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MRCP part 2 > Endocrinology / Metabolic disease > Flashcards

Endocrinology / Metabolic disease Flashcards

1
Q

Hypertriglyceridaemia treatment

A

1) Fibrates (fenofibrate, gemfibrozil)
2) Add statin OR ezetimibe
Omega 3 good for all (reduces CVD deaths)

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2
Q

Treatment (familial) hypercholesterolaemia

A

1) high dose statin
2) Add ezetimibe
Others:
- evolucumab - if LDL peristently >3.5
- fibrates… more for hypertriglyceridaemia

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3
Q

Hypothyroidism features

A
  • main: tired, cold intolerance, bradycardia, weight gain
  • skin: sweating, yellow tinge, brittle nails, coarse hair, myxoedema, co-exsistant alopecia / vitiligo
  • eyes: periorbital oedema
  • GI: constipation, decreased taste, co-existant pernicious anaemia, co-existant coeliac
  • neuromuscular: thyroid myopathy, carpal tunnel / peripheral neuropathies, myxoedema coma, hashimoto encephalopathy
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4
Q

McArdle’s Disease

A
  • autosomal recessive type V glycogen storage disease
  • decreased muscle glycogenolysis
  • muscle pain and stiffness following exercise w/ second wind phenomenon
  • muscle cramps
  • myoglobinuria
  • low lactate levels during exercise
  • avoidance of low carbohydrate diets
  • low intensity aerobic exercise
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5
Q

Hypokalaemia

A

1) urinary K
- low? Alkalosis, insulin, extrarenal losses
- high? renal losses confirmed

2) blood pressure, renin, aldosterone, blood gas
- high blood pressure, high renin: malignant HTN, renovascular disease, renin secreting tumour
- high blood pressure, low renin, high aldosterone: hyperaldosteronism e.g. Conn’s / adrenal hyperplasia
- high blood pressure, low renin, low aldosterone: Liddle’s, apparent mineralocorticoid excess (congenital adrenal hyperplasia, liquorice ingestion), cushing’s, mineralocorticoid ingestion

  • low/normal blood pressure, alkalosis: Bartter, Gietelman, diuretics, magnesium deficiency
  • low/normal blood pressure, acidosis: RTA (1/2 - 4 is hyperK)
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6
Q

Criteria for atorvastatin 20mg ON in T1DM

A

aged > 40 OR
>10 years diagnosis OR
diabetic nephropathy OR
other CVD risk factors

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7
Q

Fabry Disease

A

X linked recessive lysosomal storage disease
Symptom onset in adolescence

Pain on exercise

Hypertension
Cardiomegaly
CKD
Thrombosis e.g. VTE / CVA

Angiokeratomas on skin (red macules / papules) typically peri-umbilical

Mx: alpha galactosidase A - enzyme replacement

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8
Q

Diagnosing sulfonylureas as cause of hypoglycaemia

A
  • insulin / c-peptide measurement not helpful

- urinary sulfonylurea can be measured

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9
Q

Addisonian patients taking steroids during periods of illness should change their steroid dose by how much and for how long?

A

2-3 x dose for 3 days and review

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10
Q

Side effects of sulfonylureas

A

Hypogylcaemia, weight gain

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11
Q

Indications for GLP-1 drugs e.g. exenatide, liraglutide, dulaglutide

A

Add to metformin / sulfonylurea for BM control if

  • BMI ≥35 and problems associated with high weight
  • BMI <35 and insulin is unacceptable because of hypo risk OR weight loss would benefit co-morbidities (e.g. ischaemic heart disease)
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12
Q

DPP4 inhibitors e.g. sitagliptin

A
  • do not cause weight gain
  • no hypos
  • HOWEVER, has a heart failure risk
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13
Q

SGLT2 inhibitors e.g. dapagliflozin

A

Benefits: weight loss, improvements in heart failure, no hypos

Indications: BM control in addition to metformin in heart failure patients

Risks: UTIs, DKA

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14
Q

Subacute (post viral) thyroiditis mx

A

1) NSAIDs

2) prednisolone

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15
Q

MEN-1

A 
AD
PaPaPi
- parathyroid adenoma
- pancreatic tumour (most typically gastrinoma -> zollinger-ellison syndrome)
- pituitary gland tumours
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16
Q

MEN-2a

A 
AD
PaPhThy
- parathyroid adenoma
- phaeo
- medullary thyroid cancer
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17
Q

MEN-2b

A

AD

PhThy + marfanoid and neurofibromas

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18
Q

Sick euthyroidism

A
  • low T3 and T4
  • normal / low TSH
  • associated with severe illness
  • do not treat!
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19
Q

Type 1 amiodarone thyroiditis

A
  • goitre
  • USS hypervascularity
  • Mx: stop amiodarone, carbimazole
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20
Q

Type 2 amiodarone thyroiditis

A
  • no goitre
  • low radioiodine uptake
  • Mx: stop amiodarone, start steroids
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21
Q

Type of diabetes caused by hereditary haemochromatosis

A

Type 2 DM

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22
Q

Papillary carcinoma

A
  • most common
  • hard nodules
  • often young females
  • good prognosis
  • Mx: total thyroidectomy + radioiodine therapy
  • yearly thyroglobulin to monitor recurrence
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23
Q

Folliculuar adenoma and carcinoma

A
  • adenoma is without local capsular invasion
  • solitary thyroid nodule
  • Mx: total thyroidectomy + radioiodine therapy
  • yearly thyroglobulin to monitor recurrence
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24
Q

Medullary carcinoma

A
  • MEN-2 associated
  • secretes calcitonin - marker of recurrence
  • poor prognosis when nodes invovled
25
Q

Anaplastic carcinoma

A
  • elderly females
  • local invasion common
  • Mx: resection where possible. Consider palliative surgery + RT
26
Q

Thyroid lymphoma

A
  • rare

- associated with Hashimoto’s

27
Q

Relevance of TSH in thyroid cancer

A
  • high risk cancers should have TSH suppressed <0.1 with supplemental thyroxine post op
  • if low risk aim TSH 0.1-0.5
28
Q

Thyroid nodule ix

A
  • USS: <1cm, age 20-60, no symptoms, not rapidly growing, no prev ca / irradiation -> no further ix
  • otherwise FNA
29
Q

Congenital adrenal hyperplasia phenotypes

A
  • classical phenotype: presents early childhood with salt wasting and failure to make cortisol
  • non-classical phenotype: androgen excess -> hirsuitism, primary amenorrhoea, acne, precocious puberty in males
30
Q

Causes of CAH

A
  • 95% 21 hydroxylase deficiency. 60-70% salt wasting crisis in early life
  • 11 beta hydroxylase deficiency: apparent mineralocorticoid excess (low renin/aldosterone), androgen excess. Classically ambiguous genitalia
  • 17-hydroxylase deficiency: non-virilising in females, inter-sex in boys, hypertension
31
Q

Management of hyperthyroidism in pregnancy

A
  • 1st trimester: propylthiouracil (risk hepatotoxicity)
  • 2nd trimester: carbimazole (risk congenital defects)
  • breast feeding: propylthiouracil
  • keep free T4 in upper 1/3 of normal range to avoid foetal hypothyroidism
32
Q

Management of hypothyroidism in pregnancy

A
  • most require 50% increase in dose
  • do this in steps of 25mcg and review every month
  • thyroxine is safe with pregnancy and breastfeeding
33
Q

Post partum thyroiditis

A
  • hyperthyroidism in first few months after birth -> normal / low thereafter
  • TPO and TSH -R abs may be +ve
34
Q

Grave’s in pregnancy

A
  • measure TSH-R abs and treat if +ve, even if euthyroid

as can cross placental barrier

35
Q

Pseudohypoparathyroidism

A
  • PTH insensitivity
  • AD inheritance of receptor GPC-R defect
  • low calcium, high phosphate, but HIGH PTH
  • short 4-5th metacarpals, short stature, cognitive impairment, obesity
36
Q

VIPoma

A
  • pancreatic tumour with malignant potential
  • watery diarrhoea, hypokalaemia, acidosis
  • facial flushing
37
Q

Klinefelter syndrome

A
  • XXY Males
  • tall
  • cognitive impairment
  • lack of secondary sexual characteristics
  • infertile
  • gynaecomastia
  • raised FSH & LH
  • low testosterone
38
Q

Autoimmune polyglandular syndrome type 2

A

Triad

  • primary adrenal insufficiency
  • type 1 diabetes
  • hypothyroidism

NB: sometimes primary gonadal failure is also present.

Assoc with vitiligo and pernicious anaemia

39
Q

Autoimmune polyglandular syndrome type 1

A

2+

  • hypoparathyroidism
  • primary adrenal insufficiency
  • chronic mucocutaneous candidiasis
  • primary gonadal failure
  • primary hypothyroidism
40
Q

Thyrotoxicosis fictitia

A
  • thyroxine OD
  • high T4, low TSH
  • THYROGLOBULIN LEVELS LOW
  • low uptake of thyroid scintigraphy
  • NO GOITRE
41
Q

Hyperprolactinaemia causes

A
  • pituitary adenoma -> pituitary stalk compression
  • prolactinoma (macro >10000)
  • acromegaly
  • drugs: D-R antagonists, verapamil,
  • hypothyroidism
  • pregnancy
  • oestrogens
  • physiological: stress, sleep, exercise
  • seizures
42
Q

Features of hyperprolactinaemia

A
  • men: impotence, loss of libido
  • women: amenorrhoea
  • both: galactorrhoea
43
Q

Thyroid storm mx

A
  • IV fluids
  • electrolyte replacement
  • carbimazole / propylthiouracil -> then lugol’s iodine
  • hydrocortisone 100mg
  • VTE prophylaxis
44
Q

Myxoedema coma management

A
  • IV fluids
  • IV hydrocortisone (until adrenal insufficiency excluded)
  • levothyroxine (T4) and liothyronine (T3) IV
  • electrolyte replacement
45
Q

Features of acquired GH deficiency (e.g. secondary to TBI)

A
  • fatigue
  • depression
  • reduced muscle mass
  • reduced libido
  • increased fat mass
46
Q

Acromegaly mx

A

1) Transphenoidal excision

2) Somatostatin analogues e.g. octreotide

47
Q

Cushing’s ix

A

Initial test options

  • 24 hour urinary cortisol
  • midnight cortisol

1st proper test
- overnight dexamethasone suppression test -> failure to suppress indicates Cushing’s

Late night ACTH is used for localisation

  • suppressed indicates adrenal adenoma / tumour
  • non-suppressed suggests ACTH dependent cause e.g. pituitary OR ectopic ACTH

Other localisation tests

  • MRI pituitary (>6mm significant)
  • high dose dex suppression (pituitary adenoma will suppress)
  • inferior petrosal sinus sampling (central -> peripheral ACTH gradient suggests central cause)
48
Q

Type of diabetes insipidus caused by lithium

A

Nephrogenic diabetes insipidus

49
Q

Mx nephrogenic diabetes insipidus

A
  • Low salt diet
  • Discontinue precipitating agent
    2) Thiazide diuretics or amiloride
50
Q

Mx hypertension in Conn’s

A

Spironolactone

51
Q

Mx of Grave’s if neutropenia occurs during carbimazole

A
  • stop carbimazole permanently
  • not for propylthiouracil
  • surgery or radioiodine instead
52
Q

Mx macroprolactinoma

A
  • dopamine agonist e.g. cabergoline

- transphenoidal excision only if medical mx fails

53
Q

Ix insulinoma

A
  • insulin, C-peptide and glucose during an episode
  • no role for random bloods of the above
  • exercise provocation after overnight fast +/- above bloods
54
Q

Apparent mineralocorticoid excess

A
  • low renin and aldosterone
  • AR 11-hydroxysteroid dehydrogenase mutation
  • excess liquorice can inhibit this enzyme too
55
Q

Gestational diabetes diagnosis and management

A

Diagnosis

  • fasting glucose ≥5.6
  • 2 hour glucose ≥7.8

Fasting BM <7

  • > trial diet/exercise and re-check in 1-2 weeks
  • if BMs still raised but <7 -> metformin (OR glibenclamide)
  • if BMs still raised, <7 but complications with baby -> insulin

BMs ≥ 7
- insulin

56
Q

Thyroid eye disease

A

Aetiology

  • 25-50% graves
  • can have any thyroid status
  • RFs: smoking, radioiodine

Features

  • exopthalmos
  • conjuntival oedema
  • optic disc swelling
  • loss of colour vision
  • complex ophthalmoplegia

Mx

  • topical lubricants
  • steroids +/- decompressive surgery
57
Q

Agents that reduce thyroxine absorption

A
  • calcium
  • iron
  • PPIs
  • antacids
  • colestyramine
58
Q

Effect of beta blockers on thyroxine

A

reduces conversion to more active t3

MRCP part 2 (11 decks)

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