Endocrinology and Diabetes Flashcards
Atypical features of T1DM
> 50
BMI >,25
Slow evolution of hyperglycaemia
Which drugs used in diabetes can cause hypos?
Sulfonylureas
Insulin
Which drugs used in diabetes can cause weight gain?
Thiazolidinedione: Pioglitazone
Sulfonylureas
Name a DPP4 inhibitor. What effect do DPP4 inhibitors have on weight?
Sitagliptin
No weight gain
Name a GLP1 mimetic. What effect do GLP1 mimetics have on weight?
Exenatide
Weight loss
What management can be used for painful diabetic neuropathy?
Amitriptyline
Pain Mx clinics
What drug can be used for gastroparesis in diabetes?
Metaclopramide
If on metformin and HbA1c >48 but <58 what should be done?
Increase dose
If on metformin and HbA1c >58 what should be done?
Dual therapy
Name a side effect of SGLT2 inhibitors
Fourniers Gangrene
5 causes of cranial DI
Idiopathic
Head injury
Pituitary surgery
Craniopharyngioma
Haemochromatosis
Nephrogenic DI causes
Lithium
Hypokalaemia
Hypercalcaemia
Tubulo-interstitial disease e.g. sickle cell
Genetic (ADH receptor)
S/S of DI
Polyuria
Polydipsia
Describe plasma and urine osmolality in DI
High plasma osmolality
Low urine osmolality
What test is used for diabetes insipidus?
Water deprivation test
Mx of nephrogenic DI
Thiazides
Low salt/ protein diet
Mx of cranial DI
Desmopressin
Name 2 ACTH dependent causes of Cushing’s syndrome
Cushing’s disease: pituitary tumour secreting ACTH
Ectopic ACTH: SLCL
Name 3 ACTH independent causes of Cushing’s syndrome
Iatrogenic: STEROIDs
Adrenal adenoma
Adrenal carcinoma
What is pseudo-cushing’s?
Mimics Cushing’s
Often due to alcohol excess/ severe depression
False +ve dexamethasone suppression test
Need insulin stress test to differentiate
What test is used for Cushing’s syndrome?
- Low dose overnight Dexamethasone suppression test
- High dose dexamethasone suppression test
Describe results of high dose dexamethasone suppression test in Cushing’s disease
Cortisol: Suppressed
ACTH: Suppressed
Describe results of high dose dexamethasone suppression test in Cushing’s syndrome due to other causes
Cortisol: Not suppressed
ACTH: Suppressed
What test can distinguish between pituitary and ectopic ACTH secretion?
Petrosal sinus sampling
Medical Mx of Cushing’s
Ketoconazole + Metyrapone inhibit glucocorticoid synth + secretion in adrenals
Surgical Mx of Cushings
Cushings disease: trans-sphenoidal hypophysectomy
Adrenal adenoma: laprascopic excision
Most common cause of hypoadrenalism. What does this result in?
AI destruction (Addisons)
Reduced cortisol + aldosterone
List 6 S/S of Addisons
Lethargy, weakness
N+V
WL + anorexia
HYPERPIGMENTATION, vitiligo
Hypotension
Hypoglycaemia
Electrolytes in Addisons
Hyponatraemia
Hyperkalaemia
What test is used for Addisons disease?
Short synACTHen test
Plasma cortisol measured before + 30 mins after giving Synacthen 250ug IM
(or 9am serum cortisol can be used)
Mx of Addisons
Hydrocortisone 2 divided doses (majority in 1st half of day)
Fludrocortisone
Adrenal crisis Sx
Collapse
Shock
Pyrexia
Adrenal crisis Mx
100mg Hydrocortisone IM
1L NaCl over 30-60 mins +/- dextrose
Most common cause of primary hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
3 features of primary hyperaldosteronism
HTN
Hypokalaemia: muscle weakness
Metabolic alkalosis
What tests are used for primary hyperaldosteronism?
Aldosterone-renin ratio
(high aldosterone + low renin)
HRCT abdomen + adrenal vein sampling to distinguish between unilateral adenoma + bilateral hyperplasia
Management of primary hyperaldosteronism
Adrenal adenoma (Conns): surgery (laparoscopic adrenalectomy)
Bilateral adrenocortical hyperplasia: Spironolactone
What is a phaeochromocytoma?
Catecholamine secreting tumour
5 S/S of phaeochromocytoma
HTN
Headache
Palpitations
Sweating
Anxiety
Ix for phaeochromocytoma
24 urinary metanephrines
Mx for phaeochromocytoma
- Phenoxybenzamine
- Propranolol
- Surgery
What is Kallmann syndrome?
What measurements are seen?
Hypogonadotrophic hypogonadism
X-linked recessive
Low Testosterone
Low/ inappropriately norm LH + FSH
List 4 characteristics of Kallmann syndrome
Delayed puberty
Hypogonadism
Anosmia
Normal/ above average height
Mx of Kallmanns syndrome
Testosterone supplementation
Gonadotrophin supplementation for sperm production (fertility)
What is Klinefelter syndrome? What measurements are seen?
Primary hypogonadism
High LH + FSH
Low Testosterone
Name 4 S/S of Klinefelter syndrome
Taller than average
Lack secondary sexual characteristics
Gynaecomastia
Infertile
What is Androgen insensitivity syndrome?
End organ resistance to Testosterone
Genotypically MALE but have FEMALE PHENOTYPE
List 3 features of AIS
Undescended testes: Groin swelling
“Primary amenorrhoea”
Breast development
What results from an increased oestrogen: androgen ratio?
Gynaecomastia
List 4 drugs that cause an increased oestrogen: androgen ratio
Spironolactone
Digoxin
Cannabis
Goserelin (GnRH agonist)
Pituitary adenoma classification by size
Microadenoma <1cm
Macroadenoma >1cm
Pituitary adenoma classification by hormonal status
Secretory/ functioning: produces excess of a particular hormone
Non-secretory/ functioning: doesn’t produce a hormone to excess
Name 3 drugs that increase prolactin
Metoclopramide
Domperidone
Haloperidol
4 features of excess prolactin in women
Amenorrhoea
Infertility
Galactorrhoea
Osteoporosis
3 features of excess prolactin in men
Impotence
Loss of libido
Galactorrhoea
3 S/S of macroadenomas
Headache
Visual disturbances: bitemporal hemianopia
S/S of hypopituitarism
Ix for prolactinoma
MRI
Medical Mx of prolactinoma
Cabergoline/ Bromocriptine (Dopamine agonists)
Inhibit release of prolactin
Surgical Mx of prolactioma
Trans-sphenoidal hypophysectomy
Causes of hyperparathyroidism
Parathyroid adenoma (most common)
Hyperplasia
Multiple adenoma
Carcinoma
S/S of hyperparathyroidism
Bones: pain/ fracture
Stones: renal stones, polydipsia, polyuria
Moans: peptic ulcers, anorexia, nausea, constipation
Groans: depression
Bloods in primary hyperparathyroidism
High calcium
Low phosphate
High (or inappropriately normal) PTH
Definitive Mx for primary hyperparathyroidism
Total parathyroidectomy
Mx for primary hyperparathyroidism when surgery not suitable
Cinacalcet (calcimimetic)
2 main causes of hypercalcaemia
Primary hyperparathyroidism
Malignancy
5 less common causes of hypercalcaemia
Sarcoidosis
Acromegaly
Thiazides
Dehydration
Thyrotoxicosis
4 causes of hypocalcaemia
Osteomalacia
CKD
Hypoparathyroidism (post thyroid/ parathyroid surgery)
Acute pancreatitis
Features of hypocalcaemia
Cramping
Arrhythmias: QT prolongation
Tetany
Numbness
2 specific signs of hypocalcaemia
Trousseau’s sign: carpal spasm
Chvostek’s sign: facial muscle twitch
What is osteomalacia?
Softening of bones secondary to low vitamin D that leads to low bone mineral content
4 causes of low vitamin D
Deficiency: malabsorption, lack of sunlight, diet
CKD
Cirrhosis
Drugs (anticonvulsants)
4 S/S of osteomalacia
Bone pain
Bone/ muscle tenderness
Fractures: esp. NOF
Proximal myopathy- waddling gait
Bloods in osteomalacia
Low vit D
Low calcium
Low phosphate
Raised ALP
3 features of organic ED
Gradual onset Sx
Lack of tumescence
Normal libido
7 features of psychogenic ED
Sudden onset Sx
Decreased libido
Good quality spontaneous/ self-stimulated erections
Major life events
Problems/ changes in relationship
Previous psychological problems
Hx premature ejaculation
7 RFs for ED
Age
Obesity
DM
Dyslipidaemia
HTN
Smoking
Alcohol
2 drugs that can cause ED
SSRIs
B-blockers
Ix for ED
10y cardiovascular risk calculated (lipids + fasting glucose)
Free testosterone (AM)
Mx of ED
Sildenafil (PDE5 inhibitor)
Vacuum erection devices
Stop cycling if >3h/ week
Which group should be referred to urology for ED?
Young men who has always had difficulty achieving an erection
What are the organic causes of ED?
Vasculogenic: CVD, HTN, PAD, obesity, DM
Neurogenic (central): MS, PD, Stroke
Neurogenic (peripheral): DM, CKD
Endocrine: DM, primary/ secondary hypogonadism, hypo/hyperthyroidism, hyperprolactinaemia, Cushing’s disease
7 features of hypothyroidism
Lethargy
Weight gain
Cold intolerance
Skin changes: dry, non pitting oedema
Constipation
Menorrhagia
CTS + decreased reflexes
What are the causes of primary hypothyroidism?
Hashimoto’s (AI. most common)
Subacute thyroiditis
Post-thyroidectomy
Drugs: lithium, amiodarone
Mx of hypothyroidism
Levothyroxine
What antibody is associated with hashimotos hypothyroidism?
Anti-thyroperoxidase (TPO)
Describe TFTs in hypothyroidism
High TSH
Low T3 + T4