endocrine Flashcards
what is the x-ray findings of primary hyperparathyroidism?
pepperpot skull
osteitis fibrosa cystica
how do SGLT2 inhibitors cause euglycaemic ketoacidosis?
it is hypothesised that as these agents lower blood sugar levels by increasing the excretion of glucose the resulting reduction in plasma glucose results in reduced insulin secretion from pancreatic beta-cells and these patients entering a state of relative insulin deficiency. This leads to a lowering of the antilipolytic activity of insulin, and the consequent stimulation of the production of free fatty acids, which are then converted to ketone bodies by beta-oxidation in the liver.
Moreover, insulin stimulates the activity of acetyl-CoA carboxylase, which produces malonyl-CoA, a potent inhibitor of carnitine palmitoyltransferase (CPT-I). Given that CPT-I promotes the transport of fatty acids into mitochondria and hence increases the rate of beta-oxidation, the decrease in the circulating level of insulin promotes the production of ketone bodies through activation of CPT-I.
what is seen on thyroid scintigraphy for de-quverian’s thyroiditis?
thyroid scintigraphy: globally reduced uptake of iodine-131
who is statin treatement offered to in type 1 diabetics?
atorvastatin 20 mg should be offered if type 1 diabetics who are:
- older than 40 years, or
- have had diabetes for more than 10 years or
- have established nephropathy or
- have other CVD risk factors
what is barrtter’s syndrome?
similar to taking a lot of furosemide
defective NKCC2 channel
usually presents in childhood, e.g. Failure to thrive
polyuria, polydipsia
hypokalaemia
normotension
weakness
what are side effects of sufonylureas?
- hyponatraemia secondary to syndrome of inappropriate ADH secretion
- bone marrow suppression
- hepatotoxicity (typically cholestatic)
- peripheral neuropathy
what is the difference between IFg and IGT? (physiologically)
impaired fasting glucose (IFG) - due to hepatic insulin resistance
impaired glucose tolerance (IGT) - due to muscle insulin resistance
what is CRP and how is it synthesized?
CRP is a protein synthesised in the liver and binds to phosphocholine in bacterial cells and on those cells undergoing apoptosis. In binding to these cells it is then able to activate the complement system. CRP levels are known to rise in patients following surgery. However, levels of greater than 150 at 48 hours post operatively are suggestive of evolving complications.
what are the different type of multiple endocrine neoplasia
MEN type 1 - 3Ps : hyperparathyroidism. pituitary, pancreas (insulinoma, gastrinoma)
MEN type 21:
parathyrioid, pheochromocytoma
+
medullary thyroid cancer
MEN type 2b
medullary thyroid cancer + pheochromocytoma
marfanoid body habitus, neuromas
what medications does levothyroxine interact with?
iron, calcium carbonate
absorption of levothyroxine reduced, give at least 4 hours apart
what do the results of 9am cortisol suggest when it comes to ? addisons disease
sending a 9 am serum cortisol can be useful:
> 500 nmol/l makes Addison’s very unlikely
< 100 nmol/l is definitely abnormal
100-500 nmol/l should prompt a ACTH stimulation test to be performed
what is the screening test for conn’s syndrome?
aldosterone/renin ratio is the first-line investigation in suspected primary hyperaldosteronism
should show high aldosterone levels alongside low renin levels
how is hypothyroidism treated?
- serum thyroid-stimulating hormone measured in each trimester and 6-8 weeks post-partum
- women require an increased dose of thyroxine during pregnancy
by up to 50% as early as 4-6 weeks of pregnancy
what does the abg look like in cushing’s syndrome?
hypokalaemic metabolic alkalosis may be seen, along with impaired glucose tolerance.
what is diagnosis in someone with hashimoto’s thyroiditis who has new mass?
The presence of a new thyroid mass on a background of longstanding Hashimoto’s thyroiditis should arouse the suspicion of mucosa-associated lymphoid tissue (MALT) lymphoma.
