Endocrinology Flashcards
What is the intial rate of insulin in DKA
0.1 units per kilo/hour
outline the treatment of acromegaly
Trans-sphenoidal surgery is the first-line treatment for acromegaly in the majority of patients
Dopamine agonists
for example bromocriptine
the first effective medical treatment for acromegaly, however now superseded by somatostatin analogues
effective only in a minority of patients
Somatostatin analogue directly inhibits the release of growth hormone for example octreotide effective in 50-70% of patients may be used as an adjunct to surgery
Pegvisomant
GH receptor antagonist - prevents dimerization of the GH receptor
once daily s/c administration
very effective - decreases IGF-1 levels in 90% of patients to normal
doesn’t reduce tumour volume therefore surgery still needed if mass effect
what is used to define ‘metabolic syndrome’
elevated waist circumference: men > 102 cm, women > 88 cm
elevated triglycerides: > 1.7 mmol/L
reduced HDL: < 1.03 mmol/L in males and < 1.29 mmol/L in females
raised blood pressure: > 130/85 mmHg, or active treatment of hypertension
raised fasting plasma glucose > 5.6 mmol/L, or previously diagnosed type 2 diabetes
what biochemical affect can SGLTs inhibitors have
increase cholesterol
give some drugs that can cause gynaecomastia
spironolactone (most common drug cause) cimetidine digoxin cannabis finasteride GnRH agonists e.g. goserelin, buserelin oestrogens, anabolic steroids
give a reason why Hba1c may be falsely higher than it is
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
give reasons why hba1c may be falsely low
sickle cell anamia
G6PD deficiency
hereditory spherocytosis
what is exposure ketratopathy
damage to the cornea due to dryness caused by incomplete or inadequate eyelid closure, resulting in loss or insufficiency of the tear film.
a cause would be thyroid eye disease
what cancer is associated with acromegaly
colorectal
which hpv strains are associated with cervical cancer
16, 18 and 33
what is barters syndrome
an inherited cause (usually autosomal recessive) of severe hypokalaemia due to defective chloride absorption at the Na+ K+ 2Cl- cotransporter (NKCC2) in the ascending loop of Henle. It should be noted that it is associated with normotension (unlike other endocrine causes of hypokalaemia such as Conn’s, Cushing’s and Liddle’s syndrome which are associated with hypertension).
how do SGLT2 inhibitors work
reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule
what is the mechanism of action of the “gliptins”
DPP4 inhibitor - increase incretins e.g. GLP1 and GIP
what is gitelmans syndrome
rare autosomal recessive disorder which occurs due to a mutation causing a resorptive defect of the sodium chloride co-transporter. Its pathogenesis is similar to the mechanism of a thiazide diuretic. It is characterised by hypokalemia-hypomagnesemia and alkaline urine
what is the major complication of carbimazole therapy
agranulocytosis
