Therapeutics of endocrine disease

Question 1

What are the 3 main management options for thyrotoxicosis?

Answer 1

Inhibit thyroid hormone synthesis- thionamides
Destroy the thyroid- radioactive iodine
Remove the gland

Question 2

What are the most common thyroid blocking drugs?

Answer 2

Carbimazole and propylthiouracil

Question 3

What are the side effects of thionamides? What is the very rare side effect?

Answer 3

Rash, pruritis, nausea, vomiting, arthralgias

Agranulocytosis

Question 4

What is the treatment for hypothyroidism?

Answer 4

Levothryoxine

Question 5

What is the first line treatment for prolactinomas?

Answer 5

Dopamine agonist such as cabergolinine, bromocriptine and quinagolide

Question 6

What are important side effects to warn patients about with use of DAs?

Answer 6

Blocked nose, nausea, headaches, orthostasis, mood swings

Question 7

What are the management options for acromegaly?

Answer 7

Trans-sphenoidal hypophysectomy is 1st line

Somatostatin analogues, human GH receptor antagonist, dopamine agonist

Question 8

What are the management options for Cushing’s disease?

Answer 8

1st line- Trans-sphenoidal hypophysectomy

Question 9

What is diabetes insipidus?

Answer 9

Hypo-ADH production. ADH acts on the collecting ducts of the kidney to incorporate aquaporins which allows reabsorption of fluid into the collecting ducts

Question 10

What is SIADH? What is the management?

Answer 10

Syndrome of inappropriate anti-diuretic hormone release.
Vasopressin antagonists (vaptans)