Medicine Flashcards
Acromegaly
Investigations:
management:
Serum IGF-1 levels
OGTT only recommended to confirm the diagnosis if IGF-1 levels are raised
Serum IGF-1 may also be used to monitor disease
Trans-sphenoidal surgery is first line
if unsuccessful: Octreotide
Pegvisomant (does not reduce tumour size)
Addisons disease
Electrolyte disturbance:
Investigation:
Management:
Management with intercurrent illness
Hyponatraemia and hyperkalaemia and Hypoglycaemia
Short-SYNACTHEN test
Hydrocortisone: usually around 30 mg/day
Fludrocortisone
Glucocorticoid dose should be doubledwith fludrocortisone staying the same. In crisis, patients may require IM formulation
Carbimazole:
Mechanism of action
Adverse effects
Blocks thyroid peroxidase from coupling and iodinating residues on thyroglobulin -> reducing thyroid hormone
Agranulocytosis
Crosses the placenta - may be used in only low doses in pregnancy
Glucocorticoid side effects:
endocrine:
MSK:
Immunosuppression:
Psychiatric:
Gastrointestinal:
Ophthalmic:
Impaired glucose regulation, increased appetite and weight gain, hirsutism, hyperlipidaemia
Osteoporosis, proximal myopathy, AVN of femoral head
Increased susceptibility to severe infection, reactivation of TB
Mania, insomnia, depression
Peptic ulceration, acute pancreatitis
Glaucoma, cataracts
Misc: suppression of growth in children, intracranial hypertension, neutrophilia
Cushing’s syndrome:
Tests:
First line localisation test:
Explain high-dose dexamethasone suppression test
Other tests:
Insulin stress test:
1) Overnight (low-dose) dexamethasone suppression test (1st line) -> Patient’s with Cushing’s do not have their morning cortisol spike suppressed.
2) 24 hr urinary cortisol
3) Bedtime salivary cortisol
9am and midnight plasma ACTH (and cortisol) levels
Cortisol (not suppressed) ACTH (suppressed) = Cushing’s syndrome
Cortisol (suppressed) ACTH (suppressed) = Cushing’s disease (Pituitary ACTH secretion)
Cortisol (not suppressed) ACTH (not suppressed) = ectopic ACTH syndrome
Petrosal sinus sampling of ACTH may be needed to differentiate between pituitary and ectopic ACTH secretion
Used to differentiate between true Cushing’s and pseudo-cushing’s
Diagnostic criteria for T1DM:
C-peptide levels in T1DM
Fasting glucose greater than or equal to 7
Random glucose greater than or equal to 11.1 (or after 75g OGTT)
If asymptomatic this must be demonstrated on at leats 2 occasions
Low
Diagnostic criteria for T2DM:
If HbA1c used:
Fasting glucose greater than or equal to 7
Random glucose greater than or equal to 11.1 (or after 75g OGTT)
HbA1c of greater than or equal to 48 (6.5%)
In patients without symptoms, the test must be repeated to confirm the diagnosis.
T2DM management:
HbA1c to aim for:
HbA1c to add drug:
HbA1c target if on hypoglycaemic drug
Drug regime:
If missing targets on triple therapy:
If starting insulin, which drug should be continued
Risk-factor modification: Htn:
Should statins be offered:
48 (6.5)
58
53 (7)
Metformin
Metformin plus SGLT2i (if any cardio risk, CVD, CHF)
If metformin contraindicated: (CV risk) SGLT2i
if no CV risk - DPP-4, sulphonylurea or pioglitazone
switch one of the drugs to a GLP-1 mimetic (liraglutide) - BMI >35 or BMI <35 if insulin would have significant occupational implications
Metformin
ACEi first line
only if QRISK >20%