MRCP Endo Flashcards
Treatment of acromegaly
1st line - transsphenoidal surgery
Then medical - usually as adjunct
Somatostatin analogue (octreotide)- directly inhibits release of growth hormone
Pegvisomant (GH receptor antagonist) very effective in decreasing IGF-1 levels but doesn’t reduce tumour volume therefore needs surgery if mass effect
Screening for gestational diabetes
If previous then OGTT asap and then again at 24-28 weeks in normal originally
Any other risk factors then OGTT at 24-28 weeks
Diagnostic thresholds for gestational diabetes
Fasting >5.6
2-hour glucose >7.8
Management of gestational diabetes with fasting BM <7 at time of diagnosis
2 week trial of diet/exercise
if no improvement then metformin
if still no improvement then add insulin
Management of gestational diabetes with fasting BM >7 at time of diagnosis
Start insulin
When would you start insulin in gestational diabetes if initial fasting BM <7
If complications such as macrosomia or hydramnios and BM between 6-6.9
Management in pregnancy if pre-existing diabetes
stop oral antiglycemics other than metformin and start insulin
Details re: Thiazolidinediones including example?
Pioglitazone
Used for T2DM - PPAR-gamma receptor agonist, reduce peripheral insulin resistance.
can cause weight gain, liver impairment (monitor LFTs), fluid retention (++ with insulin), increased risk #’s and bladder cancer
Side effects of metformin
Lactic acidosis, GI side-effects
Side effects of sulfonylureas
Hypoglycaemic episodes, increased appetite and weight gain, SIADH, cholestatic liver dysfunction
Hypothyroidism, non-tender goitre and anti-thyroid peroxidase antibodies
Hashimotos
Painful goitre and raised ESR
de Quervains - initial hyper and then hypothyroid
Hyperthyroid + anti-TSH receptor stimulating antibodies
Graves
