Endocrinology

Question 1

How do you treat cushings syndrome?

Answer 1

You need to treat the underlying cause
Trans- sphenoidal to remove pituitary tumour (cushings disease)
Surgical removal of an andrenal tumour
surgical removal of tumour producing ectopic ACTH- small cell lung cancer

If surgery can’t be done- remove both adrenal glands and give the patient replacement steroids for life

Question 2

How do you treat addisons?

Answer 2

Replacement corticosteroids (hydrocortisone) and fludrocortisone

Question 3

How do you treat DKA?

Answer 3

FIG PICK 
FLUIDS 
INSULIN (ACTRAPID INFUSION AT 0.1 UNIT/KG/HOUR)
GLUCOSE 
POTASSIUM 
INFECTION (Treat underlying triggers)
CHART (FLUID balance(
monitor blood ketones (or bicarbonate if ketones are unavailable)

Question 4

At what rate should potassium be infused?

Answer 4

Not a rate more than 10mmol per hour

Question 5

What is the prescription of insulin for type 1 diabetics normally?

Answer 5

Background long acting insulin and short acting insulin- 30 mins before carb intake

Question 6

At what dose is the insulin infusion in DKA?

Answer 6

0.1 units/kg/hr

Question 7

What is the treatment of Hyperosmolar hyperglycaemic state?

Answer 7

Crystalloid fluids aiming to replace 50% of estimated loss within the first 12 hours
Fixed rate insulin infusion of 0.05units/kg/hour
Monitor potassium and renal function
Anticoagulation?