therapy and regular follow up

Question 24

Risk factors for osteoporosis

Answer 24

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

Question 25

Investigations for osteoporosis

Answer 25

Calcium, phosphate P1NP | DEXA scan if <2.5 then osteoporosis

Question 26

Treatment osteoporosis

Answer 26

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

Question 27

Blood results in osteomalacia

Answer 27

Low calcium and phosphate and high PTH

Question 28

Causes of hyperthyroidism

Answer 28

``` Graves Toxic multinodular goitre Toxic adenoma Thyroiditis Drug ```

Question 29

Causes of hypothyroidism

Answer 29

worldwide: iodine deficiency iatrogenic Autoimmune-hashimotos amiodarone

Question 30

Treatment for hyperthyroidism

Answer 30

Carbimazole Radioiodine Thyroidectomy

Question 31

Treatment for hypothyroidism

Answer 31

Levothyroxine 50micrograms OD

Question 32

Pathophysiology of addison's disease

Answer 32

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

Question 33

Examination findings with addisons disease

Answer 33

``` Pigmented palmer creases and buccal mucosa Postural hypotension lean tearful abdo pain ```

Question 34

Investigations for addison's disease

Answer 34

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

Question 35

Treatment for addisons

Answer 35

Crisis? Hydrocortisone 100mg IV stat | Otherwise just replace steroids-higher dose of glucocorticoids if unwell

Question 36

Causes of SIADH

Answer 36

Malignancy Hypothyroidsim Opiates and SSRIs

Question 37

Diagnosis of SIADH

Answer 37

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

Question 38

Diagnosis of diabetes insipidus

Answer 38

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