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PM Finals > Endo > Flashcards

Endo Flashcards

1
Q

Multiple endocrine neoplasia types

A

MEN1 (MEN1 gene)
- Pituitary
- parathyroid
- Pancreas

MEN 2a (RET oncogene)
- Parathyroid
- Pheochromocytoma
- Medullary thyroid

MEN 2b (RET oncogene)
- Pheochromocytoma
- Medullary thyroid
- Marfanoid, neuroma

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2
Q

Acromegaly ix & mx

A

1st line: Serum IGF-1 levels, if raised -> OGTT to confirm diagnosis

Mx: 1st. Trans-sphenoidal surgery

2nd: somatostatin analogue (octreotide), pegvisomant, dopamine agonists (bromocriptine)

3rd: radiotherapy

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3
Q

Addison’s disease ix

A

ACTH stimulation test (short Synacthen test)

cortisol measured before & after Synacthen 250ug IM

> 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

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4
Q

Addison’s disease mx

A

hydrocortisone: 20-30 mg per day, with the majority given in the first half of the day

fludrocortisone

  • MedicAlert bracelets and steroid cards
  • hydrocortisone for injection with needles and syringes to treat an adrenal crisis

intercurrent illness
- glucocorticoid dose should be doubled, with the fludrocortisone dose staying the same

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5
Q

addisonial crisis mx

A

hydrocortisone 100 mg im or iv

1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic

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6
Q

Congenital adrenal hyperplasia features

A

autosomal recessive disorders

21-hydroxylase deficiency features
- male features in female (virillisation)
- precocious puberty in males
- salt-losing crisis at 1-3 wks of age

11-beta hydroxylase deficiency features
- virilisation of female genitalia
- precocious puberty in males
- hypertension
- hypokalaemia

17-hydroxylase deficiency features
- non-virilising in females
- inter-sex in boys
- hypertension

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7
Q

Cushing syndrome ix

A

Confirming Cushing:
1st. overnight (low-dose) dexamethasone suppression test
(also 24 hr urinary free cortisol, bedtime salivary cortisol)

Localising test:
1st. 9am and midnight plasma ACTH (and cortisol) levels. If ACTH is suppressed then a non-ACTH dependent cause is likely such as an adrenal adenoma

2nd. high-dose dexamethasone suppression
- Cushing’s disease: suppressed ACTH & cortisol
- Ectopic ACTH syndrome: ACTH & cortisol not suppressed
- other causes (adrenal adenoma) - suppressed ACTH, cortisol not suppressed

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8
Q

DVLA diabetes:

A

GBV license
- no severe hypoglycaemic event in the previous 12 months

group 1 drivers:
- if no insulin one or less hypoglycaemia requiring the assistance within the last 12 months
- if on tablets, no need to inform

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9
Q

Graves mx

A

initial: propranolol

Refer to secondary care
- 1st. carbimazole
- 2nd. radioiodine (CI: pregnancy, <16yrs, thyroid eye disease)

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10
Q

Hyperosmolar hyperglycaemic state (HHS) ix & tx

A

dx
- hyperglycaemia (>30 mmol/L)
- hypovolaemia
- high serum osmolarity (2 * Na+ + glucose + urea)
(no significant ketonaemia or acidosis)

mx
- fluids - IV 0.9% sodium chloride solution, 0.5-1L/hour
- insulin- only if glucose stops falling
- VTE prophylaxis

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11
Q

Klinefelter’s syndrome features

A

47, XXY.
often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels but low testosterone

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12
Q

Maturity-Onset Diabetes of the Young (MODY) I features

A

autosomal dominant

persistent, asymptomatic hyperglycemia detected before the age of 25, without the typical features of Type 1 or Type 2 diabetes.

e diagnosis is confirmed by genetic testing,

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13
Q

Phaeochromocytoma mx

A

24 hr urinary collection of metanephrines

Surgery is the definitive management.

first stabilized:
alpha-blocker (e.g. phenoxybenzamine), given before a
beta-blocker (e.g. propranolol)

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14
Q

Pregnancy thyrotoxicosis tx

A

propylthiouracil in first trimester

Then switch to carbimazole

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15
Q

Primary hyperaldosteronism tx

A

plasma aldosterone/renin ratio is the first-line investigation. Then CT abdomen and adrenal vein sampling to distinguish unilateral/ bilateral

adrenal adenoma: surgery (laparoscopic adrenalectomy)

bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

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16
Q

Primary hyperparathyroidism tx

A

1st. total parathyroidectomy

2nd. cinacalcet, a calcimimetic

17
Q

Prolactinomas tx

A

1st: symptomatic patients are treated medically with dopamine agonists (e.g. cabergoline, bromocriptine)

2nd: A trans-sphenoidal approach

18
Q

Sulfonylureas side effects

A

( increasing pancreatic insulin secretion )

hypoglycaemic episodes
weight gain

hyponatraemia
hepatotoxicity

avoid in breastfeeding and pregnancy.

19
Q

Thiazolidinediones SEs

A

agonists to the PPAR-gamma receptor and reduce peripheral insulin resistance

weight gain
liver impairmen
fluid retention
fractures
bladder ca

20
Q

Diabetes mellitus (type 1) dx

A

fasting glucose (>= 7.0) and random glucose/ OGTT (11.1 mmol/l )

If atypical features: >50yrs, BMI>25, slow hyperglycaemia: (to distinguish between T1&2 if doubt)
- diabetes-specific autoantibodies
- C-peptide low
(HbA1c not useful)

21
Q

DMT2 dx, fasting & impaired glucose tolerance

A

(If symptomatic one measurement, if asymptomatic 2 separate occasions)
fasting glucose (>= 7.0)
glucose/ OGTT (11.1 mmol/l )
a HbA1c (48mmol/mol)

Impaired fasting: 6.1-7
Impaired glucose tolerance: fasting<7, OGTT 7.8-11.1

(People with IFG should then be offered an oral glucose tolerance test to determine if diabetes or IGT)

22
Q

Ramadan DM rules

A
  • eat a meal containing long-acting carbohydrates prior to sunrise (Suhoor)
  • for metformin dose should be split one-third before sunrise (Suhoor) and two-thirds after sunset (Iftar)
  • for sulfonylureas: OD after sunset, BD- most after sunset
23
Q

T1DM mx

A

monitor Hba1c every 3-6 months - target <48
blood glucose at least 4x a day - target 5-7 on waking & 4-7 before meals

Insulin
- basal–bolus insulin regimens better than twice‑daily mixed insulin regimens,

adding metformin if the BMI >= 25 kg/m²

24
Q

DMT2 mx

A

Mx
- Lifestyle
- (>48) ++ metformin
- (>58) ++2nd drug (sulfonylurea/ DPP-4 inhibitor/ pioglitazone)
- ++ 3rd drug from above/ insulin-based tx

  • SGLT-2 inhibitors - start w metformin/ at any point if: QRISK ≥ 10%, established CVD, chronic heart failure
  • If triple therapy not effective - switching one of the drugs for a GLP-1 mimetic if BMI>35 or weight loss needed. continue only if at 6 months reduction of >= HbA1c 11 mmol/mol & weight loss 3%

Targets
Lifestyle - target HbA1c = 48mmol/mol
Lifestyle + metformin - 48mmol/mol
++ any hypoglycaemic drug - 53 mmol/mol

25
Q
A

PM Finals (21 decks)

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