Week 9 - Endocrine Flashcards

1
Q

What is the mechanism of action of Metformin?

A

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

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2
Q

Give an example of a sulphonyurea

A

Glibeclamide

Glipizide

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3
Q

What does pioglitazone do?

A

glitazone

Increases transcription of insulin sensitising genes. increased GLUT 4

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4
Q

Name some GLP-1

A

Liraglutide

exenatide

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5
Q

What is hirsutism?

A

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

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6
Q

What screening tests would you use to investigate for cushings?

A

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

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7
Q

What investigations would you do to test for adrenal insufficiency?

A

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

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8
Q

What is Kallmann’s syndrome?

A

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

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9
Q

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

A

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

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10
Q

What is hypogonadotrophic hypogonadism?

A

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

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11
Q

What is SIADH?

A

Excess ADH or inappropriate ADH for serum osmolality

Hyponatraemia with inappropriately low plasma osmolality

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12
Q

What is thyrotoxicosis?

A

Syndrome resulting from excessive free T3 and T4

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13
Q

What is T1DM?

A

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

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14
Q

What is the diagnostic criteria for T1DM?

A

One abnormal test value and symptomatic OR

Two abnormal tea values and asymptomatic

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15
Q

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

A

Ketones +/- bicarbonate
C-peptide level
Autoantibodies

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16
Q

What is the Whipples triad?

A
  1. Sx consistent with hypoglycaemia
  2. Low plasma glucose concentration
  3. Relief of Sx after plasma glucose level raised
17
Q

What is T2DM?

A

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

18
Q

What is the pathophysiology for T2DM?

A
Risk factors
Insulin resistance 
Hyperinsulinemia
Exhausted Beta cells
Hyperglycaemia
19
Q

What is the MoA of metformin?

A

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

20
Q

What is PCO?

Gonadotrophs, Androgens, insulin resistance

A

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

21
Q

What is hypogonadism?

A

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

22
Q

How could you manage pancreatic diabetes?

A

SU +/- insulin

23
Q

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

A

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

24
Q

What are some causes of primary amenorrhoea?

A

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

25
What are some causes of secondary amenorrhoea?
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
26
How could you manage Hirsutism?
Topical inhibitors - Elfornithine Adrenal androgen suppression - corticosteroids 5 Alpha reductase inhibitors - Finasteride Insulin sensitiser - metformin Adrenal receptor antagonist - Spironolactone
27
What are some causes of primary gonadal failure?
Adult lending cell failure. Seminiferous tubule failure Klinfelters Cryptochidism
28
How would you establish there is a cortisol excess?
Dexamethasone suppression test, 24 hour urinary free cortisol, late night salivary cortisol then establish the source of the excess
29
What diseases are associated with mutation to teh RET protooncogene?
Familial medullary thyroid cancer Multiple endocrine neoplasia type 2 and 3 (pheochromocytoma) Hirschsprungs
30
How might a patient with Graves disease present?
Exophthalmos, Goitre, Pretibial myxoedema (deposits of mucin under the skin, very specific to graves), Thyroid acropathy
31
What are some rules if you are on steroids?
``` 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 ```
32
What are the different patterns on nuclear imaging in thyrotoxicosis?
Diffuse uptake - Graves Irregular uptake - Toxic multinodular goitre Hot nodule - Toxic adenoma Reduced uptake - thyroiditis
33
When is radio iodide contraindicated?
Lactaion, pregnancy, active thyroid eye disease
34
What are some contra-indications to metformin?
eGFR <30, metabolic acidosis, chronic heart failure, MI, DKA