Passmed - Endo Flashcards
Thyrotoxicosis with tender goitre =
subacute (De Quervain’s) thyroiditis
De Quervain’s thyroiditis 4 phases
phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to norma
De Quervain’s thyroiditis investigations?
thyroid scintigraphy: globally reduced uptake of iodine-131
first-line investigation in suspected primary hyperaldosteronism
plasma aldosterone/renin ratio
Primary hyperaldosteronism causes?
bilateral idiopathic adrenal hyperplasia: the cause of around 60-70% of cases
adrenal adenoma: 20-30% of cases
unilateral hyperplasia
familial hyperaldosteronism
adrenal carcinoma
Primary hyperaldosteronism features?
hypertension
Hypokalaemia e.g. muscle weakness
metabolic alkalosis
Primary hyperaldosteronism treatment?
adrenal adenoma: surgery (laparoscopic adrenalectomy)
bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone
GnRH agonists (e.g. goserelin) used in the management of prostate cancer may result in
gynaecomastia
Drug causes of gynaecomastia
spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids
Causes of gynaecomastia
physiological: normal in puberty
syndromes with androgen deficiency: Kallman’s, Klinefelter’s
testicular failure: e.g. mumps
liver disease
testicular cancer e.g. seminoma secreting hCG
ectopic tumour secretion
hyperthyroidism
haemodialysis
Side-effects of thyroxine therapy
hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation
What should be used first-line for black TD2M patients who are diagnosed with hypertension
angiotensin II receptor blocker
In type 1 diabetics, a general HbA1c target of
48 mmol/mol (6.5%)
SGLT-2 inhibitors (gliclazide)
should also be given in addition to metformin if any of the following apply:
-the patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ 10%)
-the patient has established CVD
-the patient has chronic heart failure
metformin should be established and titrated up before introducing the SGLT-2 inhibitor
SGLT-2 inhibitors should also be started at any point if a patient develops CVD (e.g. is diagnosed with ischaemic heart disease), a QRISK ≥ 10% or chronic heart failure
T2DM second-line management?
metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea
metformin + SGLT-2 inhibitor (if NICE criteria met)
T2DM third-line treatment?
metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea
metformin + (pioglitazone or sulfonylurea or DPP-4 inhibitor) + SGLT-2 if certain NICE criteria are met
insulin-based treatment
If triple therapy is not effective or tolerated for T2DM?
consider switching one of the drugs for a GLP-1 mimetic
SGLT-2 inhibitor examples?
canagliflozin, dapagliflozin, and empagliflozin
DPP-4 inhibitor examples?
sitagliptin, saxagliptin, linagliptin, and alogliptin
Pioglotazone?
Increases insulin sensitivity
Sulphonylurea examples?
Gliclazide
GLP-1 agonist examples
dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide
Liraglutide should be considered as an adjunct for weight loss in
obese class II patients (BMI >35) who are prediabetic
Sick euthyroid syndrome
= low T3/T4 and normal TSH with acute illness
Acute management of DKA?
insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin
The Hba1c target for patients on a drug which may cause hypoglycaemia (eg sulfonylurea) is
53 mmol/mol
characteristic electrolyte disturbances seen in patients with refeeding syndrome
Hypophosphataemia, hypokalaemia and hypomagnesaemia
Hypercalcaemia causes?
thiazides
Addison’s disease
thyrotoxicosis
primary hyperparathyroidism
squamous cell lung cancer
vitamin D intoxication
dehydration
bone metastases
sarcoidosis
acromegaly
myeloma
milk-alkali syndrome
Hypokalaemia causes
thiazides
diarrhoea
vomiting
primary hyperaldosteronism
Cushing’s syndrome
magnesium deficiency
renal tubular acidosis (types 1 and 2)
acetazolamide
Addison’s signs? Electrolyte
hypotension, hyperpigmentation, lethargy
hyperkalaemia, hyponatraemia, hypoglycaemia
hypercalcaemka
Hyperkalaemia causes?
ACE inhibitors
acute renal failure
angiotensin 2 receptor blockers
Addison’s disease
spironolactone
metabolic acidosis
rhabdomyolysis
massive blood transfusion
renal tubular acidosis (type 4)
ciclosporin
newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be a
basal-bolus using twice-daily insulin detemir
MODY is inherited in an x fashion so a family history is often present
autosomal dominant
De Quervain’s thyroiditis:
initial hyperthyroidism, painful goitre and globally reduced uptake of iodine-131
x is the key parameter to monitor in patients with hyperosmolar hyperglycaemic state
Serum osmolality
Primary hyperaldosteronism (Conn’s syndrome) symptoms
-Hypertension
-Hypokalaemia (e.g. muscle weakness)
-Metabolic alkalosis
Primary hyperaldosteronism causes
bilateral idiopathic adrenal hyperplasia (60-70% of cases)
adrenal adenoma (20-30% of cases)
unilateral hyperplasia
familial hyperaldosteronism
adrenal carcinoma
Primary hyperaldosteronism first line investigation?
a plasma aldosterone/renin ratio
should show high aldosterone levels alongside low renin levels (negative feedback due to sodium retention from aldosterone)
In toxic multinodular goitre, nuclear scintigraphy reveals
patchy uptake
hypokalaemic metabolic alkalosis
Cushing’s syndrome
Whipple’s triad of symptoms of
1) hypoglycaemia with fasting or exercise, 2) reversal of symptoms with glucose, and 3) recorded low BMs at the time of symptoms is hallmark for an insulinoma
Causes of raised prolactin - the p’s
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone
T2DM initial therapy: if metformin is contraindicated + patient has a risk of CVD, established CVD or chronic heart failure →
SGLT-2 monotherapy (dapagliflozin)
Hypertension in diabetics - x are first-line regardless of age
ACE inhibitors/A2RBs
x test is the best test to diagnosis Cushing’s syndrome
The low-dose (overnight) dexamethasone suppression
