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)
