Endocrinology Flashcards
Primary hyperaldosteronism: manage with –
Primary hyperaldosteronism: manage with spironolactone
Cushing’s syndrome = hyp-kalaemic metabolic a-
Cushing’s syndrome - hypokalaemic metabolic alkalosis
Management DKA
—replacement:
most patients with DKA are deplete around 5-8 litres. – is used initially.
–: an intravenous infusion should be started at 0.1 unit/kg/hour.
Once blood glucose is < – mmol/l an infusion of 5% – should be started
correction of –
long-acting insulin should be continued, short-acting insulin should be stopped
Management
fluid replacement: most patients with DKA are deplete around 5-8 litres. Isotonic saline is used initially. Please see an example fluid regime below.
insulin: an intravenous infusion should be started at 0.1 unit/kg/hour. Once blood glucose is < 15 mmol/l an infusion of 5% dextrose should be started
correction of hypokalaemia
long-acting insulin should be continued, short-acting insulin should be stopped
– is a specific feature of Grave’s disease rather than generic hyperthyroidism
Exophthalmos is a specific feature of Grave’s disease rather than generic hyperthyroidism
Features seen in Graves’ but not in other causes of thyrotoxicosis:
– signs (30% of patients)
exophthalmos
ophthalmoplegia
pretibial myxoedema
thyroid acropachy, a triad of:
digital–
soft tissue swelling of the –
– formation
Autoantibodies
- antibodies (90%)
- antibodies (75%)
Features seen in Graves' but not in other causes of thyrotoxicosis eye signs (30% of patients) exophthalmos ophthalmoplegia pretibial myxoedema thyroid acropachy, a triad of: digital clubbing soft tissue swelling of the hands and feet periosteal new bone formation
Autoantibodies
TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)
–and — account for 90% of hypercalcaemia cases
Malignancy and primary hyperparathyroidism account for 90% of hypercalcaemia cases
Hypoglycaemia with impaired GCS: give IV –if there is access
Hypoglycaemia with impaired GCS: give IV Glucose if there is access
Tertiary hyperparathyroidism is characterised by extremely high – with moderately raised –
Tertiary hyperparathyroidism is characterised by extremely high serum PTH with moderately raised serum calcium
Phaeochromocytoma typically present symptomatically with a triad of –, –, and –
Phaeochromocytoma typically present symptomatically with a triad of sweating, headaches, and palpitations
Women with hypothyroidism may need to – their thyroid hormone replacement dose by up to –% as early as 4-6 weeks of pregnancy
Women with hypothyroidism may need to increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy
Associated electrolyte abnormalities are seen in around one-third of undiagnosed Addison's patients: hyp--kalaemia hyp--natraemia hyp--glycaemia metabolic --
Associated electrolyte abnormalities are seen in around one-third of undiagnosed patients: hyperkalaemia hyponatraemia hypoglycaemia metabolic acidosis
SGLT-2 inhibitors have been linked to necrotising fasciitis of the – or– (– Gangrene)
SGLT-2 inhibitors have been linked to necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)
– is recommended in the treatment of Turner’s syndrome
Growth hormone is recommended in the treatment of Turner’s syndrome
Impaired hypoglycaemia awareness occurs due to neuropathy of parts of the –
Impaired hypoglycaemia awareness occurs due to neuropathy of parts of the autonomous nervous system
Tertiary hyperparathyroidism is characterised by extremely high – with moderately raised –
Tertiary hyperparathyroidism is characterised by extremely high serum PTH with moderately raised serum calcium
Hypo–, hypo–, –cardia and seizures, think myxoedemic coma
Hypothermia, hyporeflexia, bradycardia and seizures, think myxoedemic coma
If there is clubbing with hyperthyroidism, think –
If there is clubbing with hyperthyroidism, think Graves’ disease
Causes of raised prolactin - the p's p- p-- p-- p-- primary -- ph--, m--, do--
Causes of raised prolactin - the p's pregnancy prolactinoma physiological polycystic ovarian syndrome primary hypothyroidism phenothiazines, metoclopramide, domperidone
– thyroid cancer, hyp–calcaemia, –cytoma - multiple endocrine neoplasia type IIa
Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma - multiple endocrine neoplasia type IIa
MEN type I
3 P’s
Most common presentation =
Also: adrenal and thyroid
MEN 2
- thyroid cancer (70%)
2 P’s
RET oncogene
Men 3
Medullary thyroid cancer
1 P
Marfanoid body habitus
Neuromas
MEN1 gene
RET oncogene
MEN type I
3 P’s
Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
Most common presentation = hypercalcaemia
Also: adrenal and thyroid
MEN 2 Medullary thyroid cancer (70%) 2 P's Parathyroid (60%) Phaeochromocytoma RET oncogene
Men 3
Medullary thyroid cancer
1 P
Phaeochromocytoma
Marfanoid body habitus
Neuromas
MEN1 gene
RET oncogene
Primary hyperaldosteronism: manage with –
Primary hyperaldosteronism: manage with spironolactone
Klinefelter’s syndrome causes high – and low –
Klinefelter’s syndrome causes high LH and low testosterone
Cushing’s syndrome - hyp-kalaemic metabolic –
Cushing’s syndrome - hypokalaemic metabolic alkalosis
Hashimoto’s thyroiditis = hyp-thyroidism + goitre + anti-
Hashimoto’s thyroiditis = hypothyroidism + goitre + anti-TP0
