Endocrinology Flashcards
Hypoglycaemia cut off
Less than 4 mmol/L
Make 4 the floor
Drug most likely to cause hypoglycaemia
Sulphonylureas
Alcohol withdrawal
Lorazepam/diazepam
Pabrinex
Glucos
Supportive care
Hyperthyroidism medication in pregnancy
1st trimester stop carbimazole and start propylthiouracil
- carbimazole risk of congenital abnormalities
2nd trimester switch back to carbimazole
- propylthiouracil high risk of severe hepatic injury
Is levothyroxine safe in pregnancy and breastfeeding?
Yes
How does thyroxine requirement change in pregnancy
Increases
So hypothyroid patients need to increase by 50%
SGLT-2 inhibitors example, MOA and side effects
Empaglifozin, ertugliflozin
Reversible inhibit sodium glucose co transporter 2 in renal PCT to reduce glucose reabsorp and more glucose peed out
Benefit is also lose weight
Risk is glucosuria results in UTI, thrush
Also, normoglycaemic ketoacidosis
insulinoma triad of symptoms
whipple’s triad
- hypoglycaemia with fasting/ exercise
- recorded low BMs at time of symptoms
- reversal of symptoms with glucose (food)
which MEN disease is associated with insulinomas?
MEN 1
symptoms of hypoglycaemia
weakness, diplopia, dizziness
corticosteroid side effects
endocrine - impaired glucose regulation, increased appetite, weight gain, hyperlipidemia, hirsutism, cushing’s syndrome
Musk - osteoporosis, avascular necrosis of femoral head, proximal myopathy
immunosuppressive (+ paradoxical raised neutrophils)
psychiatric - insomnia, depression, psychosis
GI: peptic ulceration, pancreatitis
opthalmic: cataracts
derm: acne
grow suppression in children
mineralocorticoid side effects
fluid retension
hypertension
useful antibody for type 1 diabetes
anti-GAD
glutamic acid decarboxylase
present in 80% of patients
bony mets vs multiple myeloma as a cause of hypercalcaemia
very hard to distinguish
multiple myeloma: CRAB
primary vs secondary adrenal insufficiency
skin pigmentation
primary - high ACTH but adrenal gland not responding. ACTH is a large pre-cursor that includes melanocyte-stimulating hormone so more pigmented
Klinefelters vs Kallman’s syndrom
Klinefelter’s syndrome 47 XXY - low testosterone, high Lh/FHS
Kallman’s X linked - hypogonadotrophic hypogonadism - low/normal LH, FSH, low testosterone
lady on long term steroids for rheumatoid arthritis, has surgery for something and then shortly after becomes hypotensive and delirious
adrenal insufficiency!
long term steroidshas resulted in adrenal insufficiency
surgery has increased her coritsol requirements
she is having an addisonian crisis so needs IV hydrocortisone
1st line treatment for brain mets
high dose dexamethasone to reduce cerebral oedema
diabetes drug contraindicated in heart failure
Thiazolidinediones eg. Pioglitazone
what diabetes drug is contraindicated in breast feeding and pregnancy?
sulfonylureas eg. gliclazide
Ectopic ACTH secretion from?
small cell lung cancer
cardiac symptoms of thyrotoxicosis
AF, high output cardiac failure
consequence of overtreatment with levothyroxine
osteoporosis
reasons why HbA1c might not be accurate
increased RBC turnover rate (shorter lifespan) - haemolysis, sickle cell, G6PD deficiency
decreased HbA1c turnover rate (longer lifespan) - B12/ folate/ iron deficiency, splenectomy
effect of thyrotoxicosis on heart
AF
high output heart failure
Less important antibodies t1dm
Auto islet cell antibodies
Auto insulin antibodies
T2dm starting on statin?
QRISK Score CVD risk in 10 years
Over 10
Start on statin
Reason to avoid metformin
eGFR < 30
T3 vs T4
T3 is 4 times more active than the more abundant T4. The half-life of T4 is 5-7 days; the half-life of T3 is only 1 day.
which diabetes drug has increased risk of urinary/genital infections?
SGLT-2 inhibitors (empagliflozin, dapaglifoflozin)
they reversible inhibit the SGLT-2 in the renal PCT
there is glycosuria which increases urine/genitala infections
