Endocrinology Flashcards
1
Q
What is in the osteoporosis screen?
A
Ca Vit D PTH ALP - high in osteomalacia TSH EPG/IEPG Anti-TTG LFT Renal function
2
Q
What is the management of new DM?
A
Weight loss: waist-hip ratio <0.9 F, <0.8 M
Fat intake < 30% of kJ
Monounsaturated fats
Nephropathy: restrict protein intake to ~10% of kJ intake.
3
Q
Which tests should be perfored in metabolic syndrome?
A
First line
- Fasting BSL, HbA1c, OGTT
- Lipid profile
Second line:
- Diabetic or hypertensive nephropathy: Cr, eGFR, urine ACR
- NAFLD: LFTs, liver US
- Hypothyroidism:TSH
- Uric acid level
- PCOS: hormones (testosterone, DHEAS, androstenedione, LH, FSH, SHBG), ovarian US
- Male hypogonadism: testosterone, SHBG
4
Q
What are the management options in obesity?
A
Goals
- Aim for waist circ 102cm (men) or 88cm (women). Ideally <94cm and <80cm respectively
- Aim for weight loss of 1-4kg per month short term, or 5-10% body weight long term
Diets
- Reduced energy diet: energy deficit of 480-960kcal/day
- Low energy diet: 1000-1200kcal/day total
- Very low energy diet 800kcal/day total. Recommended for 8-12 weeks.
- Dietitian referral
Exercise
- 300min moderate or 150min vigorous activity
Psychologist
Pharmacological
- Orlistat inhibits intestinal lipase, reducing fat absorption
- Phentermine (sympathomimetic) may be prescribed short term for 3 months. Appetite suppressant. SE of HTN, tachycardia, insomnia, pulmonary HTN.
Bariatric surgery
- Consider if BMI>40, or BMI>35 with comorbidities that may improve with weight loss
5
Q
What are the contraindications to a very low energy diet?
A
- Pregnancy/lactation
- Severe psychological disturbance (depression, anxiety), drug or EtOH abuse
- Recent ACS or stroke
- Porphyria
- Age>65
6
Q
What are the complications of obesity?
A
OSA OHS Asthma OA GORD Biliary disease NAFLD T2DM FSGS HTN Hyperlipidaemia Coronary artery disease Stroke Cancers of breast, colon, endometrium Depression Infertility Erectile dysfunction
7
Q
Which conditions should be screened for in obesity?
A
Hypothyroidism
Cushing’s syndrome
PCOS
Insulinoma
