Endocrinology Flashcards
Iodine deficeincy
Most common cause of hypothyroidism globally and suspect in cases where iodine is not added to diet.
Pheochromocytoma
Triad of sweating, headaches and palpitations. investigate with urinary metanephrines
Nephrogenic DI
Urine osmolality low after fluid deprivation and desmopressin
Prolactinomas
First line treatment with dopamine agonists (cabergoline, bromocriptine)
Prednisolone
Steroids increase the risk of osteonecrosis
Primary hyperaldosteronism
Symptoms include hypertension, headaches, muscle weakness and nocturia. Investigated with aldosterone/renin ratio
Klinefelter’s syndrome
Causes high LH and low testosterone
Wilm’s tumour and neuroblastoma
Refer any child with a palpable abdominal mass or unexplained enlarged organ very urgently to specialist
Primary hyperparathyroidism
Parathyroid adenoma may have normal PTH level
SGT2 inhibitors
Increased risk of urinary tract infection
Sulfonylureas
Often cause weight gain
Angiotensin II receptor blocker
Used first line in all black T2DM patients with hypertension
Diabetes blood pressure
Aim for 135/85 home readings
Metoclopramide
Can cause galactorrhoea
Adrenal venous sampling
After inconclusive CT AVS can be used to determine between unilateral adenoma and bilateral hyperplasia in primary hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
Most common cause of primary hyperaldosteronism
Pregabalin
Used in neuropathic pain with a history of benign prostatic hyperplasia
Adrenal insufficiency
Can occur on surgery after long term steroid use and needs IV hydrocortisone 100mg
Diabetic ketoacidosis
Hyperglycaemia and ketones, man aged with immediate IV fluids then insulin infusion and potassium
Glucocorticoids
Can induce neutrophilia
Smoking
Risk factor for Grave’s disease
Cushing’s syndrome
Hypokalaemia and metabolic acidosis seen
Addison’s disease
Can cause hypoglycaemia
Addison’s disease management
Prescribed hydrocortisone and fludrocortisone
MODY
Autosomal dominant inheritance pattern
Pretibial myzoedema
Specific feature of Grave’s disease
Spironolactone
Can cause gynaecomastia
Goserelin
A GnRH agonist used in the management of prostate cancer
-can cause gynaecomastia
DKA
Stop short acting insulin but continue fixed rate long acting insulin
Addison’s crisis
- hyponatraemia
- hyperkalaemia
- hypoglycaemia
Thyrotoxic storm
Consider in patients with Grave disease and infection
-give corticosteroids, PTU and propranolol
Cushing’s disease
Low dose dexamethasone does not cause suppression but high dose does
Addison’s disease
- tiredness
- hyperpigmentation
Levothyroxine
Needs to be increased in pregnancy by about 50% from 4-6 weeks
Metoclopramide
Can cause galactorrhoea
Diabetes type 2
Requires two abnormal HbA1c readings if asymptomatic
Acromegaly
Trans-sphenoidal surgery
Anaplastic thyroid carcinoma
- late presenting and aggressive
- pressure symptoms including dysphagia
- hoarseness
Grave’s disease
Propranolol should be given to help control symptoms
Insulinoma
Whipple’s triad of hypoglycaemia with fasting or exercise, reversal of symptoms with glucose and low BMs
DKA insulin
Give fixed rate intravenous insulin infusion at 0.1units/kg/hour
HbA1c
Target 48 mmol/mol for type two diabetes
Latent autoimmune diabetes of adulthood
Slow autoimmune destruction of the islets
Levothyroxine
Iron and calcium carbonate tablets can reduce absorption of levothyroxine
Bromocriptine
Treatment for galactorrhoea
Myxoedema comas
- confusion
- hypothermia
- hyponatraemia
- hypercarbia
Empagliflozin
SGLT-2 inhibitor
Primary hyperaldosteronism
The most common cause is bilateral idiopathic adrenal hyperplasia
- high bp
- muscle weakness
- low K
- high aldosterone to renin ratio
Sick euthyroid syndrome
- occurs post infection
- TSH low and free T4 low
Subacute thyroiditis
- low TSH
- very high free T4
- tender goitre
- raised ESR
- globally reduced iodine uptake
