Endocrinology Flashcards
Diagnostic tests for Cushing’s disease
- late night salivary cortisol
- 24hr urinary free cortisol excretion
- overnight 1mg dexamethasone suppression test
Clinical features of Cushing syndrome
- proximal muscle wasting + weakness
- central obesity, buffalo hump
- moon face
- hirsutism
- abdominal striae
- HTN
- hyperglycaemia
- lethargy / depression
Conn’s syndrome
Primary hyperaldosteronism
- most commonly due to adrenal adenoma
Addison disease - clinical features
Adrenal insufficiency
- lethargy, fatigue, weakness
- anorexia, nausea
- diarrhoea / abdo pain
- weight loss
- dizziness, funny turns
- hyperpigmentation
Addison disease - dx
- elevated serum K+, low serum Na+
- short synacthen stimulation test is definitive test
Indications for tx of Paget’s disease of bone
- pain
- neurological complications
- significant osteolytic lesions
- involvement of long bones
- before surgery involving pagetic bones
- significant joint involvement
Tx for Paget’s disease of the bone
Bisphosphonate
- IV Zoledronic acid 5mg single dose over 15 mins
Mx options for relapsing hyperthyroidism (following cessation of Carbimazole after 12-18 months)
- Recommencement of antithyroid medication
- Radioiodine ablation
- Total thyroidectomy
Assessment tool for risk of T2DM
AUSDRISK, score of 12 or more = high risk
- age, gender, ethnicity, family and past history of diabetes, current medications, smoking status, diet, physical activity, BMI, and waist circumference
Criteria for clinical dx of Metabolic Syndrome
presence of 3/5 confirms METSY
- Elevated waist circumference
- Elevated TGs
- Reduced HDL-C
- Elevated BP
- Elevated fasting glucose
Clinical features androgen deficiency
- small testes
- failure of enlargement of penis
- failure of growth of the larynx
- poor facial, body and pubic hair
- gynaecomastia
- poor muscle development
- low semen volume
- low libido
- lethargy
- mood changes, irritability
Initial invx for suspected Klinefelter syndrome 47XXY
- serum total testosterone (fasting, morning sample)
- LH and FSH
- TFT
- semen analysis
Klinefelter syndrome, long-term health implications
Reproductive
- small firm testes (<4ml), infertility
- gynaecomastia
- diminished facial / pubertal hair
- increased risk of osteoporosis
Non-reproductive
- Endocrine: Impaired glucose tolerance, diabetes, hypothyroidism
• Cardiovascular: mitral valve prolapse, IHD, VTE
• Auto-immune: SLE
• Tumours: mediastinal germ cell tumour, breast cancer
• Cognitive and behavioural: learning difficulties
Need lifelong testosterone replacement
Mx acute gout flare
- Oral NSAID 3-5 days
- Local corticosteroid joint injection
- Oral Prednisolone 15-30mg daily for 3-5 days
Gout prevention
- Allopurinol: start low 50-100mg daily and increase the dose every 2-5 weeks (max 900mg)
- Monitor serum urate levels - aim to <0.36 or if gouty tophi aim for <0.30
