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Endocrinology Flashcards

1
Q

What is required for DM diagnosis in symptomatic and asymptomatic patients?

A

Symptomatic -
Fasting >=7 OR
Random >=11.1

Asymptomatic -
Raised venous glucose twice separately OR
2hOGTT >=11.1

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2
Q

What are the secondary causes of DM?

A

Drugs - Steroids, HIV meds, neuroleptics, thiazides
Pancreatic - CF, chronic itis, HH, panc Ca
Endo - phaeo, cushings, acromegaly, hyperthyroidism
Glycogen storage disease

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3
Q

Outline the conservative management of DM

A

MDT approach

Monitor the 4Cs
Control glucose levels
Complications
Competency
Coping
Life style modifications - DELAYS
Diet
Exercise
Lipids
ABP
Aspirin
Yearly check ups
Smoking cessation
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4
Q

What are the side effects of metformin?

A

Nausea, diarrhoea, abdo pain, lactic acidosis (therefore CI if GFR<30)

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5
Q

What medication should be added if lifestyle and metformin alone are not controling glucose levels?

A

Sulphonylureas - e.g. Gliclazide MR 30mg with breakfast

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6
Q

What are the side effects of gliclazide?

A

Hypos and weight gain

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7
Q

What can be added to metformin if the patient is prone to hypos instead of gliclazide?

A

Pioglitazone/sitagliptin (causes weight)

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8
Q

What is the benefit of Exenatide?

A

Also lowers BP so is cardioprotective

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9
Q

What are the two commonest insulin regimes, and what are their benefits and drawbacks?

A

BD Biphasic -
A mixture of rapid and long acting insulin given 30 minutes before breakfast and dinner good for old people and children but does cause fasting hyperglycaemias

Basal-bolus regime
Bedtime long acting glargine with short acting actrapid before each meal adjusting to meal size
Used for T1Dm allowing greater flexibility if appropriately managed

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10
Q

What considerations surrounding insulin should be made when a patient becomes ill?

A

Insulin requirements rise even when fasting
Maintain calories
Check BMs every 4 hours and test ketones and adjust insulin accordingly

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11
Q

What -broadly- are the complications of DM?

A

Macro and microvavscular

Macro
MI
PVD
CVA

Micro
Retinopathy
Neuropathy
Nephropathy

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12
Q

What type of foot ulcers do diabetics tend to get?

A

Ischaemic and neuropathic

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13
Q

What is the progression of diabetic retinopathy?

A

Background
Pre-proliferative
Proliferative
Maculopathy

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14
Q

What are the fundoscopy findings of background retinopathy

A

Dots - microaneurysms
Blot haemorrhages
Yellow exudates

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15
Q

What are the fundoscopy findings of pre-proliferative retinopathy

A

Cotton wool infarcts
Venous beading
Haemorrhages

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16
Q

What are the fundoscopy findings of proliferative retinopathy

A

Neovascularization

Vitreous haemorrhage

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17
Q

What are the fundoscopy findings of maculopathy

A

Impaired acuity +-

Hard exudates close to the macula

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18
Q

What are the features of autonomic neuropathy secondary to DM?

A 
Postural hypos
Gastroparesis
Diarrhoea
Urinary retention 
ED
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19
Q

What are the three features of DKA?

A

DKA

Dehydration
Ketogenesis
Acidosis

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20
Q

What are the diagnostic criteria for DKA?

A

Acidosis - pH<7.3 (<7.1 is severe)
Hyperglycaemia - >=11.1
Ketosis - >=3 (>=2+ on dipstick

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21
Q

What is the management of DKA?

A
  1. Fluids
    If SBP<90: 0.9% saline over 15 minutes (repeat if nec)
    If SBP>90: maintenance fluids

Start K+ (if deranged) in second bag (40mmol/L) unless evidence of anuria

  1. Insulin
    Actrapid 0.1u/kg/hr IV (max 15u)
    Continue any SC regimens
3. Assess and investigations
Hx and exam
Catheter
NGT if vomiting or GCS<8
LMWH
Address precipitating factors
Hourly monitoring
  1. Glucose
    Once glucose <14, add 10% dextrose to saline infusion at 125ml/hr
5. Insulin
Once ketones <0.3 AND
pH>7.3 AND
Patient able to eat...
Switch to subcut actrapid and a meal, and stop the insulin infusion 1 hour later
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22
Q

How do hyperosmolar hyperglycaemic non ketotic states usually present?

A

Older pt with first presentation of T2DM

Marked dehydration and hyperglycaemia with NO acidosis due to absence of ketones

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23
Q

What are the complications of HHNK, and what should be done to prevent them?

A

VTE ->LMWH

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24
Q

What is Whipple’s triad?

A

Hypoglycaemia:

Low glucose
Symptoms associated with hypo
Relief of symptoms on glucose administration

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25
What is the role of C-peptide in determining the cause of a hypo?
Exogenous insulin doesnt give C-peptide
26
What endocrine syndrome are insulinomas associated with?
MEN1
27
What are the features of thyrotoxicosis unique to Graves disease?
``` Opthalmoplegia Exopthalmos Gritty eyes Pre-tibial myxoedema Thyroid acropachy ```
28
Isotope scan shows increased and decreased uptake in which two conditions?
Increased in Graves | decreased in thyroiditis
29
Which other conditions is Graves associated with?
T1DM Vitiligo Addisons
30
What is the management of thyrotoxicosis?
Medical - B-blockers Carbimazole - causes agranulocytosis Radioiodine - CI in pregnancy Surgical - thyroidectomy; SFx - Laryngeal nerve damage, low pTH, hypothroid
31
What is the commonest cause of hypothyroidism in the UK and worldwide?
UK - Hashimoto's | Worldwide - Iodine def
32
What drugs precipitate hypothyroidism?
Carbimazole Amiodarone Lithium
33
What antibodies are seen in Hashimoto's thyroiditis?
Anti-TPO
34
What are the four types of thyroid cancer, which is the most common and which is the most aggressive?
Papillary - commonest Follicular Medullary - CEA+ Anaplastic - worst
35
What are the complications of thyroid surgery?
``` Early Haematoma ->airway obst Laryngeal oedema ->obst Rec laryngeal palsy Hypoparathyroidism Thyroid storm ``` Late Hypothyroid Relapse Keloid scar (big scar)
36
What is the commonest cause of primary hyperpth?
Solitary adenoma
37
What are the investigative findings of primary hyperPTH?
HyperCA - Short QT, bradycardia, low PO4 Osteitis fibrosa cystica Osteoporosis
38
Rx of Primary hyperPTH?
Fluid Reduce Ca intake and thiazides Surgery
39
What are the causes of secondary hyperPTH?
Vit D def | CKD
40
What is the treatment of 2ary hyperPTH?
``` Phosphate binders (calcichew, sevelamer) Vit D - alfacalcidiol in CKD, chole in vit D def Cinaclet ```
41
What are the features of hypoparathyroidism?
``` Trousseaus Parasthesia Anxiety Seizures Spasticity Confusion Chvostek Long Qt ```
42
What are the causes of hypoparathyroidism?
Autoimmune DiGeorge Surgical
43
What is pseudohypoparathyroidism?
Target organ fails to respond to PTH causing Low Ca and High PTH
44
What is pseudopseudohypoparathyroidism?
Normal biochem with pseudohypoparathyroid phenotype
45
What are the features of Cushing's syndrome?
``` Catabolic Prox myopathy Striae Bruising Osteoporosis ``` Glucocorticoid DM Obesity Mineralocorticoid HTN Hypokalaemia
46
What are the commonest causes of Cushings synd?
Iatrogenic - commonest by far Adrenal adenoma Cushings disease Ectopic ACTH from SCLC/carcinoid
47
How would you investigate Cushings's syndrome?
24hour urinary cortisol | Dexamethasone supression tests
48
How do you treat cushing's sundrome?
Disease - excisison Adenoma - adrenalectomy Ectopic - Excision
49
What is Nelson's syndrome?
Rapid enlargement of a pituitary adenoma following bilateral adrenalectomy for Cuhings presenting with bitemphemianopia and hyperpigmentation
50
What are the features of hyperaldosteronism`/
Hypokalaemia - weakness, hypotonia, hyporeflexia, parasthesia Htn
51
What are the two causes of primary hyperaldosteronism?
70% bilateral adrenal hyperplasia | 30% solitary adenoma (Conn's synd)
52
What is the management of primary hyperaldosteronism?
Conns - surgery | Hyperplasia - spironolactone
53
What causes secondary hyperaldosteronism?
Renal hypoperfusion causes renin secretion ``` RAS Diuretics CCF Hepatic failure Nephrotic syndrome ```
54
How might you differentiate between primary and secondary hyperaldosteronism?
Aldosterone: Renin ratio Normal in 2ary High in 1ary
55
What are the causes of primary adrenal insufficiency (Addison's)
Worldwide - TB UK - autoimmune disease Lung mets Congenital adrenal hyperplasia
56
What are the syjmptoms of Addison's disease?
``` Wt loss + anorexia n/v Abdo pain Diarrhoea/constipation Lethargy Depression Hyperpigmentation Postural hypotension Hypoglycaemia Vitiligo Crises ```
57
What would investigatisons show in Addison's disease?
BLood - lowNa high K, hypoglycaemia, hypokalaemia, anaemia Short synacthen test should be negative
58
What is the management of addison's?
Replace Hydrocortisone and FLudrocortisone Dont stop steroids suddenly, and increase them during intercurrent illness. Wear medicaalert bracelet
59
What is the pathology of 2ary hypoadrenalism, and therefore its differences with Addisons?
HPA dysfunction due to chronic steroid use, pit apoplexy or microadenoma Normal mineralocorticoid production and ho hyperpigmentation
60
What is the presentation of Addison's?
Shock - tachycardia, postural drop, oliguria, confusion | Hypoglycaemia
61
WHat is the management of an adddisonian crisis?
IV hydrocortisone 100mg IV fluids C Glucose if needed
62
What is the rule of 10s regarding phaeos?
10% malignant 10% extra adrenal 10% bilateral 10% hereditary syndromes
63
WHich hereditary syndromes are linked to phaeos?
NF Men2a and 2b VHL
64
What is the classic triad of phaeo presentation?
Episodic headache, sweating and tachycardia
65
What is the diagnostic test for phaeos?
24hr urinary metanephrine
66
What is the treatment for phaeos?
Adrenalectomy with pre-op alpha and beta blockade with post op BP monitoring for hypotensive crisis
67
What are the features of MEN1
Pit adenoma Parathyroid adenoma Pancreatic tumours
68
What are the features of MEN2a/b
Thyroid medullary carcinoma Phaeos a) hyperthyroidism b)Marfanoid habitus
69
What are the features of Carney Complex/LAME Syndrome?
LAMES Lentigenes - spotty skin pigmentation Atrial Myxoma Endocrine tumours Schwannomas
70
What are the features of Peutz Jehgers?
Mucocutaneous freckls around mouth and on plantar surfaces GI hamartomas Pancreatic tumours Cancer risk
71
What are the features of VHL?
``` Bilateral RCC Renal cysts Haemangioblastomas -> cerebellar signs Phaeos Pancreatic endocrine tumours ```
72
What are the features of NF?
``` Neurofibromata Cafe au lait spots Lisch nodules (eyes) Axilliary freckling Phaeos ```
73
What are the causes of hypopituitarism?
Hypothalamic - Kallmanns, tumour, III Pit stalk - trauma, surgery, tumour Pituitary - irradiation, tumour, apoplexy, infiltration (HH, amyloid)
74
What hormones are affected by panhypopituiitarism and how does this present?
GH - central obesity, atherosclerosis, HF LH/FHS - libido reduction, ED, hair loss, amenorrhoea TSH - hypothyroidism ACTH - 2ary adrenal failure
75
What is the classification of pituitary tumours?
<1cm is microadenoma | >1cm is macroadenoma
76
Features of pituitary tumours?
``` Mostly mass effect - Headache Bitemp hemianopia CN palsies DI Rhinorrhoea CSF ``` Hormone effects- PRL - galactorhoea GF -> acromegaly ACTH -> Cushings disease
77
What is the commonest cause of acromegaly?
Pituitary adenoma - 99%
78
What are the features of acromegaly?
Hands - CTS, large, thenar wasting Face - Prominent supraorbital ridges, coarse face, ugly fuckers, big ears, prognathism, macroglossia, goitre
79
What are the complications of acromegal?
Endo - DM Cardio - HTN, LVH, IHD Neoplasia - CRC
80
What is the management of acromegaly?
1st - transphenoidal surgery 2nd - somatostatin analogue (octreotide) 3rd - GH antagonits 4th - radiotherapy
81
What are the different types of DI and their causes?
``` Cranial Idiopathic Tumours Trauma Haemorrhage Infection ``` Nephrogenic Congenital Metabolic disturbance Drugs - Lithium, Vaptans
82
What is the treatment for cranial DI?
Desmopressin PO
83
What are the causes of gynaecomastia?
``` Cirrhosis Hypogonadism Hyperthyroidism Oestrogenic tumours Spiro, digoxin, oestrogen ```

Scott's Notes (21 decks)

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