Week 9 - Endocrine

Question 1

What is the mechanism of action of Metformin?

Answer 1

Suppresses hepatic gluconeogenesis.
Increases peripheral sensitisation to insulin, increasing skeletal muscle and adipose glucose uptake and sensitisation
increases AMPK
inhibits G6Pase and PEPCK

Question 2

Give an example of a sulphonyurea

Answer 2

Glibeclamide

Glipizide

Question 3

What does pioglitazone do?

Answer 3

glitazone

Increases transcription of insulin sensitising genes. increased GLUT 4

Question 4

Name some GLP-1

Answer 4

Liraglutide

exenatide

Question 5

What is hirsutism?

Answer 5

Excess hair growth in a male pattern due to increased androgens or increased skin sensitivity to androgens
e.g. PCOS, corticosteroids, metformin, spironolactone

Question 6

What screening tests would you use to investigate for cushings?

Answer 6

24 hour urine free cortisol
Overnight dexamethasone suppression test
Late night salivary cortisol

Question 7

What investigations would you do to test for adrenal insufficiency?

Answer 7

Suspicious biochemistry - increased K, decreased Na, hypoglycaemic
Short synACTHen test
ACTH levels
Renin aldosterone levels (R inc, Aldo dec)

Question 8

What is Kallmann’s syndrome?

Answer 8

Isolated gonadotrophin deficiency (LH and FSH)
May have anosmia or hyposmia
Micropenis ± cryptochidism
deafness, renal genesis, cleft lip/palate

Question 9

Give some examples of primary gonadal failure. (low T)

Answer 9

Klinfelters, cryptorchidism, seminiferous tubules failure, adult leydig cell failure

Question 10

What is hypogonadotrophic hypogonadism?

Answer 10

A form of hypogonadism due to a problem with the pituitary or hypothalamus. E.g. Kallmann’s

Question 11

What is SIADH?

Answer 11

Excess ADH or inappropriate ADH for serum osmolality

Hyponatraemia with inappropriately low plasma osmolality

Question 12

What is thyrotoxicosis?

Answer 12

Syndrome resulting from excessive free T3 and T4

Question 13

What is T1DM?

Answer 13

A metabolic disorder of multiple aetiology characterised by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism due to deficits in insulin secretion, action or both

Question 14

What is the diagnostic criteria for T1DM?

Answer 14

One abnormal test value and symptomatic OR

Two abnormal tea values and asymptomatic

Question 15

What tests would you perform to differentiate between types of DM?

Answer 15

Ketones +/- bicarbonate
C-peptide level
Autoantibodies

Question 16

What is the Whipples triad?

Answer 16

1. Sx consistent with hypoglycaemia
2. Low plasma glucose concentration
3. Relief of Sx after plasma glucose level raised

Question 17

What is T2DM?

Answer 17

Chronic progressive metabolic disorder characterised by hyperglycaemia, insulin resistance and relative impairment of insulin deficiency

Question 18

What is the pathophysiology for T2DM?

Answer 18

Risk factors
Insulin resistance 
Hyperinsulinemia
Exhausted Beta cells
Hyperglycaemia

Question 19

What is the MoA of metformin?

Answer 19

Supresses hepatic gluconeogenesis. increases glucose uptake in skeletal muscles and adipose, inhibits PEPCK and. G6Pase.

Question 20

What is PCO?

Gonadotrophs, Androgens, insulin resistance

Answer 20

Characterised by irregular or no periods, acne, obesity and hirsutism.
Presents in adolescence

Question 21

What is hypogonadism?

Answer 21

Reduced functional activity of the gonads, testes or ovaries that may diminish production of sex hormones

Question 22

How could you manage pancreatic diabetes?

Answer 22

SU +/- insulin

Question 23

What considerations must you take in prescribing diabetes drugs in Renal disease?

Answer 23

Stop metformin when eGFR <30ml/min/1.73m2
Caution with SU - increased risk of hypo
Possible dose reduction in DPP-4 and GLP-1
Canagliflozin for renal protection

Question 24

What are some causes of primary amenorrhoea?

Answer 24

Never had a period
Congenital absence of Uterus, cervix or vagina - Rokitansky syndrome or androgen insensitivity syndrome
Chromosomal abnormality - Turners syndrome

Question 25

What are some causes of secondary amenorrhoea?

Answer 25

Haven’t had a period in 6 months
Uterine - Ashermas syndrome
Ovarian - PCOS, Premature ovarian failure
Pituitary - Prolactinoma, pituitary tumour
Hypothalamic - Stress, weight loss, opiates

Question 26

How could you manage Hirsutism?

Answer 26

Topical inhibitors - Elfornithine
Adrenal androgen suppression - corticosteroids
5 Alpha reductase inhibitors - Finasteride
Insulin sensitiser - metformin
Adrenal receptor antagonist - Spironolactone

Question 27

What are some causes of primary gonadal failure?

Answer 27

Adult lending cell failure.
Seminiferous tubule failure
Klinfelters
Cryptochidism

Question 28

How would you establish there is a cortisol excess?

Answer 28

Dexamethasone suppression test, 24 hour urinary free cortisol, late night salivary cortisol

then establish the source of the excess

Question 29

What diseases are associated with mutation to teh RET protooncogene?

Answer 29

Familial medullary thyroid cancer
Multiple endocrine neoplasia type 2 and 3 (pheochromocytoma)
Hirschsprungs

Question 30

How might a patient with Graves disease present?

Answer 30

Exophthalmos, Goitre, Pretibial myxoedema (deposits of mucin under the skin, very specific to graves), Thyroid acropathy

Question 31

What are some rules if you are on steroids?

Answer 31

Do not stop suddenly
Wear identification
If get sick contact Dr immediately 
Inform all people who treat you that you are on steroids 
Reduce dose gradually if want to stop

Question 32

What are the different patterns on nuclear imaging in thyrotoxicosis?

Answer 32

Diffuse uptake - Graves
Irregular uptake - Toxic multinodular goitre
Hot nodule - Toxic adenoma
Reduced uptake - thyroiditis

Question 33

When is radio iodide contraindicated?

Answer 33

Lactaion, pregnancy, active thyroid eye disease

Question 34

What are some contra-indications to metformin?

Answer 34

eGFR <30, metabolic acidosis, chronic heart failure, MI, DKA