Rheumatology Medicine 🩼✅ Flashcards
AI polyendocrinopathy syndrome 1?? What is this
AIRE mutation. Chronic mucocandidiasis, hypoparathyroidism, Addison’s,
AI polyendocrinopathy syndrome 2… what is it???
HLA DR3/4 associated. Addisons and thyroid AI. And more like pernicious anemia
How to diagnose and manage a Polyendocrinopathy case
Invx with the specific antibody (anti TPO, parietal cell, IF). Manage the specific disease (antifunal, B12) and immunosuppressant
Why could primary adrenal insufficiency patients get hyponatremia
They get high ADH…
addisons is associated with what acid base abnormality
Non AG met acidosis
Initial test for addisons
Morning cortisol
If suspect addisons, and done the morning cortisol test… comes back less than 3… what next
Do morning ACTH (this doesn’t confirm diagnosis)
How to confirm Addison’s disease diagnosis
Synacten test (give ACTH, and see a failure of cortisol to rise). Should measure cortisol before, 30 mins and 60 mins after
A cortisol level of what post synacten is indicative of addisons
Less than 18-20
What is the insulin tolerance test for Addison’s? CI for test?
Give insulin (usually lowers glucose which will increase ACTH and cortisol. Cortisol doesn’t increase in Addisons. CI’d in elderly and seizure patients
What is the overnight metyrapone test for addisons
Give metyrapone (usually inhibits cortisol prod, increasing ACTH, and increasing 11(OH)cortisol. In addisons 11(OH)cortisol doesn’t increase
What imaging is considered in primary adrenal insufficiency
CT/MRI abdomen
Antibody to screen for in addisons (only positive some of the time)
Anti 21(OH) ase
Treatment for addisons (consider three elements)
(Hydrocortisone or prednisolone =highest dose in morning) and (fludrocortisone =mineralcorticoid) and (DHEA =in females only who have depression/low libido)
What is stress dose steroids in addisons
Steroid dose increased in Sx, illness to reduce risk of adrenal crisis
Discuss the invx and dx of adrenal crisis
Based at first on clinical suspicion (and basic labs). Can take random cortisol level (do before admin cortisone). Synacten only once patient stabilised
How to
Manage a patient with addisons crisis (consider 4 elements)
Hydrocortisone (prednisolone 2nd line). Fludrocortisone (got flu = sepsis) only if septic shock, or if patient receiving a non-hydrocortisone GC. 1L of isotonic saline in first hour. IV dextrose.
When do we give fludrocortisone in addinsonian crisis?
Fludrocortisone only if septic shock, or if patient receiving a non-hydrocortisone GC.
HLA for RA
HLA DR4 and DR1
What is the clinical diagnosis criteria (not that strict) for RA
Arthralgia and joint stiffness for 6 or more weeks in 3 or more joints
Initial imaging for for RA
X ray (if both hands and feet). Good to get baseline too!
Why do TFTs in RA patients?
AI thyroiditis is common in RA patients
Most specific AB marker for RA?
Anti CCP
HLA in RA?
HLA DR4 and DR1 (4 propellers 1 camera)